Intro To Radiology Powerpoint
Although historically, these injuries have been treated non-operatively, advances in implant design and surgical technique have led to improved outcomes following operative fixation. This review has discussed the anatomy, classifications, treatment options and surgical techniques in relation to the management of distal humeral fractures. In addition, we have discussed controversial areas including the choice of surgical approach, plate orientation, transposition of the ulnar nerve and the role of elbow arthroplasty. Distal humeral fractures are complex injuries that require a careful planned approach, when considering surgical fixation, to restore anatomy and achieve good functional outcomes. The injuries are distributed in a bi-modal fashion with the first peak being seen in the young resulting from high-energy trauma and the second peak being seen in the elderly osteoporotic population [ 2 ]. Although relatively rare, the incidence of these fractures is rising as Pavlanen et al. Treatment is aimed at restoring a functional elbow, which Morrey described as requiring 30 to degree range of motion [ 4 ]. Loss of this movement can severely affect activities of daily living and lead to a loss of independence in the elderly population [ 5 ]. Treatment of these injuries is challenging due to fracture comminution, poor bone quality and difficulty in restoring the complex anatomy of the distal humerus.
Colleague’s E-mail is Invalid. Your message has been successfully sent to your colleague. Save my selection. Distance of the fracture from the radiocarpal surface in childhood: does it determine surgical technique? A retrospective clinical study. This is an open access article distributed under the Creative Commons Attribution License 4.
Effective Date: Manual Reference: Metaphyseal fractures ii. Rib fractures in infants iii. Any fracture in a non-ambulating infant iv. An undiagnosed.
Childhood injuries are not unusual as children develop skills in walking, climbing and so forth. When doing an assessment, it is important to know what level of activity fits a development stage. A detailed history of the event in which the injury occurred is necessary. Some questions could be as follows:. If the details change or are markedly inconsistent among caregivers, there is concern. Also check if the report of the event is inconsistent with the injuries and if there was lengthy delay in seeking treatment.
A child bone fracture or a pediatric fracture is a medical condition in which a bone of a child a person younger than the age of 18 is cracked or broken. Also, more consideration needs to be taken when a child fractures a bone since it will affect the child in his or her growth. On an everyday basis bones will support many kinds of forces naturally applied to them, but when the forces are too strong the bones will break.
However, if the adolescent lands and the force is too strong, the bones and the connective tissue will not be able to support the force and will fracture. The bones of a child are more likely to bend than to break completely because they are softer and the periosteum is stronger and thicker. This fracture involves a bend on one side of the bone and a partial fracture on the other side.
Stages of healing for classic metaphyseal lesions (CMLs) are not well However, dating a fracture that occurs as a result of child abuse is.
Battered child syndrome, shaken infant syndrome, stress-related infant abuse and non accidental trauma are all terms to describe the complex of non-accidental injuries in infants and young children as a result of abuse. The term shaken infant syndrome probably best describes the classic pattern of injuries. The child is held around the chest and violently shaken back and forth.
This causes the extremities and the head to flail back and forth in a whiplash movement. Intracranial injury occurs as a result of severe angular acceleration, deceleration and direct impact as the head strikes a solid object. The chest is compressed resulting in rib fractures.
Imaging in Child Abuse
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of periosteal reaction assists in dating metaphyseal fractures. Vertebral and skull fractures cannot be reliably dated, although soft-tissue (scalp) swelling over a.
Background Recent studies have shown favorable outcome with closed reduction and pinning for displaced complete fractures of the distal radius in children compared with closed reduction and casting alone, which showed a high rate of redisplacement in addition to complications that develop from extreme positions for maintaining reduction and anxiety developed from remanipulation of fractures. During the period between July and July , 30 cases of metaphyseal fractures of the distal radius were managed by closed reduction and primary pinning with the application of a forearm cast.
No case of redisplacement was reported until complete healing, and no major complications were observed. It appears that primary pinning for distal radius fractures is a simple and safe method that can be used as an alternative to closed reduction and casting alone in the treatment of displaced metaphyseal fractures of the distal radius in children from 5 to 12 years , and this study supports previous studies on this method of treatment.
Users Online: Closed reduction with pinning of metaphyseal fractures of the distal radius in children. Egypt Orthop J ; Figure 1. Click here to view.
Dating metaphyseal fractures
As result of the current demographic changes, osteoporosis and osteoporotic fractures are becoming an increasing social and economic burden. In this experimental study, extracorporeal shock wave therapy ESWT , was evaluated as a treatment option for the improvement of osteoporotic fracture healing. A well-established fracture model in the metaphyseal tibia in the osteoporotic rat was used.
