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Pediatric Just The Facts - part 9

Phẫu thuật tình trạng khẩn cấp mở gãy xương • Thông thường liên quan với chấn thương và chấn thương nhiều năng lượng cao. • Phân loại theo Gustillo và Anderson (1976), theo vết thương kích thước và mức độ của sự tham gia của mô mềm: 1. Loại I: Vết thương 1 cm, trung bình chấn thương mô mềm. | 508 SECTION 18 DISEASES OF THE BONE AND JOINTS reduced position. Close monitoring of position is required to assure proper harness position. Improper use is associated with nerve problems and avascular necrosis of hips. Reference Guille J Pizzutillo P MacEwen G Developmental dysplasia of the hip from birth to six months. J Am Acad Orthop Surg 2000 8 232-242. 152 FRACTURES Denise T. Ibrahim and John F. Sarwark SALTER-HARRIS CLASSIFICATION Of physeal fractures Type I Injury occurring through the physis i.e. growth plate does not extend into the metaphysis or epiphysis. Type II Injury extends along the physis and exits through the metaphysis. Type III Injury extends along the physis and exits through the epiphysis these may also be intraarticular. Type IV Injury extending from the metaphysis across the physis and into the epiphysis usually intraarticular. Type V Crushing injury to the physis from a compression force Fig. 152-1 . Descriptive terminology 1. Torus buckle fracture mild fracture with plastic deformation of one or both cortices minimal displacement. 2. Greenstick fracture cortex under tension fractures completely and the compression side undergoes plastic deformity and remains intact. 3. Physeal growth plate injuries describe using Salter-Harris classification see above . SURGICAL EMERGENCIES Open Fractures Often associated with high-energy trauma and multiple injuries. Classified by Gustillo and Anderson 1976 according to wound size and extent of soft tissue involvement 1. Type I Wound 1cm minimal soft tissue injury. 2. Type II Wound 1 cm moderate soft tissue injury. 3. Type III Extensive soft tissue injury with possible neurovascular injury and severe wound contamination. Management 1. Advanced trauma life support ATLS primary survey first. 2. Immediate IV antibiotics First generation cephalosporin for type I add aminoglycoside for types II and III if barnyard involved add penicillin or metronidazole. 3. Tetanus prophylaxis. 4. Assess .