Fractures in Children: Is conservative treatment still alive?
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Pediatric traumatology represent the first cause of death in chidren. It is also the first cause of inability And also the first reason of hospital stay
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Fractures in Children: Is conservative treatment still alive?
- 1. R.ELBAUM ORTHOPEDIE PEDIATRIQUE CHIREC ORTHOPAEDIC GROUP HOPITAL ERASME
- 2. • Pediatric traumatology represent the first cause of death in chidren. • It is also the first cause of inability • And also the first reason of hospital stay • Risk of fracrure between 0 et 16Y: • M:45% F:27% • Wrist fracture represent 20 to 35 % of all child’s fractures • Rapport mondial sur la prévention des traumatismes chez l’enfant. OMS 2008 • J. Cottalorda ,B. De Billy ,P. Chrestian: Fracture chez l’enfant . Cours Univ Paris 5 • Jones IE,Williams SM, Dow N et al. How many children remain fracture-free during growth • Khosla S, Melton LJ, Dekutoski MB et al. Incidence of childhood distal forearm fractures • over 30 years. JAMA 2003;290:1479-85.
- 4. • Pediatric bone is more moddeled and elastic but less resistant than adult • Ligaments are more resistant. • Epiphyseal fractures are more frequent than sprain and dislocation. • The remodeling capacity depends on the patient age ,the distance to the physis and the location of the fracture...
- 7. *Rapport mondial sur la prévention des traumatismes chez l’enfant. OMS 2008 Source: European Home and Leisure Accident Surveillance System – EHLASS Belgium, 1999.
- 8. General Practice Pediatrician Intern student Resident General surgeon Adult orthopedics surgeon And… Pediatrics orthopedics surgeon
- 10. Walter Putnam Blount William andWilkins 1955
- 14. General or local anesthesia (MEOPA) in case of reduction
- 17. P.CHRESTIAN
- 18. P.CHRESTIAN
- 19. P.CHRESTIAN
- 23. Méthode de BLOUNT Type 2 Type 1
- 26. J.M. Clavert
- 27. Early complication VOLKMANN SYNDROM
- 32. GREENSTICK # • Rupture of the convex cortex • Intact concave cortex
- 37. P.CHRESTIAN
- 42. Remodeling After Femoral Shaft Fractures in ChildrenTreated by the Modified Blount Method Malkawi and coll JPO 1986 One hundred forty-one children with femoral shaft fractures in the 1- 12-year age range were treated by simple skin traction without spica cast immobilization. All fractures united in an average traction period of 28 days. • Distraction should be avoided, and overriding of up to 15 mm can be compensated for by growth acceleration. • Initial angular deformities of up to 20[degrees] in the coronal plane and up to 30[degrees] in the sagittal plane will end in a satisfactory outcome. • Rotational deformity was not a problem following this method of treatment
- 43. Frequent in toddler Spiroidal « Fracture en cheveu » Metaphyseal fracture and valgus deformity Conservative treatment Rarely surgical reduction
- 47. Obstetrical fracture Clavicle Forearm under 8y (if not open) Physeal wrist # SPC (type 1 or 2) Femoral shaft < 5/6y (if not open) DiaphysealTibial # (if not open) …
- 48. Open # Displaced elbow # (specially lat condyle) Femoral neck Femoral shaft after 8y Pelvic displaced # Physeal knee or ankle # > 12Y …
- 49. You have to know your competence. You have to know the anatomy of the growing child. You have to know the specificity of the growing bone. You have to know the consequence of what you will do. You are facing a long term follow up.