Download presentation
Presentation is loading. Please wait.
Published byAnn Sabin Modified over 9 years ago
1
Diaphyseal fractures in children Mohamed M. Zamzam Associate Professor & Consultant Pediatric Orthopedic Surgeon KKUH, Riyadh, Saudi Arabia
2
Objectives To recall specific considerations of diaphyseal fractures in children To be aware of common possible complications To identify the treatment of choice in each particular situation among a big list of management options To create an algorithm as a guide for managing long bone shaft fractures in pediatric population Diaphyseal Fractures in Children
3
General Principles About 15% of injuries in children are skeletal Out of all skeletal injuries in children –Radial shaft fractures 6.4 % –Tibial shaft fractures 6.2 % –Femoral shaft fractures 2.1 % –Proximal & shaft humerus fractures 1.4 % Diaphyseal Fractures in Children
4
Specific Problems Premature complete physeal closure Progressive limb length discrepancy Nonunion Open reduction and internal fixation Diaphyseal Fractures in Children
5
General management Cast Internal fixation External fixation Diaphyseal Fractures in Children
6
General management Cast Internal fixation External fixation Diaphyseal Fractures in Children
7
General management Cast Internal fixation External fixation Diaphyseal Fractures in Children
8
General management Indications for surgery Head injury Multiple injuries Adolescence Failure of conservative means Severe soft-tissue injury Neurological disorder Malunion and delayed union Diaphyseal Fractures in Children
9
Elastic stable intramedullary nailing (ESIN) The principle 2 elastic nails Maximum curve Orientation The size Good knowledge of the technique Diaphyseal Fractures in Children
10
Elastic stable intramedullary nailing (ESIN) Advantages No need for postoperative cast Primary bone union Avoidance of growth plate injury Minimum invasive surgery Excellent functional and cosmetic results Diaphyseal Fractures in Children
11
Elastic stable intramedullary nailing (ESIN) Complications Nonunion ?? Osteomyelitis (rate is 2%) Overgrowth ( <10 mm before age of 10 years) Cortical perforation Re-fractures ? Skin irritation Diaphyseal Fractures in Children
12
Forearm The distal radial epiphyseal plate realigned well in children below 10 years Radioulnar angulation usually associated with loss of motion The risk of refracture Diaphyseal Fractures in Children
13
Forearm Treatment options Closed reduction + cast AO plates Intramedullary fixation Diaphyseal Fractures in Children
15
Forearm Closed intramedullary nailing Internal fixation of the radius only The radius has the more complicated function Better alignment of the ulnar fracture Diaphyseal Fractures in Children
16
Forearm diaphyseal fracture Open Closed Debridement in OR
17
Forearm diaphyseal fracture Open Closed Debridement in OR Angulation 0°-10° Angulation 10°-20° Angulation +20°
18
Forearm diaphyseal fracture Open Closed Debridement in OR Angulation 0°-10° Angulation 10°-20° Angulation +20° Closed reduction + 5 years All ages Long arm cast or splint 0-5 years Successful if < 10°
19
Forearm diaphyseal fracture Open Closed Debridement in OR Angulation 0°-10° Angulation 10°-20° Angulation +20° Closed reduction Open reduction +ESIN Unsuccessful + 5 years All ages Long arm cast or splint 0-5 years Successful if < 10° Successful but unstable Closed reduction + ESIN
20
Humerus Incidence is related to the cause and age group Classified according to –Fracture pattern –Location –Tissues damaged Diaphyseal Fractures in Children
21
Humerus Priority is given to conservative treatment Osteosynthesis (10%) External fixation Diaphyseal Fractures in Children
22
Humerus potential operative indications Open fractures Multiple trauma Bilateral injuries Compartment syndromes Pathological fracture Significant nerve injuries Inadequate closed reduction Diaphyseal Fractures in Children
23
Humeral diaphyseal fracture Adolescents & Older childrenInfants & younger children Immobilize in a sling & swath ClosedOpen
24
Humeral diaphyseal fracture Adolescents Older childrenInfants & younger children Debridement in OR Immobilize in a sling & swath Closed Closed reduction + ESIN External fixator Open IIII & II Adolescents & Older children
25
Humeral diaphyseal fracture Adolescents Older childrenInfants & younger children Debridement in OR Closed reduction Immobilize in a sling & swath Closed Midshaft angulation Closed reduction + ESIN Immobilize in soft dressing External fixator Open < 20°> 20° IIII & IISurgical indications Adolescents & Older children
26
Femur Stress fracture Pulmonary complications Growth disturbances resulting in 1. accelerated growth 2. retarded growth 3. axial deformities 4. rotational deformities Spontaneous correction Diaphyseal Fractures in Children
27
Femur Stress fracture Pulmonary complications Growth disturbances resulting in 1. accelerated growth 2. retarded growth 3. axial deformities 4. rotational deformities Spontaneous correction Diaphyseal Fractures in Children
28
Femur Stress fracture Pulmonary complications Growth disturbances resulting in 1. accelerated growth 2. retarded growth 3. axial deformities 4. rotational deformities Spontaneous correction Diaphyseal Fractures in Children
