Specific Fractures and Joint injury in Children

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Specific Fractures and Joint injury in Children

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Special Features of Fractures and Dislocation in
Children

• 1. Fractures more common
• 2. Stronger and more active periosteum
• 3. More rapid fracture healing
• 4. Special problems of diagnosis
• 5. Spontaneous correction of certain
  
• residual deformities
• 6. Differences in complications
• 7. Different emphasis on methods of treatment
• 8. Torn ligaments and dislocations less common
• 9. Less tolerance of major blood loss

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Fractures More Common
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Stronger and More Active Periosteum
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More Rapid Fracture Healing
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Special Problems of Diagnosis
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Spontaneous Correction of Certain Residual
Deformities

• Angulation
• Incomplete apposition
• Shortening
• Rotation

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Differences in Complications
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Difference Emphasis on Methods of Treatment
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Torn Ligaments and Dislocations Less Common
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Less Tolerance of Major Blood Loss
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Special Types of Fractures in ChildrenFractures
that involve the Epiphseal plate

• Anatomy
• Histology
• Physiology

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Special Types of Fractures in ChildrenFractures
That Involve the Epiphyseal Plate

• Diagnosis of Epiphyseal Plate Injuries
• Salter-Harris Classification of Epiphyseal Plate
  Injuries

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Salter-Harris Classification of Epiphyseal
Injuries

• Type I
• Type II
• Type III
• Type IV
• Type V

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Prognosis Concerning Growth Disturbance

• 1. Type of Injury
• 2. Age of the Child
• 3. Blood Supply to the Epiphysis
• 4. Method of Reduction
• 5. Open or Closed Injury
• 6. Velocity and Force of the Injury

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Dislocation and Subluxation of the Hip
Developmental Displacement of the Hip
Developmental Dysplasia of the Hip

• Incidence
• Etiology and Pathology
• Diagnosis
• Treatment

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Diagnosis of the DDH

• Physical examination
• Barlow test
• Ortolani test
• Allis or Galeazzis sign
• Trendelenburgs test
• Radiologic Findings

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Treatment of the DDH

• Birth to Three Months
• Three Months to Eighteen Months
• Eighteen Months to Five Years
• After the Age of Five Years

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Metatarsus Primus Varus
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Metatarsus Adductus ( Metatarsus Varus )
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Talipes EquinovarusClubfoot

• Incidence
• Etiology and Pathology
• Diagnosis
• Treatment

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Neoplasms of Musculoskeletal Tissue

• Neoplasm-like Lesions
• True Neoplasms

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Classification of Neoplasm-like Lesions of Bone (
I )

• A. Osteogenic
• 1. Osteoma
• 2. Single osteochondroma
• 3. Multiple osteochondroma
• 4. Osteoid osteoma
• 5. Benign ostoblastoma
• B. Chondrogenic
• 1. Enchondroma
• 2. Multiple enchondromata

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Classification of Neoplasm-like Lesions of Bone (
II )

• C. Fibrogenic
• 1. Subperiosteal cortical defect
• 2. Nonosteogenic fibroma
• 3. Monostotic fibrous dysplasia
• 4. polyostotic fibrous dysplasia
• 5. Osteofibrous dysplasia
• 6. Brown tumor

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Classifiction of Neoplasm-like Lesions of Bone (
III )

• D. Angiogenic
• 1. Angioma of bone
• 2. Aneurysmal bone cyst
• E. Uncertain origin
• 1. Simple bone cyst

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Classification of True Primary Neoplasms of Bone
( I )

• A. Osteogenic
• 1. Osteosarcoma
• 2. Surface osteosarcoma ( parosteal
  sarcoma periosteal sarcoma )
• B. Chondrogenic
• 1. Benign chondroblastoma
• 2. Chondromyxoid fibroma
• 3. Chondrosarcoma
• C. Fibrogenic
• 1. Fibrosarcoma of bone
• 2. Malignant fibrous histiocytoma of
  bone

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Classification of True Neoplasms of Bone ( II )

• D. Angiogenic
• 1. Angiosarcoma of bone
• E. Myelogenic
• 1. Myeloma of bone
• 2. Ewings sarcoma
• 3. Hodgkins lymphoma of bone
• 4. Non-Hodgkins lymphoma
• 5. Skeletal reticuloses
• 6. Leukemia
• F. Uncertain origin
• 1. Giant cell tumor of bone

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General Consideration

• Incidence
• Diagnosis
• Clinical Features
• Diagnostic Imaging
• Laboratory Investigation
• Biopsy

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Diagnosis of Bone Tumor

• Clinical Features

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Diagnosis of Bone Tumor

• Diagnostic Imaging
• Plain Radiography
• Plain ( conventional ) Tomography
• Computed Tomography ( CT )
• Scintigraphy ( Bone Scan )

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Diagnosis of Bone Tumor

• Laboratory Investigations
• Complete blood count ( CBC )
• Erythrocyte sedimentation rate ( ESR )
• Serum calcium
• Serum phosphorus
• Serum alkaline phosphatase
• Serum acid phosphatase
• Prostatic specific antigen ( PSA )
• Serum protein electrophoresis
• Urinary Bence-Jones protein

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Treatment of Bone Tumor

• Surgical Procedures
• Chemotherapy
• Radiotherapy

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Disorders of Epiphyses and Epiphyseal Growth

• Idiopathic Avascular Necrosis of Epiphyses
• ( The Osteochondroses )

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Pathogenesis and Pathology of the Osteochondroses

• Early Phase of Necrosis ( The phase of
  Avascularity )
• Phase of Revascularization with Bone Deposition
  and Resorption
• Phase of Bone Healing
• Phase of Residual Deformity

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Osteochondrosis of the Femoral Head
(Legg-Perthes Disease)

• Clinical Features
• Diagnosis
• Treatment

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Osteochondrosis of the Capitellum (Panners
Disease)
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Osteochondrosis of a Metatarsal Head(Freibergs
Disease)
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Osteochondrosis of Secondary Centers of
Ossification in the Spine(Scheuermanns Disease)
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Osteochondrosis of the Tarsal Navicular(Kohlers
Disease)
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Osteochondrosis of the Lunate(Kienbocks Disease)
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Osteochondrosis of a Primary Center of
Ossification in the Spine(Calves Disease)
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