shalter chap 16
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Clavicle The slender newborn clavicle: MOST susceptible to
fracture during delivery, particularly in abroadshouldered baby.
Infants tends not to move the aected limb duringst wee!.
"racture unites with remar!able rapidity.
#allus becoming apparent both cinically $radiographically: % wee!s
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Sling as simple protection is the onlytreatment re-uired.
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Humerus
*umeral shaft: issusceptible to a birthfracture during a di cultbreech delivery.
#omplete fracture in heshaft $ fre-uentlyassociated with a radialnerve in/ury.
"ractured arm is obviously
0oppy.Infant1s arm should be
bandaged to the chest for 2wee!s 33 clinically united.
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Humerus
Mild residual angulatory deformities improve withsubse-uent growth, but rotational deformities arepermanent.
)arely pro4imal humeral epiphysis is separated by abirth in/ury.
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Femur
(irth fracture of femur 33 MOST occur duringdelivery of a baby who has presented as a fran!breech.
sually in the midshaft.Overhead s!in traction on both lower limbs provide
ade-uate alignment of the fracture 33 clinicallyunited 5 wee!s.
+lternative treatment: hip spica cast for a full term
baby6 a palvi! harness for a tiny premature baby.
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Femur
Traumatic separation ofthe distal femoralepiphysis 33 di cult to
recogni
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Femur
(eing type I epiphyseal plate in/ury in an epiphysisthat has a good blood supply, the prognosis forsubse-uent growth is e4cellent 33 a long leg cast is
a reasonable alternative. Traumatic separation of the pro4imal femoral
epiphysis is di cult to dierentiate clinically fromdislocation of the hip.
Treatment consists of immobili
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The hand
&halangeal fractures must be
accurately reduce to avoid a
persistent angulatory deformity.
)otational deformity in a =nger should
also be corrected, beacuse it seriouslyimpairs function of the hand.
'ither angulatory6rotational malunion
of a pro4imal phalan4 will cause that=nger to cross over its neighbor when
the = ngers are completely 0 e4ed.8isplaced intra articular fractures of
=nger /oints merit O)I" with =ne
!irschner wire to restore a perfect
/oint surface.
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The hand
Metacarpohalangeal dislocationof the thumb is common inchildren 33 as result of ahypere4tension in/ury.
The = rst metacarpal headescapes through a small tear inthe /int capsule that then tendsto rip the narrow nec! ofmetacarpal and act as a>buttonhole? 33 it1s di cult to
reduce by close manipulation.)e-uires open reduction 33 then
immobili
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The hand
(o4er1s fracture 33 a fracture of the nec! of themobille @th metacarpal 33 responds well to closedreduction 33 pressure along the a4is of the pro4imal
palan4 with the metacarpophalangeal /oint 0e4ed to aright angle 33 immobli
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The wrist and forearm
I t is common in children 33fre-uent falls in which the forcesare transmited from the hand tothe radius and ulna.
Distal radial epiphsis
+ type I I fracture separation ofdistal radial epiphysis.
May be accompanied by agreenstic! fracture of the ulna.
This fracture separation resultsfrom a forced hypere4tension andsupination in/ury, it can bereduced by a combination of0e4ion$pronation.
I t should be immobil i
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The wrist and forearm
Distal 3rd of radius andulna: incomplete fractures.
MOST fre-uent fracture in this
region 33 (uc!le fracture.
S&'#I"I# ")+#T)' $ 8IS;O#+TIO
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The wrist and forearm
Distal 3rd of radius and ulna:incomplete fractures .
Breenstic! fracture of the distalmetaphyseal region of the radiusand ulna 33 re-uire closedreduction by manipulation if theangulation is signi=cant.
The angulation is graduallycorrected to the point where the
remaining intact part of thecorte4 is heard and felt to crac!through, but not becomedisplaced.
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The wrist and forearm
Distal 3rd of radius andulna: complete fractures.
Chen radius alone is
fractured, the in/ury hasbeen one of supination
)eduction is more stablewith the forearm in theneutral position.
In either case a well molded,above elbow plaster cast isre-uires D wee!s.
S&'#I"I# ")+#T)' $ 8IS;O#+TIO
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The wrist and forearm
Middle 3rd of radius andulna
Breenstic! fracture: This
fracture reduced by closedmanipulation.
&rovide the aforementionedpractice of crac!ing throuhthe remaining intact pasrt of
the corte4 is used.
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The wrist and forearm
Middle 3rd of radius and ulna
8isplaced fracture: is unstable 33 may be di=cultto reduce 33 how much of the deformity is due
to angulation and how much to rotation often isbetter assesed by loo!ing at the child1s forearmstham ny loo!ing radiographs.
Immobili
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The wrist and forearm
Middle 3rd of radiusand ulna
nstable fracture of bothbones of the forearm
should be e4amineradigrhaphically each
wee! at least A wee!s todetect ay deterioration inthe position of thefragments.
If angulation recurs duringthe period ofimmobili
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The wrist andforearm
Middle 3rd of radiusand ulna
"ractures of bothbones of the forearmin children may bedi cult to treat 33some of avoidable
pitfalls of treatment.
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The wrist and forearm
proximal 3rd of radius andulna
Montegia fractureFdiislocaion
33 important because thedislocation component is sofre-uently unrecogni
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The wrist and forearm
proximal 3rd of radius andulna
In children 33 closed reduction
of a monteggia fracturedislocation 33 correcting theangulation of the ulnar fractureImmobili
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The elbow dan the arm
Pulled elbow
#hildren of preschool age arevulnerable to a sudden
longitudinal pull on their arms. It occur while lifting the small
child up a step by pulling awayfrom potential danger.
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The elbow dan the arm
Pulled elbow
+ sudden pull on the e4tendedelbow while forearm is
pronated produces a tear indistal attachment of theannular ligament to the radialnec!.
S&'#I"I# ")+#T)' $ 8IS;O#+TIO
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The elbow dan the arm
Pulled elbow
Treatment: deft supination of child1s forearm whilethe elbow is 0e4ed. + slight >clic!? can usually be
felt over the anterolateral aspect of the radial headas the annular ligament is freed from /oint.
+fter treatment consist of a sling for 2 wee!s toallow the tear in the distal attachment of the anularligament to heal.
S&'#I"I# ")+#T)' $ 8IS;O#+TIO
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The elbow dan the arm
Proximal radial epiphsis
"racture separation of thepro4imal radial epiphysis is
produced by a fall thate4erts a compression andabduction force on theelbow /oint.
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The elbow dan the arm
Proximal radial epiphsis
Treatment: satisfactory closed reduction can usuallybe obtained by pressing upward and medially on the
tilted radial head while an assistant holds the armwith the elbow e4tended and adducted.
+fter closed reduction 33 immobili