29
Femur Stress fracture Pulmonary complications Growth disturbances resulting in 1. accelerated growth 2. retarded growth 3. axial deformities 4. rotational deformities Spontaneous correction Diaphyseal Fractures in Children
30
Femur Adequately managed non-operatively Operative approach 2-5 years post-injury non-debilitating pain Strict adherence to a surgical technique Diaphyseal Fractures in Children
31
Femur Treatment options Immediate hip spica Delayed hip spica Plate osteosynthesis Conventional IMN Stainless steel K-wires Titanium elastic nailing External fixation Diaphyseal Fractures in Children
32
Femur The optimal method Economic reasons Parents’ decision 7 - 10 years (no man's land) Diaphyseal Fractures in Children
33
Femur Conservative mode Low risk of overgrowth Rotational malalignment of up to 20 degrees corrects during growth Economically, cheap Diaphyseal Fractures in Children
34
Femur Narrow low-contact DCP Minimal exposure Percutaneous screw placement Stable mode of fixation Biologic healing potential Early patient mobilization Diaphyseal Fractures in Children
35
Femur Rigid intramedullary nail In older children and adolescents Placement through the lateral aspect of GT 1. Safe technique 2. Effective 3. Well tolerated Growth arrest of the greater trochanter Hip function Diaphyseal Fractures in Children
36
Femur ESIN simple procedure Minimal blood loss Short operative time K-wires # Titanium 2 to 14 years # Ender nails Diaphyseal Fractures in Children
37
Femur External fixation Simple and elegant Risk of refracture Length of hospital stay Time to union Wire site infection Diaphyseal Fractures in Children
38
Femoral shaft fracture Debridement in OR Adolescent Open InfantsYounger childOlder child
39
Femoral shaft fracture Yes Debridement in OR Adolescent Open Abused InfantsYounger childOlder child No Hospital & invest. Immediate Hip spica
40
Femoral shaft fracture Yes Debridement in OR Adolescent Open Excessive shorteningAbused InfantsYounger childOlder child No Yes Hospital & invest. Immediate Hip spica Traction Then cast ESIN Choice
41
Femoral shaft fracture Yes Debridement in OR Adolescent External fixator Open Excessive shorteningAbused InfantsYounger childOlder child Comminution No Yes No Hospital & invest. Immediate Hip spica Traction Then cast ESIN Choice
42
Femoral shaft fracture Yes Debridement in OR Adolescent External fixator Open Excessive shorteningAbused InfantsYounger childOlder child Comminution No Yes No Reamed rod Hospital & invest. Immediate Hip spica Traction Then cast ESIN Choice
43
Tibia Special considerations Child abuse Isolated tibial fractures Open fractures Pathological fractures Stress fractures Diaphyseal Fractures in Children
44
Tibia Special considerations Child abuse Isolated tibial fractures Open fractures Pathological fractures Stress fractures Diaphyseal Fractures in Children
45
Tibia Special considerations Child abuse Isolated tibial fractures Open fractures Pathological fractures Stress fractures Diaphyseal Fractures in Children
46
Tibia Special considerations Child abuse Isolated tibial fractures Open fractures Pathological fractures Stress fractures Diaphyseal Fractures in Children
47
Tibia Special considerations Child abuse Isolated tibial fractures Open fractures Pathological fractures Stress fractures Diaphyseal Fractures in Children
48
Tibia Specific problems Delayed unions Nonunion Malunion Compartment syndromes Diaphyseal Fractures in Children
49
Tibia Specific problems Delayed unions Nonunion Malunion Compartment syndromes Diaphyseal Fractures in Children
50
Tibia Specific problems Delayed unions Nonunion Malunion Compartment syndromes Diaphyseal Fractures in Children
51
Tibia Specific problems Delayed unions Nonunion Malunion Compartment syndromes Diaphyseal Fractures in Children
52
Tibia Treatment is based on: patient age concomitant injuries fracture pattern surgeon experience Diaphyseal Fractures in Children
53
Tibia Treatment options Closed reduction and casting External fixation Internal fixation ESIN Diaphyseal Fractures in Children
54
Tibia Treatment of sequelae after union: Physeal closure Leg-length discrepancy Progressive valgus deformity Diaphyseal Fractures in Children
55
Tibia Treatment of sequelae after union: Physeal closure Leg-length discrepancy Progressive valgus deformity Diaphyseal Fractures in Children
56
Tibia Treatment of sequelae after union: Physeal closure Leg-length discrepancy Progressive valgus deformity Diaphyseal Fractures in Children
57
Tibial shaft fracture Open Debridement in OR Closed IIII & II External fixatorClosed reduction + ESIN Polytrauma
58
Tibial shaft fracture Open Debridement in OR Closed IIII & II External fixatorClosed reduction + ESIN Polytrauma
59
Tibial shaft fracture Open Debridement in OR Closed IIII & II External fixatorClosed reduction + ESIN Polytrauma FailedSucceed Closed reduction & cast Consider wedging the cast
60
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 Always, consider the high healing power of children Diaphyseal Fractures in Children
62
Thank you
Similar presentations
© 2024 SlidePlayer.com Inc.
All rights reserved.