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Trauma Pediatric - part 9

Gãy là không ổn định và thường đòi hỏi phải ghim phiên bản trong. Tỷ lệ tăng trưởng bị bắt sau khi những thương tích này physeal là lên đến 40%. Các mô hình vết nứt thường là một Salter-Harris loại II. Type II thương tích trong các xương khác có một tỷ lệ thấp bị bắt giữ tăng trưởng. | Pediatric Orthopedic Trauma 343 Figure 20 Displaced intra-articular fractures require accurate open reduction and internal fixation to minimize the risk of growth abnormalities and osteoarthrosis. uncommon. The fracture is unstable and often requires pinning. The incidence of growth arrest after these physeal injuries is up to 40 . The fracture pattern is usually a Salter-Harris type II. Type II injuries in other bones have a low incidence of growth arrest. The high rates seen around the knee are due to the particular anatomy of those physes. Deep undulations confer stability to these growth plates. A large force is needed to rupture them and the subsequent fracture plane affects all layers of the physis including the germinal cells. Complete or partial arrests result Fig. 22 . Fractures of the shaft of the femur are now increasingly managed operatively. For children under six years a closed reduction and application of a spica cast with or without preliminary traction is recommended 85 . It is important to be aware that over 50 of femoral shaft fractures occurring in non-ambulatory children are due to abuse. Children between 6 and 10 years can be managed in the same way but flexible nails also give good results without the difficulties of plaster 86 . External fixation can be used for open or comminuted fractures and plating is still used in some situations Figs. 23 and 24 . As children approach skeletal maturity rigid nails that are inserted through the greater trochanter can be used with low risk of clinically significant trochanteric growth arrest 87 . There is a significant risk of avascular necrosis of the femoral head if the nail is inserted through the piriformis fossa of the skeletally immature. Even with a trochanteric entry point avascular necrosis has been reported 88 89 . Femoral neck fractures are rare but associated with high complication rates due to avascular necrosis. To minimize this risk urgent reduction and internal fixation are usually .