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 +
'iaph"seal (ractures in Children
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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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Elastic stable intramedullarynailing (ESIN
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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Elastic stable intramedullarynailing (ESIN
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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Forearm diaphyseal fracture
Open
ClosedDebridement in OR
Angulation 0-10
Angulation 10-20
Angulation +20
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Forearm diaphyseal fracture
Open
ClosedDebridement in OR
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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Forearm diaphyseal fracture
Open
ClosedDebridement in OR
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
$mmobili)e in a sling ' s*at(
Closed
Closed reduction + #$%
#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
$mmobili)e in a sling ' s*at(
Closed
,ids(a!t angulation
Closed reduction + #$%
$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
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'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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