Subject(s)
Casts, Surgical , Radius Fractures , Wrist Injuries , Humans , Radius Fractures/surgery , Radius Fractures/diagnostic imaging , Wrist Injuries/surgery , Wrist Injuries/diagnostic imaging , Fracture Healing/physiology , Postoperative Complications/prevention & control , Postoperative Complications/etiology , Salter-Harris Fractures/surgery , Fracture Dislocation/surgery , Fracture Dislocation/diagnostic imaging , Wrist FracturesABSTRACT
OBJECTIVES: This study assessed the feasibility of open surgery and determined outcome predictors for late management of epiphyseal plate fracture of the distal radius in children. METHODS: This retrospective study included 25 patients (22 male, 3 female) who underwent open surgery for late management of epiphyseal plate fracture of the distal radius. Wrist function was evaluated on Cooney score. Potential predictors comprised age, gender, fracture type, days after injury (DAI), degree of violence (DOV), and dorsal angulation before surgery (DABS). RESULTS: Overall, wrist function after surgery was classified as excellent for 16 patients (64%), good for 6 (24%), and fair for 3 (12%). The rate of excellent wrist function was 86.7% (13/15) in children older than 10 years but only 40% (4/10) for those aged under 10 years (p = 0.0280). Cooney score correlated positively with age, but there was no correlation with gender, fracture type, DAI, DOV or DABS. CONCLUSION: Open reduction surgery for late management of distal radius epiphyseal fracture yielded good results in patients aged over 10 years. LEVEL OF EVIDENCE: III.
Subject(s)
Radius Fractures , Salter-Harris Fractures , Wrist Fractures , Humans , Male , Female , Child , Aged , Radius , Radius Fractures/surgery , Growth Plate/surgery , Retrospective Studies , Fracture Fixation, Internal/methods , Bone Plates , Salter-Harris Fractures/surgeryABSTRACT
BACKGROUND: Salter-Harris type II fractures are the most common pediatric phalangeal fracture. A juxtaepiphyseal fracture is a distinct fracture pattern that, although similar in radiographic appearance, occurs 1 to 2 mm distal to the growth plate. Although subtle, there are important differences in the behavior and management of these fracture types. The purpose of this study was to compare these two fracture patterns in terms of clinical features and treatment. METHODS: An institutional review board-approved retrospective chart review was conducted of patients presenting to our tertiary care pediatric hospital. One hundred fifty-eight patients with either Salter-Harris type II or juxtaepiphyseal phalangeal fractures were identified. Primary outcomes analyzed included angulation at initial presentation, stability of reduction if attempted in the emergency department, and need for operative fixation with and without Kirschner wire fixation, with final angulation measurements. RESULTS: Salter-Harris type II fractures were more common than juxtaepiphyseal fractures (83 percent versus 17 percent, respectively). There was no significant difference between the two fracture types in the patient's age, sex, or mechanism of injury. Juxtaepiphyseal fractures were radiographically more angulated on presentation than Salter-Harris type II fractures (p = 0.02). Juxtaepiphyseal fractures required significantly more operative fixation by closed reduction and percutaneous pinning compared to Salter-Harris type II fractures (42.9 percent versus 10.8 percent, respectively; p = 0.002). There was no difference in final outcomes obtained between the two groups. CONCLUSIONS: Juxtaepiphyseal phalangeal fractures are a distinct entity from Salter-Harris type II fractures. Presenting with significantly more radiographic angulation and clinical instability, juxtaepiphyseal fractures more frequently required operative fixation. Recognizing the differences between these pediatric fracture types is important to help guide clinical management for successful healing. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
Subject(s)
Finger Phalanges/injuries , Finger Phalanges/surgery , Fracture Fixation, Internal/methods , Salter-Harris Fractures/surgery , Adolescent , Child , Female , Humans , Male , Retrospective StudiesABSTRACT
BACKGROUND: Fractures of the proximal humerus in skeletally immature patients are rare, and even rarer still in individuals approaching skeletal maturity. Concepts regarding remodeling potential, amount of deformity and functional demands can guide our treatment decision making, but criteria are poorly defined. The purpose of this manuscript is to discuss the issues and the best available evidence. METHODS: A search of the English literature was carried out using PubMed to identify papers on the topic of proximal humerus fractures in skeletally immature individuals. RESULTS: The literature available on the topic of pediatric proximal humerus fractures is limited, especially regarding fractures in patients approaching skeletal maturity. Certainly, as the remodeling potential decreases and the amount of deformity and functional demand increase, the need for operative treatment increases. The exact tolerances and criteria have not been established. A variety of surgical techniques exist, and have been shown to be helpful. CONCLUSIONS: Operative treatment may be necessary in individuals approaching skeletal maturity. Concepts discussed in this paper regarding remodeling, amount of deformity and functional demand may help the surgeon to make appropriate treatment decisions. Future prospective comparative studies which are pending will hopefully shed further light on this matter.
