shalter chap 16

8/18/2019 Shalter Chap 16

1/28


2/28

Clavicle The slender newborn clavicle: MOST susceptible to

fracture during delivery, particularly in abroadshouldered baby.

Infants tends not to move the aected limb duringst wee!.

"racture unites with remar!able rapidity.

#allus becoming apparent both cinically $radiographically: % wee!s

S&'#I"I# (I)T* ")+#T)'

Sling as simple protection is the onlytreatment re-uired.


3/28

Humerus

*umeral shaft: issusceptible to a birthfracture during a di cultbreech delivery.

#omplete fracture in heshaft $ fre-uentlyassociated with a radialnerve in/ury.

"ractured arm is obviously

0oppy.Infant1s arm should be

bandaged to the chest for 2wee!s 33 clinically united.

S&'#I"I# (I)T* ")+#T)'


4/28

Humerus

Mild residual angulatory deformities improve withsubse-uent growth, but rotational deformities arepermanent.

)arely pro4imal humeral epiphysis is separated by abirth in/ury.

S&'#I"I# (I)T* ")+#T)'


5/28

Femur

(irth fracture of femur 33 MOST occur duringdelivery of a baby who has presented as a fran!breech.

sually in the midshaft.Overhead s!in traction on both lower limbs provide

ade-uate alignment of the fracture 33 clinicallyunited 5 wee!s.

+lternative treatment: hip spica cast for a full term

baby6 a palvi! harness for a tiny premature baby.

S&'#I"I# (I)T* ")+#T)'


6/28

O7')*'+8 S9I T)+#TIO


7/28

&+7;I9 *+)'SS


8/28

Femur

Traumatic separation ofthe distal femoralepiphysis 33 di cult to

recogni


9/28

Femur

(eing type I epiphyseal plate in/ury in an epiphysisthat has a good blood supply, the prognosis forsubse-uent growth is e4cellent 33 a long leg cast is

a reasonable alternative. Traumatic separation of the pro4imal femoral

epiphysis is di cult to dierentiate clinically fromdislocation of the hip.

Treatment consists of immobili


10/28


11/28

The hand

&halangeal fractures must be

accurately reduce to avoid a

persistent angulatory deformity.

)otational deformity in a =nger should

also be corrected, beacuse it seriouslyimpairs function of the hand.

'ither angulatory6rotational malunion

of a pro4imal phalan4 will cause that=nger to cross over its neighbor when

the = ngers are completely 0 e4ed.8isplaced intra articular fractures of

=nger /oints merit O)I" with =ne

!irschner wire to restore a perfect

/oint surface.

S&'#I"I# ")+#T)' $ 8IS;O#+TIO


12/28

S&'#I"I# ")+#T)' $ 8IS;O#+TIO

The hand

Metacarpohalangeal dislocationof the thumb is common inchildren 33 as result of ahypere4tension in/ury.

The = rst metacarpal headescapes through a small tear inthe /int capsule that then tendsto rip the narrow nec! ofmetacarpal and act as a>buttonhole? 33 it1s di cult to

reduce by close manipulation.)e-uires open reduction 33 then

immobili


13/28

The hand

(o4er1s fracture 33 a fracture of the nec! of themobille @th metacarpal 33 responds well to closedreduction 33 pressure along the a4is of the pro4imal

palan4 with the metacarpophalangeal /oint 0e4ed to aright angle 33 immobli


14/28

The wrist and forearm

I t is common in children 33fre-uent falls in which the forcesare transmited from the hand tothe radius and ulna.

Distal radial epiphsis

+ type I I fracture separation ofdistal radial epiphysis.

May be accompanied by agreenstic! fracture of the ulna.

This fracture separation resultsfrom a forced hypere4tension andsupination in/ury, it can bereduced by a combination of0e4ion$pronation.

I t should be immobil i


15/28


Distal 3rd of radius andulna: incomplete fractures.

MOST fre-uent fracture in this

region 33 (uc!le fracture.

S&'#I"I# ")+#T)' $ 8IS;O#+TIO


16/28


Distal 3rd of radius and ulna:incomplete fractures .

Breenstic! fracture of the distalmetaphyseal region of the radiusand ulna 33 re-uire closedreduction by manipulation if theangulation is signi=cant.

The angulation is graduallycorrected to the point where the

remaining intact part of thecorte4 is heard and felt to crac!through, but not becomedisplaced.

S&'#I"I# ")+#T)' $ 8IS;O#+TIO


17/28


Distal 3rd of radius andulna: complete fractures.

Chen radius alone is

fractured, the in/ury hasbeen one of supination

)eduction is more stablewith the forearm in theneutral position.

In either case a well molded,above elbow plaster cast isre-uires D wee!s.

S&'#I"I# ")+#T)' $ 8IS;O#+TIO


18/28


Middle 3rd of radius andulna

Breenstic! fracture: This

fracture reduced by closedmanipulation.

&rovide the aforementionedpractice of crac!ing throuhthe remaining intact pasrt of

the corte4 is used.

S&'#I"I# ")+#T)' $ 8IS;O#+TIO


19/28


Middle 3rd of radius and ulna

8isplaced fracture: is unstable 33 may be di=cultto reduce 33 how much of the deformity is due

to angulation and how much to rotation often isbetter assesed by loo!ing at the child1s forearmstham ny loo!ing radiographs.

Immobili


20/28


Middle 3rd of radiusand ulna

nstable fracture of bothbones of the forearm

should be e4amineradigrhaphically each

wee! at least A wee!s todetect ay deterioration inthe position of thefragments.

If angulation recurs duringthe period ofimmobili


21/28

The wrist andforearm

Middle 3rd of radiusand ulna

"ractures of bothbones of the forearmin children may bedi cult to treat 33some of avoidable

pitfalls of treatment.


22/28


proximal 3rd of radius andulna

Montegia fractureFdiislocaion

33 important because thedislocation component is sofre-uently unrecogni


23/28


proximal 3rd of radius andulna

In children 33 closed reduction

of a monteggia fracturedislocation 33 correcting theangulation of the ulnar fractureImmobili


24/28

The elbow dan the arm

Pulled elbow

#hildren of preschool age arevulnerable to a sudden

longitudinal pull on their arms. It occur while lifting the small

child up a step by pulling awayfrom potential danger.

S&'#I"I# ")+#T)' $ 8IS;O#+TIO


25/28


Pulled elbow

+ sudden pull on the e4tendedelbow while forearm is

pronated produces a tear indistal attachment of theannular ligament to the radialnec!.

S&'#I"I# ")+#T)' $ 8IS;O#+TIO


26/28


Pulled elbow

Treatment: deft supination of child1s forearm whilethe elbow is 0e4ed. + slight >clic!? can usually be

felt over the anterolateral aspect of the radial headas the annular ligament is freed from /oint.

+fter treatment consist of a sling for 2 wee!s toallow the tear in the distal attachment of the anularligament to heal.

S&'#I"I# ")+#T)' $ 8IS;O#+TIO


27/28


Proximal radial epiphsis

"racture separation of thepro4imal radial epiphysis is

produced by a fall thate4erts a compression andabduction force on theelbow /oint.

S&'#I"I# ")+#T)' $ 8IS;O#+TIO


28/28


Proximal radial epiphsis

Treatment: satisfactory closed reduction can usuallybe obtained by pressing upward and medially on the

tilted radial head while an assistant holds the armwith the elbow e4tended and adducted.

+fter closed reduction 33 immobili

shalter chap 16

Documents