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SPECIFIC BIRTH FRACTURE

Clavicle
The slender newborn clavicle: MOST susceptible to
fracture during delivery, particularly in abroad
shouldered baby.
Infants tends not to move the aff ected limb during
1st week.
Fracture unites with remarkable rapidity.
Callus
becoming
apparent
both
cinically
&
radiographically: 10 weeks
Sling as simple protection is the only
treatment required.

SPEC IFIC BIRT H FRAC TUR E

Humerus
Humeral
shaft:
is
susceptible
to
a
birth
fracture during a diffi cult
breech delivery.
Complete fracture in he
shaft
&
frequently
associated with a radial
nerve injury.
Fractured arm is obviously
fl oppy.
Infants
arm
should
be
bandaged to the chest for 2
weeks >> clinically united.

SPECIFIC BIRTH FRACTURE


Humerus
Mild residual angulatory deformities improve with
subsequent growth, but rotational deformities are
permanent.
Rarely proximal humeral epiphysis is separated by a
birth injury.

SPECIFIC BIRTH FRACTURE


Femur
Birth fracture of femur >> MOST occur during
delivery of a baby who has presented as a frank
breech.
Usually in the midshaft.
Overhead skin traction on both lower limbs provide
adequate alignment of the fracture
>> clinically
united 3 weeks.
Alternative treatment: hip spica cast for a full term
baby/ a palvik harness for a tiny premature baby.

OVERHEAD SKIN TRACTION

PAVLIK HARNESS

SPECIFIC BIRTH FRACTURE


Femur
Traumatic separation of
the
distal
femoral
epiphysis >> diffi cult to
recognize clinically. Until
knee becomes enlarged
by extensive new bone
formation >> it can be
detected.
Overhead skin traction
is
required
for
10 days.

SPECIFIC BIRTH FRACTURE


Femur
Being type I epiphyseal plate injury in an epiphysis
that has a good blood supply, the prognosis for
subsequent growth is excellent >> a long leg cast is
a reasonable alternative.
Traumatic separation of the proximal femoral
epiphysis is diffi cult to diff erentiate clinically from
dislocation of the hip.
Treatment consists of immobilization of the hip in
abduction and fl exion in a spica cast >> 2 weeks.

SPECIFIC FRACTURE & DISLOCATION


The hand
Phalangeal
fractures
must
be
accurately
reduce
to
avoid
a
persistent angulatory deformity.
Rotational deformity in a fi nger should
also be corrected, beacuse it seriously
impairs function of the hand.
Either angulatory/rotational malunion
of a proximal phalanx will cause that
fi nger to cross over its neighbor when
the fi ngers are completely fl exed.
Displaced intra articular fractures of
fi nger joints merit ORIF with fi ne
kirschner wire to restore a perfect
joint surface.

SPECIFIC FRACTURE & DISLOCATION


The hand
Metacarpohalangeal
dislocation
of the th umb is common in
children >> as res ult of a
hyperextension injury.
Th e
fi rst
metacarpal
head
escapes through a small tear in
the jint capsule that then tends
to
rip
th e
narrow
neck
of
metacarpal
an d
act
as
a
buttonh ole >> its diffi cult to
reduce by close man ipulation.
Requires open reduction >> th en
immobilization of the joint in the
stable
pos ition
of
moderate
fl exion >> 3 weeks

SPECIFIC FRACTURE & DISLOCATION


The hand
Boxers fracture >> a fracture of the neck of the
mobille 5th metacarpal >> responds well to closed
reduction >> pressure along the axis of the proximal
palanx with the metacarpophalangeal joint fl exed to a
right angle >> immoblization for 4 weeks wit the
fi nger in moderate fl exion.

SPECIFIC FRACTURE & DISLOCATION


The wri st and forearm
It is commo n in c hildren >>
frequent falls in w hic h t he fo rc es
are t ransmit ed from t he hand t o
the radius and ulna.
Distal radial epi phsis
A t yp e II fracture sepa rat io n of
dist al radial epiphysis.
May
be
accom panied
by
a
greenst ick fr acture of t he ulna .
This fract ure separa tion result s
fro m a fo rced hyperexten sion and
su pination
injury,
it
can
be
reduced by a co m bina tion of
fl exio n&pron at io n.
It should be im mobiliza tion in an
above
elb ow
cast
w it h
t he
forearm in pronat io n > 3 w eek s

SPECIFIC FRACTURE & DISLOCATION


The wrist and forearm
Distal 3rd of radius and
ulna: incomplete fractures.
MOST frequent fracture in this
region >> Buckle fracture.

