Pediatric fractures and dislocations

Contents General Science, Treatment, and Clinical Considerations 1 Growth and Growth Disturbances . . . . . 2 Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Longitudinal Growth and Possible Growth Plate Injuries . . . . . . . . . . . . . . . . . 2 Physiological Closure of the Growth Plate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Growth Disturbances . . . . . . . . . . . . . . . . . 3 Growth Stimulation . . . . . . . . . . . . . . . . . . . 4 Growth Arrest . . . . . . . . . . . . . . . . . . . . . . . . 6 2 Corrective Mechanisms in the Growing Skeleton . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Correction of Side-to-Side Displacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Correction of Axial Deviations in the Coronal and Sagittal Planes . . . . . . . . . . . . 12 Correction of the Shortening Deformity . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Correction of the Lengthening Deformity . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Correction of the Rotational Deformity . 16 3 Consolidation and Consolidation Disturbances . . . . . . . . . . . . . . . . . . . . . . . . . 19 Bone Healing . . . . . . . . . . . . . . . . . . . . . . . . . 19 Consolidation Disturbances . . . . . . . . . . . 20 4 General Observations on the Nature and Correction of Posttraumatic Deformities . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Cause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 When Is Surgical Correction of a Posttraumatic Deformity Indicated? . . . . . . . 28 How Can One Correct Posttraumatic Deformities? . . . . . . . . . . . . . . . . . . . . . . . . . 28 5 Patterns of Injury and Prognosis of Childhood Fractures . . . . . . . . . . . . . . . . . . 30 Forms of Injury . . . . . . . . . . . . . . . . . . . . . . . 30 Growth Prognosis . . . . . . . . . . . . . . . . . . . . 32 Ligament Injuries . . . . . . . . . . . . . . . . . . . . . 35 Dislocations . . . . . . . . . . . . . . . . . . . . . . . . . . 36 6 General Observations on Prevention of Injuries in Growing Patients . . . . . . . . . . . 38 7 Classification of Pediatric Fractures . . . . 40 Shaft Fractures . . . . . . . . . . . . . . . . . . . . . . . 40 Metaphysis . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Articular Injuries . . . . . . . . . . . . . . . . . . . . . 43 Proposed Documentation System for Pediatric Fractures and Dislocations . . . . 45 8 Diagnostic Studies . . . . . . . . . . . . . . . . . . . . 49 History Taking: Interviewing the Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Inspection . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Examining the Periphery . . . . . . . . . . . . . . 51 “Painful” Clinical Examination . . . . . . . . . 52 Radiographic Studies . . . . . . . . . . . . . . . . . 53 Exceptions: “Litigation Injuries” . . . . . . . 55 Other Imaging Systems: Computed Tomography, Magnetic Resonance Imaging, and Ultrasound . . . . . . . . . . . . . . 61 Arthrography . . . . . . . . . . . . . . . . . . . . . . . . 62 Arthroscopy . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Examination under Anesthesia . . . . . . . . 62 9 Measurements . . . . . . . . . . . . . . . . . . . . . . . 63 10 General Observations on Anesthesia . . . 67 11 General Observations on Treatment . . . 69 Therapeutic Options . . . . . . . . . . . . . . . . . . 69 12 Follow-up . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Radiographic Follow-up Examinations . 78 Clinical Follow-up Examinations . . . . . . . 85