Subject(s)
Fracture Fixation , Humerus , Shoulder Fractures/surgery , Adolescent , Bone Remodeling , Child , Child Development , Fracture Fixation/adverse effects , Fracture Fixation/instrumentation , Fracture Fixation/methods , Hand Deformities, Acquired/etiology , Hand Deformities, Acquired/prevention & control , Humans , Humerus/growth & development , Humerus/surgery , Patient Selection , Salter-Harris Fractures/surgeryABSTRACT
OBJECTIVES: In this study, we describe a novel hemiepiphysiodesis technique to prevent implant-related perichondrial ring injury in a rabbit model. MATERIALS AND METHODS: Proximal tibial epiphyseal plates of a total of 16 white New Zealand rabbits were used for this animal model. The subjects were divided into three equal groups as follows: Group 1 (Kirschner wire [K-wire]/cerclage), Group 2 (8-plate) right-hind legs, Group 3 (Control) left hind legs. Using anteroposterior radiography, the medial slope angle (MSA), articular line-diaphyseal angle (ALDA), and the angle between screws of 8-plate in lateral X-ray tibial slope angle (TSA) were measured. The radiographs were taken early postoperative (Day 1) and on sacrification day (Week 8). The histological evaluation of the perichondrial ring was made on a 7-mm axial section that stained with Safranin O/fast green at X10 magnification. RESULTS: In both K-wire and 8-plate groups, the early postoperative ALDA and TSA were greater than the sacrification ALDA and TSA (p=0.028 and p<0.001, respectively). The early postoperative MSA was lower than the sacrification MSA in groups, (p<0.001). The MSA in the control group was lower than the K-wire and 8-plate groups (p<0.001 and p=0.009; respectively). The perichondrial ring thickness of the K-wire group was greater than the 8-plate group in histological evaluation (p<0.001). CONCLUSION: Both of the K-wire and 8-plate groups showed similar angulation effects in the proximal tibia, although histologically less damage to the perichondrial ring was observed in the K-wire group, compared to the 8-plate group.
Subject(s)
Bone Plates/statistics & numerical data , Bone Wires/statistics & numerical data , Growth Plate/surgery , Tibia/surgery , Animals , Cartilage/diagnostic imaging , Epiphyses , Rabbits , Radiography , Salter-Harris Fractures/surgeryABSTRACT
BACKGROUND: The treatment for displaced Salter-Harris II (S-H II) distal tibia fractures remains controversial. The purpose of this study was to review S-H II distal tibia fractures and evaluate the rate of premature physeal closure (PPC) treated by open reduction and internal fixation (ORIF). METHODS: We reviewed the charts and radiographs of S-H II fractures of the distal tibia with displacement > 3 mm between 2012 and 2019 treated by ORIF. Patients were followed up for a minimum of 6 months. CT scans of injured side or contralateral ankle radiograph were obtained if there was any evidence of PPC. Any angular deformity or shortening of the involved leg was documented. Multivariable logistic regression was performed to identify risk factors for the occurrence of PPC. RESULTS: A total of 65 patients with a mean age of 11.8 years were included in this study. The mean initial displacement was 8.0 mm. All patients but one were treated within 7 days after injury and the mean interval was 3.7 days. Supination-external rotation injuries occurred in 50 patients, pronation-eversion external rotation in 13, and supination-plantar flexion in two. The residual gap was less than 1 mm in all patients following ORIF and all fractures healed within 4-6 weeks. Superficial skin infection developed in one patient. Ten patients complained of the cosmetic scar. The rate of PPC was 29.2% and two patients with PPC developed a varus deformity of the ankle. Patients with associated fibular fracture had 7 times greater odds of developing PPC. Age, gender, injured side, mechanism of injury, amount of initial displacement, interval from injury to surgery, or energy of injury did not significantly affect the rate of PPC. CONCLUSIONS: ORIF was an effective choice of treatment for S-H II distal tibia fractures with displacement > 3 mm to obtain a satisfactory reduction. PPC is a common complication following ORIF. The presence of concomitant fibula fracture was associated with PPC.
