วัตถุประสงค รูและเขาใจความแตกตางระหวางกระดูกหักและขอเคลื่อน ในเด็กและในผูใหญ รูและเขาใจเกี่ยวกับ Epiphyseal plate injury ในแงการใหการวินิจฉัยและแนวทางการรักษา รูและเขาใจกระดูกหักและขอเคลื่อนที่พบบอยในเด็ก Differences of fractures and dislocations between in children and in adults 1.Easier to occur :smaller in size :less density of bone 2.Difficult to diagnose :presence of growth plate :presence of secondary ossification centers :less cooperation :difference of x-ray findings in different age 3 months 12 months 3 years 5 years 8 years 12 years 15 years 3.Difference in treatment :mostly can be treated nonoperatively 4.Faster to heal :the older needs more time to heal 5.Greater capacity to remodel Bayonet apposition 6.Less incidence of ligamentous injuries , joint dislocations and intra-articular fractures :less strength of growth plate 7.Difference in complications :less incidence of nonunion , joint stiffness 8.Difference in fracture patterns Torus or Buckle Fractures Greenstick fracture Plastic Deformation Epiphyseal Plate Injuries •Epiphyseal plate = growth plate = physis •Locate at the end of the long bone •Responsible for longitudinal growth •Is the weakest structure of the immature bone Salter and Harris Classification Type I S-H Type I Type II Thurston-Holland fragment sign Type III Type IV Type V Treatment •Type I & II : Closed reduction +/- fixation •Type III & IV : Operative Rx •Type V : Gentle reduction Closed observation Surgical correction Supracondylar Fracture of Humerus :most common elbow injury (75%) :peak incidence 5-8 year of age :classified by mechanism of injury 1.Extension Type (97%) 2.Flexion Type (3%) Gartland Classification Depend on severity of injury 1.Type I :non displaced or minimally displaced Rx. Long Arm Slab (90º) for 3 weeks 2.Type II : displaced but intact posterior cortex Rx. Closed reduction and Long Arm Slab (120º) for 3 weeks 3.Type III : totally displaced Rx. Closed reduction and percutaneous pinning ORIF in combined vascular injury or failure to closed reduction Complications 1. Volkmann’s ischemia 2. Nerve injury 3. Vascular injury 4. Cubitus varus Lateral Condyle Fracture of Humerus :the second most common (17%) of elbow injury in children :common missed diagnostic fracture :may further displaced by extensor muscle group Treatment •0-2 mm. : Long arm cast 4wks ( FU every 3-5 days) •2-4 mm. : Closed reduction and Percutaneous pinning •>4 mm. or : ORIF rotated fragment Forearm Fracture :common fracture in children caused by fall on the outstretched hand :incidence – distal(70-80%) , middle(15-25%) proximal(5%) :associated elbow injury 13% (Be careful) Treatment :can be treated by long arm cast because of good ability to heal and to remodel :older children may be treated by ORIF or intramedullary pin Long Arm Cast in Rx of forearm fracture in children Intramedullary pinning Plate and Screws Femoral Shaft Fracture :is common childhood fractures :70% occurs at the diaphysis :identify mechanism of trauma to evaluate degree of injury :fracture in younger child (<4 yrs old) –child abused has to be ruled out Treatment Depends on age and severity :Mostly can be treated by nonoperative methods esp. younger children - Pavlik harness splint (0-6 months) - Hip spica cast One and half hip spica cast Treatment :Surgery are also choices for older children Flexible IM rod Plate and Screws External fixation .