SPECIFIC FRACTURE & DISLOCATION


The wrist and forearm
Distal 3rd of radius and ulna:
incomplete fractures .
Greenstick fracture of the distal
metaphyseal region of the radius
and ulna >> require closed
reduction by manipulation if the
angulation is signifi cant.
The
angulation
is
gradually
corrected to the point where the
remaining intact part of the
cortex is heard and felt to crack
through,
but
not
become
displaced.

SPECIFIC FRACTURE & DISLOCATION


The wrist and forearm
Distal 3rd of radius and
ulna: complete fractures.
When
radius
alone
is
fractured, the injury has
been one of supination
Reduction is more stable
with the forearm in the
neutral position.
In either case a well molded,
above elbow plaster cast is
requires 6 weeks.

SPECIFIC FRACTURE & DISLOCATION


The wrist and forearm
Middle 3rd of radius and
ulna
Greenstick
fracture:
This
fracture reduced by closed
manipulation.
Provide the aforementioned
practice of cracking throuh
the remaining intact pasrt of
the cortex is used.

SPECIFIC FRACTURE & DISLOCATION


The wrist and forearm
Middle 3rd of radius and ulna
Displaced fracture: is unstable >> may be difi cult
to reduce >> how much of the deformity is due
to angulation and how much to rotation often is
better assesed by looking at the childs forearms
tham ny looking radiographs.
Immobilization in a well molded, above elbow
cast with the forearm in the most stable position
should be maintained > 8 weeks.

SPECIFIC FRACTURE & DISLOCATION


The wrist and forearm
Middle 3rd of radius
and ulna
Unstable fracture of both
bones
of
the
forearm
should
be
examine
radigrhaphically
each
week at least 4 weeks to
detect ay deterioration in
the
position
of
the
fragments.
If angulation recurs during
the
period
of
immobilization
>>
remaipulaton >> 2 weeks
after injury.

The
wrist
and
forearm
Middle 3rd of radius
and ulna
Fractures
of
both
bones of the forearm
in children may be
diffi cult to treat >>
some
of
avoidable
pitfalls of treatment.

SPECIFIC FRACTURE & DISLOCATION


The wrist and forearm
proximal 3rd of radius and
ulna
Montegia
fracture-diislocaion
>>
important
because
the
dislocation component is so
frequently unrecognized and
consequently
remains
untreated.

SPECIFIC FRACTURE & DISLOCATION


The wrist and forearm
proximal 3rd of radius and
ulna
In children >> closed reduction
of
a
monteggia
fracture
dislocation >> correcting
the
angulation of the ulnar fracture
Immobilization >> a cast with
the elbow in fl exion > for 6
weeks >> to ensure union of
ulna & maintain the reduction of
radial head.

SPECIFIC FRACTURE & DISLOCATION


The elbow dan the arm
Pulled elbow
Children of preschool age are
vulnerable
to
a
sudden
longitudinal pull on their arms.
It occur while lifting the small
child up a step by pulling away
from potential danger.

SPECIFIC FRACTURE & DISLOCATION


The elbow dan the arm
Pulled elbow
A sudden pull on the extended
elbow
while
forearm
is
pronated produces a tear in
distal
attachment
of
the
annular ligament to the radial
neck.

SPECIFIC FRACTURE & DISLOCATION


The elbow dan the arm
Pulled elbow
Treatment: deft supination of childs forearm while
the elbow is fl exed. A slight click can usually be
felt over the anterolateral aspect of the radial head
as the annular ligament is freed from joint.
After treatment consist of a sling for 2 weeks to
allow the tear in the distal attachment of the anular
ligament to heal.

SPECIFIC FRACTURE & DISLOCATION


The elbow dan the arm
Proximal radial epiphysis
Fracture separation of the
proximal radial epiphysis is
produced by a fall that
exerts a compression and
abduction
force
on
the
elbow joint.

SPECIFIC FRACTURE & DISLOCATION


The elbow dan the arm
Proximal radial epiphysis
Treatment: satisfactory closed reduction can usually
be obtained by pressing upward and medially on the
tilted radial head while an assistant holds the arm
with the elbow extended and adducted.
After closed reduction >> immobilized 3 weeks at the
right angle with the forearm supinated.