Subject(s)
Ankle/abnormalities , Fracture Fixation, Internal/methods , Open Fracture Reduction/methods , Salter-Harris Fractures/surgery , Tibial Fractures/surgery , Adolescent , Age Factors , Child , Child, Preschool , Female , Foot Deformities, Acquired/etiology , Fracture Fixation, Internal/adverse effects , Humans , Logistic Models , Male , Open Fracture Reduction/adverse effects , Postoperative Complications/etiology , Retrospective Studies , Risk Factors , Salter-Harris Fractures/classification , Tibial Fractures/classification , Tibial Fractures/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Inappropriate treatment of growth plate injury may cause complications such as malunion or early arrest of the growth plate. Identification of intra-articular lesions is mandatory in patients with a growth plate injury of the distal tibia. Arthroscopic assessment is useful in identifying intra-articular injury. We report three cases of intra-articular growth plate injury of the distal tibia that were treated via internal fixation with arthroscopic assessment in our hospital. MATERIALS AND METHODS: All three cases were performed pre- and postoperative arthroscopic assessment and open reduction and internal fixation with a cannulated cancellous screw (CCS; Meira, Japan). All patients were then examined for postoperative complications, functional recovery, at the end of the final follow-up consultation. RESULTS: Intraoperatively, a small cartilage injury was found in the non-fracture area in two cases; the remaining case had a reversed cartilage fragment at the talus, which was arthroscopically removed. CONCLUSIONS: Arthroscopic assessment followed by internal fixation is a useful minimally invasive method for the identification of intra-articular lesions such as osteochondral injury or free bodies.
Subject(s)
Arthroscopy/methods , Fracture Fixation, Internal/methods , Intra-Articular Fractures , Salter-Harris Fractures , Tibia , Tibial Fractures , Adolescent , Feasibility Studies , Female , Humans , Intra-Articular Fractures/diagnosis , Intra-Articular Fractures/surgery , Japan , Open Fracture Reduction , Perioperative Care , Salter-Harris Fractures/diagnostic imaging , Salter-Harris Fractures/surgery , Tibia/diagnostic imaging , Tibia/surgery , Tibial Fractures/diagnostic imaging , Tibial Fractures/surgery , Treatment OutcomeABSTRACT
CASE: We describe a case of posterior hip dislocation in a 13-year-old boy after a contact football injury with attempted closed reduction resulting in complete separation of the epiphysis from the femoral neck metaphysis with associated femoral head fracture and posterior dislocation of the femoral head. Treatment was emergently performed with a greater trochanteric osteotomy, open reduction internal fixation using cannulated screws, and additional small diameter drill holes in the femoral head to promote blood flow. The patient did well postoperatively and at over 4 years follow-up had no evidence of avascular necrosis and returned to full athletics participation. CONCLUSION: Particular attention should be taken when reducing hip dislocations in the adolescent population who may be predisposed to epiphysiolysis. Preservation of periosteal soft-tissue attachments and the use of small diameter drill holes to promote femoral head blood flow may have contributed to the excellent outcome.
