case conference fracture both bone forearm in children
TRANSCRIPT
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Case conference ศุภกฤษ อัศวสดุสาคร
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Patient profile• เด็กหญิง 7 ปี• ขีร่ถจกัรยานล้มเอง 3 ชัว่โมงก่อนมา รพ. ใชม้อืยนัพื้น
เจบ็แขนซา้ยทันที แขนซา้ยผิดรูป ไมม่สีลบ ไมม่อีาเจยีน
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Primary survey• A : can speak, can move neck• B : CCT negative, equal BS• C : vital sign stable• D : E4V5M6, pupils 3 mm RTLBE• E : no external wound,
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Secondary survey• A : ไมแ่พย้า แพอ้าหาร• M : no medication• P : no U/D• L : 6 hr• E : ขีจ่กัรยานล้มเองบนพื้นคอนกรตี
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Physical examination• Left arm : no external wound, deformities, tender,
limit ROM due to pain, swelling• Neurovascular intact
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Investigation
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Diagnosis“Closed fracture both bone left forearm”
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Fracture both bone forearm in children
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Anatomy
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Mechanism of injury• Fall on out stretched arm
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Type of fracture• Green stick• Complete fracture
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Treatment• Non operative• Operative
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Non operative• Close reduction • Immobilization
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Acceptable reduction alignment for pediatricinitial considerations: - angular / rotational deformity: (growth will not correct rotational deformity) - age - distance from physis - direction of angulation - amount of deformity
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Bayonette apposition• there was no deviation of radius and ulna toward
each other.• there was no encroachment of the interosseous
space.• pt is less than 10 yrs of age.
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Age< 6 year 6-10 year > 12 year
Angulation < 15° < 10° 0°
Rotation < 5° 0° 0°
Bayonet apposition
accept accept -
Displaced Distal Third Frx: angulation up to 20-25 deg during first ten years is OK
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OperativeIndication • Open fracture• Unacceptable alignment after reduction more than
twice• Compartment syndrome• Neurovascular compromise• Refracture
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Operation • Intramedullary fixation with flexible
nails or K-wires•ORIF with plates and screws •Percutaneous K-wire fixation
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Follow up• weekly radiographs for first 3-4 weeks to monitor
reduction• casting for 6-12 weeks total
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Complication •Malunion• Premature or partial physeal arrest• Cross-union of the radius and ulna•Nonunion • Compartment syndrome• Infection•Neurovascular injury
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Thank you