TREATMENT OF FRACTURES IN THE SKELETALL Y IMMATURE

TREATMENT OF FRACTURES IN THE SKELETALL Y IMMATURE

The treatment principles that were described for the adult are equally applicable to the child (i.e. reduce, hold, heal, rehabilitate). A major di ff erence to consider is that in extra-articular fractures there is a remodelling potential, which means that increased degrees of deformity may be accepted. Remodelling happens best in the plane of the joint and the closer the injur y rowth plate. Rotational and joint surface remodelling is to the g are poor. Fractures occurring near the site of greatest longi - tudinal growth will remodel the most (e.g. fractures around the distal femur have a greater remodelling potential than the proximal femur). The younger the patient, the greater the remodelling potential. Significant r emodelling essentially ceases when the growth plates have closed. - A further di ff erence is that paediatric fractures heal more rapidly and, as such, do not need to be held as long as in the adult counterpart. Similarly , fixation does not need to be as rigid, as fracture union is more rapid. Growth plate injuries require special mention ( Figure 32.12 ). In general, gro wth plate injuries should be anatomically reduced to minimise the potential for growth disturbance. Howev er, in the process of reducing the fracture, further injury to the growth plate should be avoided. Repeated manipulation of physeal injuries should be avoided. Injury to the perichondral ring and placing metal -

Talus (d) Talus (c, d) Intraoperative views of the reconstruc

avoided. If fixation necessitates crossing the physis, consider limited damage by using the smallest smooth K-wires with a single pass in the middle of the physis if possible. The paediatric periosteum is often thick and very strong; this needs to be considered when reducing the fracture, requir ing an exaggeration of the deformity and pushing the fracture back into place instead of just applying longitudinal traction. The periosteal hinge should be preserv ed as it also allows for better holding of the fracture if it remains intact, as pre viously described ( Figure 32.12 ). Always consider the possibility of non-accidental injury , as discussed in Chapters 26 and 44 . TREATMENT OF FRACTURES IN THE SKELETALL Y IMMATURE

The treatment principles that were described for the adult are equally applicable to the child (i.e. reduce, hold, heal, rehabilitate). A major di ff erence to consider is that in extra-articular fractures there is a remodelling potential, which means that increased degrees of deformity may be accepted. Remodelling happens best in the plane of the joint and the closer the injur y rowth plate. Rotational and joint surface remodelling is to the g are poor. Fractures occurring near the site of greatest longi - tudinal growth will remodel the most (e.g. fractures around the distal femur have a greater remodelling potential than the proximal femur). The younger the patient, the greater the remodelling potential. Significant r emodelling essentially ceases when the growth plates have closed. - A further di ff erence is that paediatric fractures heal more rapidly and, as such, do not need to be held as long as in the adult counterpart. Similarly , fixation does not need to be as rigid, as fracture union is more rapid. Growth plate injuries require special mention ( Figure 32.12 ). In general, gro wth plate injuries should be anatomically reduced to minimise the potential for growth disturbance. Howev er, in the process of reducing the fracture, further injury to the growth plate should be avoided. Repeated manipulation of physeal injuries should be avoided. Injury to the perichondral ring and placing metal -

Talus (d) Talus (c, d) Intraoperative views of the reconstruc

avoided. If fixation necessitates crossing the physis, consider limited damage by using the smallest smooth K-wires with a single pass in the middle of the physis if possible. The paediatric periosteum is often thick and very strong; this needs to be considered when reducing the fracture, requir ing an exaggeration of the deformity and pushing the fracture back into place instead of just applying longitudinal traction. The periosteal hinge should be preserv ed as it also allows for better holding of the fracture if it remains intact, as pre viously described ( Figure 32.12 ). Always consider the possibility of non-accidental injury , as discussed in Chapters 26 and 44 . TREATMENT OF FRACTURES IN THE SKELETALL Y IMMATURE

The treatment principles that were described for the adult are equally applicable to the child (i.e. reduce, hold, heal, rehabilitate). A major di ff erence to consider is that in extra-articular fractures there is a remodelling potential, which means that increased degrees of deformity may be accepted. Remodelling happens best in the plane of the joint and the closer the injur y rowth plate. Rotational and joint surface remodelling is to the g are poor. Fractures occurring near the site of greatest longi - tudinal growth will remodel the most (e.g. fractures around the distal femur have a greater remodelling potential than the proximal femur). The younger the patient, the greater the remodelling potential. Significant r emodelling essentially ceases when the growth plates have closed. - A further di ff erence is that paediatric fractures heal more rapidly and, as such, do not need to be held as long as in the adult counterpart. Similarly , fixation does not need to be as rigid, as fracture union is more rapid. Growth plate injuries require special mention ( Figure 32.12 ). In general, gro wth plate injuries should be anatomically reduced to minimise the potential for growth disturbance. Howev er, in the process of reducing the fracture, further injury to the growth plate should be avoided. Repeated manipulation of physeal injuries should be avoided. Injury to the perichondral ring and placing metal -

Talus (d) Talus (c, d) Intraoperative views of the reconstruc

avoided. If fixation necessitates crossing the physis, consider limited damage by using the smallest smooth K-wires with a single pass in the middle of the physis if possible. The paediatric periosteum is often thick and very strong; this needs to be considered when reducing the fracture, requir ing an exaggeration of the deformity and pushing the fracture back into place instead of just applying longitudinal traction. The periosteal hinge should be preserv ed as it also allows for better holding of the fracture if it remains intact, as pre viously described ( Figure 32.12 ). Always consider the possibility of non-accidental injury , as discussed in Chapters 26 and 44 .