Subject(s)
Epiphyses, Slipped/etiology , Fracture Fixation, Internal/methods , Hip Dislocation/complications , Salter-Harris Fractures/etiology , Adolescent , Epiphyses, Slipped/diagnostic imaging , Epiphyses, Slipped/surgery , Football/injuries , Hip Dislocation/diagnostic imaging , Hip Dislocation/surgery , Humans , Male , Salter-Harris Fractures/diagnostic imaging , Salter-Harris Fractures/surgery , Tomography, X-Ray ComputedABSTRACT
CASE: A 12-year-old male patient sustained a multisegmental both-bone forearm fracture. Definitive stabilization was ulna intramedullary pinning, with stainless steel plating of the radius followed by a titanium plate stacked atop and extending internal fixation. Currently, 36 months after surgery, he experiences no limitations or complications. All hardware remains in situ. CONCLUSION: We believe this is the first description of different material plates in direct contact, of stacked plates, and of 1 plate extending another's fixation. No adverse effects developed.
Subject(s)
Bone Plates , Forearm Injuries/surgery , Fracture Fixation, Internal/instrumentation , Salter-Harris Fractures/surgery , Child , Humans , Male , Stainless Steel , TitaniumABSTRACT
CASE: A 10-year-old boy presented with a Salter-Harris II distal radius fracture that was irreducible by closed methods. An open reduction was performed in the operating room where a sleeve of periosteum was found interposed between the fracture fragments. Successful reduction was performed without difficulty after the periosteum was removed from the fracture. CONCLUSION: Soft-tissue interposition must be kept in mind when having difficulty performing closed reductions of pediatric distal radius physeal fractures to avoid excessive reduction attempts.
Subject(s)
Fracture Fixation, Internal/methods , Radius Fractures/surgery , Salter-Harris Fractures/surgery , Wrist Injuries/surgery , Child , Humans , Male , Radiography , Radius Fractures/diagnostic imaging , Salter-Harris Fractures/diagnostic imaging , Wrist Injuries/diagnostic imagingABSTRACT
The cartilaginous primary physis, or growth plate, at the end of long bones in children allows for longitudinal bone growth. A variety of insults to the physis can lead to physeal bridge formation, which in turn can lead to limb-shortening and angular deformities. This paper begins with a description of the causes, risk factors and mechanisms by which bridges form. Then it reviews the use of imaging in the diagnosis and characterization of bridges and in the evaluation of treatment and post-treatment complications. It is important for radiologists taking care of children to be aware of the indirect and direct imaging findings of physeal bridges to aid in their diagnosis, to be able to characterize bridges as part of preoperative planning, and to know the imaging finding of post-resection complications.
Subject(s)
Bone Diseases, Developmental/diagnostic imaging , Bone Diseases, Developmental/etiology , Magnetic Resonance Imaging/methods , Salter-Harris Fractures/complications , Salter-Harris Fractures/diagnostic imaging , Tomography, X-Ray Computed/methods , Bone Diseases, Developmental/surgery , Child , Growth Plate/diagnostic imaging , Growth Plate/surgery , Humans , Salter-Harris Fractures/surgeryABSTRACT
BACKGROUND: Although physeal fractures and physeal bars can result in significant clinical consequences to growth and development of the injured physis, little orthopaedic research has focused upon this topic. Our objective was to extend a previously developed rat model to examine the immunohistochemical features following surgical application of techniques disrupting the physis. METHODS: Physes were surgically disrupted using fracture (control), epiphyseal scrape (ES), or epiphyseal drill (ED). After 1, 3, 6, 10, or 21 days, animals were euthanized, sites processed for histology and immunohistochemical localization of vascular endothelial growth factor (VEGF), Factor VIII, Sox-9, PTHrP (parathyroid hormone-related protein) and PTHrP-R (parathyroid hormone-related protein receptor) in resting, proliferative, and hypertrophic physeal zones. Incidence of physeal bars, vertical septa and islands within the metaphysis was quantified. Semiquantitative analysis of immunohistochemistry was performed. RESULTS: Physeal bars, vertical septa, and displaced cartilage islands were present each of the surgical treatments. Fisher's exact test showed a statistically significant increase in the presence of physeal bars (P=0.002) and vertical septa (P=0.012) in the ED group at 10 and 21 days. Analysis of VEGF showed significant differences among the surgical treatments involving the resting zone, and the proliferative zone for days 1, 6, and 21 (P≤0.02) with greater mean scores present in the fracture (control) group, followed by the ED group; the lowest scores were present in the ES group. PTHrP-R immunolocalization showed significant differences among treatments in the hypertrophic zone at days 6 and 21 (P=0.022 and 0.044, respectively). CONCLUSIONS: On the basis of the type of surgical treatment, results show significant differences in the presence of VEGF (reflecting the vascular bed) in the resting and proliferating zones at days 1, 6, and 21. VEGF localization was less abundant in the ED group (which had more physeal bars), suggesting that lack of vascular ingrowth plays a role in physeal bar formation. CLINICAL RELEVANCE: Basic science data presented here provide insight into the importance of the various regions of the physis and its repair and continued growth after physeal fracture. We suggest that a better understanding of the cellular basis of physeal arrest following physeal fracture may have future relevance for the development of treatments to prevent or correct arrest.
