Young Bones. Characteristics. Klaus Hindsø
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1 Young Bones Characteristics Klaus Hindsø
2 What s so special Periostium Elasticity Growth
3 The envelope Periostium Elasticity Growth Connects displaced fragments building a bridge during healing Interposed between fragments makes the reposition difficult
4 The envelope Periostium Elasticity Growth
5 Compliance Periostium Elasticity Growth Stable fractures Tendency to underestimate force/trauma. Pelvic/costal/vertebral fractures
6 Compliance Periostium Elasticity Growth Torus fracture Green stick
7 Compliance Periostium Elasticity Growth
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9 Friend or foe Periostium Elasticity Growth Some deformities improve by growth Some deformities worsen by growth
10 No screws crossing growth plate Final surgery within few days
11 Articular surface has priority over growth plate
12 Progressive deformity by growth early intervention
13 A deformity can be corrected joint surface can not
14 Invisibility
15 Invisibility Total physiolysis of distal humerus
16 Characteristics of childrens bones Periosteum can heal the bone despite severe dislocation Bowing fractures is difficult to diagnose and difficult to treat. Injury to the growth plate gives progressive deformity. Joint surface, however, has the highest priority.
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20 Fraktur af radiale condyle - operation NO dissection posterior to the condyle - vascular supply Direct inspection Two diverging K-wire from the lateral side.
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26 JAKOB s CLASSIFICATION (JBJS 1975) Jakob et al (1975) Reproduced #s in a cadaveric study Presence/absence of medial cartilage hinge is the key prognostic factor Best way to identify hinge I. Nondisplaced < 2 mm gap II. Minimally displaced 2-4 mm III. Displaced > 4 mm (complication Stage 3 >>> Stage 2 >Stage 1) et al 2009 Weiss In your experience how effective is this classification in determining management prospectively?
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32 Lateral condyle Intraarticular fractures heal slowly K-wires cut under the skin allows for early mobilisation Risk of pseudarthrosis and fish-tail-deformity
33 Fracture of the lateral condyle: Intraarticular fracture NO deformity accepted Open reduction with direct inspection of the joint surface Long time to heal, and risk of pseudarthrosis.
34 Case 9 12-year-old boy, fall from tree, painful swollen elbow What are your thoughts about this injury?
35 Case10 9-year-old boy fell whilst running in playground What are your thoughts about this fracture?
36 Case10 9-year-old boy fell whilst running in playground Classification 22u D /6.1 21r M/3.1 III
37 Case10 9-year-old boy fell whilst running in playground How would you treat this?
38 Technique
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40 Case10 9-year-old boy fell whilst running in playground This is what was done
41 Case10 9-year-old boy fell whilst running in playground This is what was done Previous position
42 Case10 9-year-old boy fell whilst running in playground This is what was done
43 Case10 9-year-old boy fell whilst running in playground
44 Case10 9-year-old boy fell whilst running in playground What was done
45 Case 2 12-year-old girl, Traffic accident; swollen, painful right hip, no other injuries What are your thoughts about this fracture?
46 Case 2 12-year-old girl, Traffic accident; swollen, painful right hip, no other injuries Classification 31 M/3.1 I
47 Case 2 12-year-old girl, Traffic accident; swollen, painful right hip, no other injuries How would you treat this?
48 Case 2 12-year-old girl, Traffic accident; swollen, painful right hip, no other injuries Treatment? Non operative? // operative? If operative, then how? àclosed // open reduction? à which implant?
49 Case 2 12-year-old girl, Traffic accident; swollen, painful right hip, no other injuries This is what was done
50 Case 2 12-year-old girl, Traffic accident; swollen, painful right hip, no other injuries This is what was happen
51 Case 2 12-year-old girl, Traffic accident; swollen, painful right hip, no other injuries Right leg in neutral position; Clinically decreasing abduction, no rotation, flexion up to 40
52 Case 2 12-year-old girl, Traffic accident; swollen, painful right hip, no other injuries 16 months after injury
53 Case 2 12-year-old girl, Traffic accident; swollen, painful right hip, no other injuries Treatment options? - Wait and see; later total hip? - initial total hip? - surgical hip dislocation and head reshaping? - intertrochanteric OT?
54 Case 3 15-year-old girl, car accident, no other injuries, neuro-vascular o.k. What are your thoughts about this fracture?
55 Case 3 15-year-old girl, car accident, no other injuries, neuro-vascular o.k. Classification Oblique femoral shaft fracture (32 D/5.1)
56 Case 3 15-year-old girl, car accident, no other injuries, neuro-vascular o.k. How would you treat this?
57 Case 3 15-year-old girl, car accident, no other injuries, neuro-vascular o.k. Treatment? Operative / conservative? Operative - Plate? - ExFix? - solid nail (ALFN)? - ESIN? - MIPO
58 Case 3 15-year-old girl, car accident, no other injuries, neuro-vascular o.k. This is what was done In a first step: X-ray of the other side! How would you treat this now?
59 Case 3 15-year-old girl, car accident, no other injuries, neuro-vascular o.k. This is what was done
60 Case 3 15-year-old girl, car accident, no other injuries, neuro-vascular o.k.
61 Case 3 15-year-old girl, car accident, no other injuries, neuro-vascular o.k. 4 months after surgery full weight bearing was allowed
62 Case 4 15-year-old boy, closed isolated injury, 70 kg, 1.80 m What are your thoughts about this fracture?
63 Case 4 15-year-old boy, closed isolated injury, 70 kg, 1.80 m Classification transverse femoral shaft fracture (32 D/4.1)
64 Case 4 15-year-old boy, closed isolated injury, 70 kg, 1.80 m How would you treat this?
65 Case 4 15-year-old boy, closed isolated injury, 70 kg, 1.80 m How would you treat this? 1. Conservative 2. ORIF and Plate 3. ExFix 4. ESIN 5. MIPO 6. ALFN
66 Case 4 15-year-old boy, closed isolated injury, 70 kg, 1.80 m This is what was done
67 Case 4 15-year-old boy, closed isolated injury, 70 kg, 1.80 m What is the difference? 3 weeks after surgery Asking when he can return to sport
68 Case 4 15-year-old boy, closed isolated injury, 70 kg, 1.80 m 12 weeks after injury No symptoms Normal strength FROM hip & knee Asking to return to sport? Answer?
69 Case 4 2 years later returns with complaint of low back pain. 2.1 cm longer left lower limb (14mm femur + 7mm tibia) Relevant? Other investigations? Diagnostic tests? Treatment?
70 Case year-old boy, ski accident, neuro-vascular o.k.; closed! What are your thoughts about this fracture?
71 Case year-old boy, ski accident, neuro-vascular o.k.; closed! How would you treat this?
72 Case year-old boy, ski accident, neuro-vascular o.k.; closed! How would you treat this? Conservative / operative? ORIF and Plate ExFix Closed reduction MIOP ESIN ESIN and EndCaps
73 Case year-old boy, ski accident, neuro-vascular o.k.; closed! This is what was done 6 weeks post OP; full weight bearing was allowed
74 Case year-old boy, ski accident, neuro-vascular o.k.; closed! Situation 8 months after nailing
75 Case year-old girl; supination injury during school sport What are your thoughts about this fracture?
76 Case year-old girl; supination injury during school sport Classification?
77 Case year-old girl; supination injury during school sport How would you treat this?
78 Case year-old girl; supination injury during school sport How would you treat this? Operative / conservative Operative: open / closed reduction - cannulated screws - Screws + K-wires - Only K-wires - Others
79 Case year-old girl; supination injury during school sport This is what was done Closed treatment, foot direct on the intensifier
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