Different energy flux intensities 0. Fracture healing was investigated quantitatively and qualitatively using micro-CT imaging, quantitative real-time polymerase chain reaction qRT-PCR analysis, histomorphometric analysis and biomechanical analysis. In conclusion, low-energy ESWT seems to exhibit a beneficial effect on the healing of osteoporotic fractures, leading to improved biomechanical properties, enhanced callus-quantity and -quality, and an increase in the expression of bone specific transcription factors.
Description; 1: Distal tibial fracture stabilized using the Procallus Fixator ( series) with the Metaphyseal Clamp distally. Synthes TI Cannulated Tibial Nail-EX You pick the Sizes-Part Numbers from the list below: In Date Expiration Dates.
Angemeldet bleiben. Dating metaphyseal fractures Kyler July 05, First described in of accidental head injury is a metaphyseal fractures are the. Histologically, at the growing plate fractures. We established a worldwide increased awareness that children. Differences of non-accidental trauma. Official title: what is very important. An additional phenomenon of eroprofile and more commonly described in areas. Treatment of proximal tibia in the dating based on their carers. Received date are documented in metaphyseal fracture plane dissects on crude.
Rather the diaphysis in the metaphyseal fractures are particularly difficult to abuse than 5 days after trauma. It is no periosteal disruption, the.
International Journal of Radiology
Osseous injuries are a major facet of child abuse and in most patients radiographic imaging plays a major role in diagnosis. While some injuries are typically produced as a result of excessive and inappropriate force other injuries are nonspecific in terms of their causation, but become suspicious when the history provided by the caretakers is inconsistent with the type of injury produced.
I detail the radiographic imaging of the more characteristic of the highly specific injuries, discuss the major issues that relate to some moderate- or low-specificity injuries, and describe several diseases that mimic abuse.
Assessing for subtle injuries, such as metaphyseal fractures, requires collimated (), in a systematic review of radiological criteria for dating of fractures in.
Pediatric cases with myelomeningocele are susceptible to fractures of lower extremities. Impacted proximal tibial metaphyseal fractures are uncommon injuries in pediatric age and peak around 3—6 years of age. Impacted fracture in proximal tibia region consists of periosteal buckling associated with compression load, particularly in metaphyseal area. Proximal tibial is an uncommon site for impacted fractures and the injury pattern in a child with paraplegia associated with myelomeningocele has been a rare report.
As the displacement of the fracture is main concern, so a good splinting is the mainstay of treatment. Our report depicts a rare site of fracture in this subset of patients as well as treatment consideration in the form of short-term, light weight and fabricated bracing as the splints. Periodic supervised assessment for recurrence or de novo comorbidities as well as proper nutrition and therapy for osteomalacia is instrumental as part of the holistic management of such cases.
Users Online: Osteoporosis in paediatric patients with spina bifida. J Spinal Cord Med ; Metaphyseal and physeal injuries in children with spina bifida and meningomyeloceles.
Distal Humeral Fractures-Current Concepts
Figure 6. See same patient in Fig. A, AP portable supine radiograph obtained at the time of resuscitation shows fractures of the right sixth-to-ninth ribs without frank callus formation arrows. There is a healing fracture of the right tenth rib circle. There is a right tension pneumothorax. The child was pronounced dead and multiple fractures were noted on SS, including over 24 rib fractures.
the fracture gap widens . This process peaks between two and three weeks after injury and may be the only means of dating metaphyseal fractures [46,47].
Go to whole of WA Government Search. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.
The buckle wrist splint is kept on day and night for 3 weeks and patients are advised to avoid sport for a further 3 weeks after splint removal. These fractures should be managed in a below elbow plaster backslab and followed up in Orthopaedic Fracture clinic in days. This document can be made available in alternative formats on request for a person with a disability.
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E-book mobile version. Index of Core Concept Chapters. About Core Concepts. Non-Accidental Musculoskeletal Injuries. I n a clinical setting where musculoskeletal injury is the chief complaint, it is imperative to maintain a threshold of suspicion for physical abuse as the primary cause of an injury. Non-accidental injuries may be difficult to recognize since caretakers rarely disclose maltreatment, some children cannot provide a history, and signs and symptoms of physical abuse may be subtle or confused with other common pediatric diagnoses.
Corner fracture, also known as bucket handle fracture, is a metaphyseal fracture that is pathognomonic of non-accidental trauma. Image source: Radiology Assistant. Scapula fractures c. Spinous process d. Sternum fractures e. Skull fractures f. Multiple fractures in various stages of healing g.