Subject(s)
Growth Plate/metabolism , Salter-Harris Fractures/metabolism , Ablation Techniques , Animals , Epiphyses/injuries , Epiphyses/metabolism , Factor VIII/metabolism , Growth Plate/surgery , Immunohistochemistry , Parathyroid Hormone-Related Protein/metabolism , Rats , Receptor, Parathyroid Hormone, Type 1/metabolism , SOX9 Transcription Factor/metabolism , Salter-Harris Fractures/surgery , Vascular Endothelial Growth Factor A/metabolismABSTRACT
A 10-year-old girl presented to the emergency department having sustained a fall onto an outstretched left hand while playing soccer. Clinical and radiographical assessment identified a Salter-Harris I distal ulna fracture, as well as a buckle fracture of the distal radius. The injury was closed, and she had no neurovascular deficits on examination. She was brought to the operating theatre the following morning for closed reduction under general anaesthesia. Image intensification was used to confirm anatomical reduction, and an above-elbow moulded plaster-of-paris cast was applied. Follow-up clinical assessment at 6 weeks confirmed healing of the fracture, and she proceeded to make a full recovery. This case describes the anatomy and physiology of such rare injuries and outlines treatment principles and potential pitfalls based on best available evidence.
Subject(s)
Athletic Injuries/diagnostic imaging , Radius Fractures/diagnostic imaging , Salter-Harris Fractures/diagnostic imaging , Ulna Fractures/diagnostic imaging , Athletic Injuries/surgery , Child , Closed Fracture Reduction , Female , Humans , Radiography , Radius Fractures/surgery , Salter-Harris Fractures/surgery , Treatment Outcome , Ulna Fractures/surgeryABSTRACT
In this case report, a 13-year-old girl with a distal Salter-Harris type II physeal fracture was treated by open reduction and internal fixation. She had to undergo a CT scan to establish the extent of injury prior to treatment. Distal physeal fractures of the femur are rare fractures, which often present various difficulties in the post-operative regimen. The classification and dislocation of the fracture have therapeutical and prognostic values in terms of treatment planning and growth disturbances. Follow-up after these fractures is recommended in order to detect malunion or anisomelia.
Subject(s)
Femoral Fractures , Joint Dislocations , Salter-Harris Fractures , Adolescent , Female , Femoral Fractures/surgery , Fracture Fixation, Internal , Growth Plate , Humans , Salter-Harris Fractures/surgery , Tomography, X-Ray ComputedABSTRACT
RATIONALE: The physeal separations and septic osteomyelitis in newborns are unusual, which represents a challenging problem in diagnosis and treatment. PATIENT CONCERNS: A 2-day-old mature male suddenly complained by parents about minimal swelling around the left knee, decreased left extremity motion and no fever. DIAGNOSIS: Preliminary x-rays of the lower extremities demonstrated a displaced distal femoral physeal, Laboratory investigation indicated infection. Magnetic resonance imaging and ultrasound showed displaced distal femoral physeal. A needle aspiration confirmed the diagnosis. INTERVENTION: Debridement and ultrasound guide reduction with pinning of physeal separations was performed. OUTCOME: At 5 years later, his last follow-up showed that there was only 1.6âcm limb-length discrepancy without angular deformity, the child did not report any pain and was perfectly able to perform his daily activities. LESSONS: Distal femoral physeal fractures after neonatal osteomyelitis requires immediate and reliable decision for management. We point out the important role of the application of sonography, which is helpful to make an early diagnosis and guide reduction and percutaneous pinning of distal femoral physeal fractures.
