Diaphyseal Fractures in Children Final_2

7/27/2019 Diaphyseal Fractures in Children Final_2

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Diaphyseal fractures inchildren

Mohamed M. Zamzam

Associate Professor & Consultant PediatricOrthopedic Surgeon

KKUH !i"adh Saudi Ara#ia


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Objectives

$ %o recall specific considerations of diaph"seal

fractures in children$ %o #e aare of common possi#le complications

$ %o identif" the treatment of choice in each particular

situation among a #ig list of management options

$ %o create an algorithm as a guide for managing long#one shaft fractures in pediatric population

'iaph"seal (ractures in Children


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General Principles

$ A#out )*+ of in,uries in children are

s-eletal

$ Out of all s-eletal in,uries in children !adial shaft fractures /.0 +

%i#ial shaft fractures /.1 +

(emoral shaft fractures 1.) +

Pro2imal & shaft humerus fractures ).0 +



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Specific Problems

$ Premature complete physeal closure

$ Progressive limb length discrepancy

$ Nonunion

$ Open reduction and internal fixation



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General management

$ Cast

$ Internal fixation

$ External fixation



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General management

$ Cast

$ Internal fixation

$ External fixation



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General managementIndications for surgery$ Head in,ur"

$ Multiple in,uries

$ Adolescence

$ (ailure of conser3ati3e means

$ Se3ere soft4tissue in,ur"$ 5eurological disorder

$ Malunion and dela"ed union



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Elastic stable intramedullarynailing (ESIN

The principle$ 1 elastic nails

$ Ma2imum cur3e

$ Orientation

$ %he size$ 6ood -noledge of the techni7ue



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Advantages$ 5o need for postoperati3e cast

$ Primar" #one union

$ A3oidance of groth plate in,ur"

$ Minimum in3asi3e surger"$ 82cellent functional and cosmetic results



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Complications

$ 5onunion 99

$ Osteom"elitis :rate is 1+;

$ O3ergroth :


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Forearm

$ %he distal radial epiph"seal plate realigned ell

in children #elo )= "ears

$ !adioulnar angulation usuall" associated ith

loss of motion

$ %he ris- of refracture



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ForearmTreatment options

$ Closed reduction > cast

$ AO plates

$ ?ntramedullar" fi2ation



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ForearmClosed intramedullary nailing

$ Specific anatomic considerations

$ %he isthmus of radius and ulna is narro :range @ 4/ mm;

$ Optimum entr" points



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Forearm

Closed intramedullary nailing

$ ?nternal fi2ation of the radius onl"

$ %he radius has the more complicated function

$ Better alignment of the ulnar fracture



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Forearm diaphyseal fracture

Open

ClosedDebridement in OR


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Open


Angulation 0-10

Angulation 10-20

Angulation +20


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Open


Angulation 0-10

Angulation 10-20

Angulation +20

Closed reduction

+5years

All ages

Long arm cast or splint

0-5years

uccess!ul i! " 10


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Open


Angulation 0-10

Angulation 10-20

Angulation +20

Closed reduction

Open reduction +#$%

&nsuccess!ul

+5years

All ages

Long arm cast or splint

0-5years

uccess!ul i! " 10

uccess!ul but unstable

Closed reduction + #$%


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Humerus$ ?ncidence is related to the cause

and age group$ Classified according to

(racture pattern

ocation

%issues damaged



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Humerus

$ Priorit" is gi3en to conser3ati3e treatment$ Osteos"nthesis :)=+;

$ 82ternal fi2ation



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Humerus

potential operative indications

$ Open fractures$ Multiple trauma

$ Bilateral in,uries

$ Compartment s"ndromes

$ Pathological fracture

$ Significant ner3e in,uries

$ ?nade7uate closed reduction



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Humeral diaphyseal fracture

Adolescents Older c(ildren $n!ants ' younger c(ildren

Debridement in OR

$mmobili)e in a sling ' s*at(

Closed


#ternal !iator

Open

$$$ $ ' $$

Adolescents ' Older c(ildren


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Humeral diaphyseal fracture

Adolescents Older c(ildren $n!ants ' younger c(ildren

Debridement in ORClosed reduction

$mmobili)e in a sling ' s*at(

Closed

,ids(a!t angulation


$mmobili)e in so!t dressing

#ternal !iator

Open

20"20

$$$ $ ' $$ urgical indications

Adolescents ' Older c(ildren


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Femur$ Stress fracture

$ Pulmonary complications

$ ro!th disturbances resulting in ). accelerated groth

1. retarded groth

. a2ial deformities

0. rotational deformities$ Spontaneous correction



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Femur$ Stress fracture

$ Pulmonary complications

$ ro!th disturbances resulting in ). accelerated groth

1. retarded groth

. a2ial deformities

0. rotational deformities$ Spontaneous correction



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FemurTreatment options

$ ?mmediate hip spica

$ 'ela"ed hip spica

$ Plate osteos"nthesis

$ Con3entional ?M5

$Stainless steel K4ires

$ %itanium elastic nailing

$ 82ternal fi2ation



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Femur$ %he optimal method

$ 8conomic reasons$ ParentsD decision

$ E 4 )= "ears :no manFs land;



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FemurNarro! lo!#contact 'CP

$ Minimal e2posure$ Percutaneous scre placement

$ Sta#le mode of fi2ation

$ Biologic healing potential

$ 8arl" patient mo#ilization



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FemurESIN$ simple procedure

$ Minimal #lood loss

$ Short operati3e time

$ K4ires %itanium

$ 1 to )0 "ears$ 8nder nails



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Femoral shaft fracture

Debridement in OR

Adolescent

Open

$n!ants .ounger c(ild Older c(ild


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Femoral shaft fracture

.es

Debridement in OR

Adolescent

Open

Abused

$n!ants .ounger c(ild Older c(ild

%o

/ospital

'inest

$mmediate

/ip spica


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'i h l ( i Child


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TibiaSpecial considerations

$ Child abuse

$ Isolated tibial fractures$ Open fractures

$ Pathological fractures

$ Stress fractures



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'i h l ( t i Child


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TibiaSpecial considerations

$ Child abuse

$ Isolated tibial fractures$ Open fractures

$ Pathological fractures

$ Stress fractures


'i h l ( t i Child


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TibiaSpecific problems$ 'elayed unions

$ Nonunion

$ )alunion

$ Compartment syndromes



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Tibia

Treatment is based on*

$ patient age$ concomitant in&uries

$ fracture pattern

$ surgeon experience



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TibiaTreatment of se"uelae after union*

$ Physeal closure

$ +eg#length discrepancy

$ Progressive valgus deformity



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TibiaTreatment of se"uelae after union*

$ Physeal closure

$ +eg#length discrepancy

$ Progressive valgus deformity



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Tibial shaft fracture

Open

Debridement in OR

Closed

$$$ $ ' $$

#ternal !iator Closed reduction + #$%

3olytrauma


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Summary

$ Non surgical treatment is the treatment of choice in

most diaphyseal fractures in children

$ If surgery is indicated, ESIN is the best option

$ Special attention is directed to

Open fractures

Child abuse

Pathological fractures

$ Al!ays, consider the high healing po!er of children



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Diaphyseal Fractures in Children Final_2