Presentation on theme: "Clavicle Fractures Similar fractures in adults usually result from greater violence, are much slower to unite, and demand more care. Classification 3 groups:"— Presentation transcript:
1 Clavicle FracturesSimilar fractures in adults usually result from greater violence, are much slower to unite, and demand more care.Classification 3 groups:Mid-third, 80%Distal or inter-ligamentous, 15%Proximal-third 5%
2 Clavicle FracturesAmong the most common fracture occurring in children.In children usually heal without problems (the saying goes that if you put two ends of a fractured clavicle in the same room [pediatric] they will heal).
3 Clavicle FracturesIdeal method of management has not yet been developed.Over 200 methods have been described.Most do well with nonoperative management.It may take at least 3 months for adults to resume heavy activities.
11 AC SeparationsMOI- direct force that occurs from a fall on the point of the shoulder.Major deformity is the downward displacement of the shoulder.
12 AC Separations Classification:6 types of separation. Types I-III most common.Grade I - mild forces, Grade 6 - occurs with major forces.
13 AC SeparationStress X-rays to differentiate between Grade I and Grade 3.Gr. III has upward displacement % compared to the normal.
14 AC Separation Treatment Grade I-III is usually conservative. Sling for comfort.Early ROM.Grade IV-VI is usually surgical.Grade II injuries can develop DJD.Grade III injuries can be repaired in a young laborer who performs overhead work.
15 The Elbow Little Leaguer’s elbow Osteochondritis dissicans of the capitellumPanner’s disease-osteochondrosis of the capitellum
16 Little Leaguer’s Elbow A term used to describe a number of overuse conditions about the elbow associated with repetitive throwing that affects the skeletally immature elbowMOI is valgus extension overload, which leads to traction stress on the medial aspect of the elbow, the medial collateral ligament, and the medial epicondyle
17 Little Leaguer’s Elbow Valgus extension overload also results in compression stresses on the lateral aspect of the joint, leading to osteochondritis dissicans of the capitellum, loose bodies, and radial head overgrowthThe extension component can cause repetitive irritation of the olecranon in the olecranon fossa, which can lead to impingement & loose bodies
18 Little Leaguer’s Elbow SymptomsMedial painDiminished throwing effectivenessDecreased throwing distance
19 Little Leaguer’s Elbow ExaminationTendernessSwelling over medial epicondyleElbow flexion contraction > 15 degreesX-ray- fragmentation and widening of the epiphyseal lines
21 Little Leaguer’s Elbow TreatmentRest ( 4-6 weeks)No throwingIceNSAID’sMay strengthen when pain free (>6wk)
22 Osteochondritris Dissicans Of The Humeral Capitellum Represents an island of subchondral bone and its articular cartilage that begins to separate from the rest of the humerusSymptoms include lateral pain, which is dull and worsens with motion, which locks and catches
23 Osteochondritris Dissicans Of The Humeral Capitellum Etiology is unclearRepetitive stress most likely causeMay have genetic predispositionBetween ages 10-15Common in throwers and gymnasts
24 Osteochondritris Dissicans Of The Humeral Capitellum ExaminationRadiocapitellar tendernessFlexion contractureCrepitationEffusion
25 Osteochondritris Dissicans Of The Humeral Capitellum RadiologyCrescent shaped region of sclerotic subchondral bone at the humeral capitellumPossible loose bodies
26 Osteochondritris Dissicans Of The Humeral Capitellum TreatmentIf no evidence of separation then rest, ice, ROM, and analgesicsRepeat X-ray check for healingSurgery if locking, loose bodies, fragment separation or failure of conservative management
27 Panner’s Disease Osteochondrosis of the humeral capitellum Repetitive valgus stress causes compressive stress across the radiocapitellarOccurs between 7-12 years of age ( peak incidence at 9 years)May be susceptible at this time due to limited blood supply
28 Panner’s Disease Pathophysiology Unknown May be similar to Legg-Calve`-Perthes disease
29 Panner’s Disease Symptoms Fairly sudden pain Deep and dull achiness Worsened with throwingNo mechanical symptoms (locking or catching)
30 Panner’s Disease Physical exam Tenderness and swelling over the lateral elbowMild to moderate flexion contractures (usually from 5-20 degrees)
31 Panner’s Disease Radiology Fragmentation of the capitellum, with alternating area of sclerosis and rarefaction and an irregular joint surface
32 Panner’s Disease Treatment Conservative Complete rest from throwing until symptoms subside and ROM is normalRepeat X-rays to monitor remodelingMay return when X-rays and exam is normalLong term disability is rare
33 The WristGymnast wristTorus fracturesWrist fractures
34 Gymnast WristChronic overuse injury occurring at the physis if skeletally immature gymnastsPresents with wrist painUsually due to repetitive hyperextension and overuseArms are used as weight bearing devicesSalter-Harris type I injury
36 Gymnast WristGymnast’s wrist frequently show physeal irregularities and bony sclerosis on X-rayIf untreated can result in permanent radial deformity and shortening due to growth arrestRest relieves symptomsExtension splints can prevent recurrence