Subject(s)
Femoral Fractures/complications , Osteomyelitis/complications , Salter-Harris Fractures/complications , Debridement , Femoral Fractures/diagnostic imaging , Femoral Fractures/surgery , Humans , Infant, Newborn , Male , Salter-Harris Fractures/diagnostic imaging , Salter-Harris Fractures/surgery , Ultrasonography, InterventionalABSTRACT
The clinical and radiological outcomes of proximal tibia fractures involving the meta-diaphyseal junction treated with unilateral 3.5-mm locking precontoured anatomical plates are reported. Thirty-nine patients (41 proximal tibia fractures) who had proximal tibia fractures with complete meta-diaphyseal dissociation were enrolled in the study. For all patients, immediate postoperative and final follow-up simple radiographs were evaluated to determine the quality of the reduction by assessing coronal and sagittal alignment. In cases of intra-articular involvement, articular reduction quality and condylar width were additionally assessed. Clinical outcomes were assessed by knee range of motion and Lysholm knee score at final follow-up. Immediate postoperative radiographs showed satisfactory results: medial proximal tibial angle within 87°±5° in 87.8% (36 of 41), posterior tibia slope within 9°±5° in 85.4% (35 of 41), less than 2-mm articular step or gap in 79.3% (23 of 29), and a condylar width difference within 5 mm compared with the femoral condyles in 93.1% (27 of 29). All reductions but 1 were found to have satisfactory maintenance of the initial reduction. At final follow-up, the mean knee range of motion and Lysholm knee score were 122.5° (range, 100°-135°) and 75.8 (range, 50-100), respectively. A single lateral 3.5-mm plate fixation for proximal tibia fractures involving the meta-diaphyseal junction offers mechanically stable fixation with satisfactory clinical and radiological outcomes. [Orthopedics. 2018; 41(6):e777-e782.].
Subject(s)
Bone Plates , Fracture Fixation, Internal/instrumentation , Knee Joint/physiopathology , Salter-Harris Fractures/surgery , Tibial Fractures/surgery , Adult , Aged , Aged, 80 and over , Diaphyses/injuries , Diaphyses/surgery , Female , Humans , Lysholm Knee Score , Male , Middle Aged , Radiography , Range of Motion, Articular , Retrospective Studies , Salter-Harris Fractures/diagnostic imaging , Salter-Harris Fractures/physiopathology , Tibial Fractures/diagnostic imaging , Tibial Fractures/physiopathology , Treatment OutcomeABSTRACT
BACKGROUND: Salter-Harris fractures of the distal phalanx with or without clinical evidence of nail-bed laceration are frequently undertreated. METHODS: A retrospective review was performed of all patients with distal phalanx Salter-Harris fractures treated between 2004 and 2016. RESULTS: Seventy patients were treated for 72 Salter-Harris fractures at a mean ± SD age of 11.3 ± 3.7 years. Median follow-up was 6 weeks (interquartile range, 4 to 12.6 years). The thumb was most commonly involved (n = 21), followed by long (n = 18), ring (n =17), small (n = 9), and index (n = 7) fingers. Sport-related injuries accounted for 39 fractures (54 percent). Forty-two fractures (58 percent) had at least one clinical finding suggestive of nail-bed laceration (subungual hematoma, subluxation of the proximal nail plate, skin laceration proximal to the eponychial fold, bleeding from underneath the nail plate, eponychial fold laceration, and nail plate avulsion). Among 42 fractures with at least one feature of nail-bed laceration, surgical exploration was undertaken in 38 fractures. At exploration, a nail-bed laceration was found in 31 fractures (82 percent) and soft-tissue interposition was found in 18 (47 percent). Fractures with clinical features of nail-bed laceration (n = 42) were treated with open reduction and splinting (n = 25), open reduction and percutaneous pinning (n = 13), or splinting (n = 4). Excellent results were obtained, with few unfavorable outcomes. Infectious complications occurred in six patients. CONCLUSION: The high rate of nail-bed laceration and soft-tissue interposition in Salter-Harris fractures with clinical features of nail-bed laceration mandates surgical exploration. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Subject(s)
Finger Injuries/surgery , Finger Phalanges/injuries , Fracture Fixation/methods , Salter-Harris Fractures/surgery , Adolescent , Algorithms , Child , Child, Preschool , Female , Finger Injuries/diagnosis , Finger Phalanges/surgery , Follow-Up Studies , Humans , Male , Nails/injuries , Nails/surgery , Physical Examination , Retrospective Studies , Salter-Harris Fractures/diagnosis , Treatment OutcomeABSTRACT
Fracture of talus with Salter-Harris injury of the distal end of tibia is a rare injury in paediatric age group. The authors report a case of a 13-year-old male child who sustained type IV Salter-Harris injury to the medial malleolus with coronal spilt along with spilt and depressed fracture of the neck of talus and fracture of the lateral process of talus with stable compression fracture of spine sustained due to fall from 6 meters height. CT scan delineated the morphology of fracture pattern and helped in preoperative planning. Talar articular fracture was reduced and fixed arthroscopically while distal tibial fracture was fixed under image intensifier. We observed favourable outcome following arthroscopic reduction at 4-year follow-up.
Subject(s)
Fractures, Compression/surgery , Salter-Harris Fractures/surgery , Spinal Fractures/surgery , Talus/injuries , Tibial Fractures/surgery , Accidental Falls , Adolescent , Fractures, Compression/etiology , Humans , Male , Salter-Harris Fractures/etiology , Spinal Fractures/etiology , Talus/surgery , Tibial Fractures/etiologyABSTRACT
The treatment of pediatric patients in trauma surgery is a special situation in every aspect. For deciding on the correct treatment of fractures of the lower leg and ankle joint, various parameters, such as residual growth rate, skeletal age and height of the patient are decisive. The differences between fractures in children and adolescents are the open epiphyseal plate and the resulting residual growth. The bones of young children have a higher healing tendency and a greater potential for correction than in adolescents. Especially in the lower leg and the ankle joint, the potential for correction is decisive for the healing of fractures and for possible development of growth disorders. The limits of tolerance concerning axial malalignments and the expected spontaneous potential for correction must play an essential role for further treatment with conservative or operative therapy. This article deals with the special features of pediatric fractures of the lower leg and ankle joint.
Subject(s)
Ankle Fractures/surgery , Growth Plate/physiopathology , Salter-Harris Fractures/surgery , Tibial Fractures/surgery , Adolescent , Ankle Fractures/classification , Ankle Fractures/physiopathology , Body Height/physiology , Casts, Surgical , Child , Child, Preschool , Fracture Healing/physiology , Growth Disorders/physiopathology , Growth Disorders/prevention & control , Humans , Postoperative Complications/physiopathology , Postoperative Complications/prevention & control , Risk Factors , Salter-Harris Fractures/classification , Salter-Harris Fractures/physiopathology , Tibial Fractures/classification , Tibial Fractures/physiopathologyABSTRACT
BACKGROUND: Distal radial physeal fractures with volar displacement are rare. Several methods of operative treatment include volar plate without inserting distal screws, percutaneous technique using two anterior skin incisions and reversed Kapandji technique with pins introduced through a posterior approach and locked at the anterior cortex of the fracture. METHODS: We report three cases along with a literature review of the surgical techniques described in the past and a novel surgical technique for this uncommon fracture termed "Volar Kapandji". RESULTS: All patients had anatomic reduction at the last follow-up radiography, and all patients had a full range of motion and VAS 0 at the last follow-up. No complications were recorded. CONCLUSIONS: This case study presents the minimally invasive option for treating rare cases of physeal distal radius fractures with volar displacement. LEVEL OF EVIDENCE: V.