DISTAL FRACTURES OF THE FEMUR NEI BOTTER MONTENEGRO

DISTAL FRACTURES OF THE FEMUR NEI BOTTER MONTENEGRO DISCIPLINA DE ORTOPEDIA PEDIÁTRICA HOSPITAL DAS CLÍNICAS DA FACULDADE DE MEDICINA DA USP

PHYSEAL INJURIES FRACTURES OF THE DISTAL SHAFT

PHYSEAL INJURIES

COMPLICATIONS BONY BRIDGE RESECTION INCIDENCE

ANATOMY A X I A LESS THAN 1% OF CHILDREN’S FRACTURES L

PHYSEAL INJURY PARADOXAL RESISTENCE WIDENESS PLATE SHAPE TRACTION – SOFT TISSUES

MECHANISM OF INJURY ANGULAR FORCE – VARUS, VALGUS SAGITAL – ANTERIOR HIPEREXTENTION YOUNG CHILD – ARTROGRIPOSYS, INFECTION, LEUKEMIA, RICKETS, SCURVY

TREATMENT SALTER – HARRIS TYPE I • YOUNG CHILD • REDUCTION UNDER ANESTHESIA • LONG WELLMOLDED PLASTER CAST

ASSOCIATED NEUROVASCULAR INJURIES

TREATMENT • SMOOTH K-WIRES (2 mm) • 3 WEEKS

TREATMENT SALTER – HARRIS TYPE II • MOST COMMON (2/3) • THURSTON HOLLAND (COMPRESSION) • OVER TEN YEARS

TREATMENT REDUCTION AND CAST SALTER – HARRIS II DISTAL FEMUR VERY UNSTABLE LEE - 1977

TREATMENT REDUCTION (CLOSED / OPEN) - OSTEOSINTHESIS

TREATMENT 9 YEARS OLD GIRL / CLOSED REDUCTION AND PERCUTANEOUS SCREWS

TREATMENT 6 YEARS P. O.

INTRAARTICULAR FRACTURES

SALTER – HARRIS III AND IV INTRAARTICULAR: • DISPLACED AT THE TRAUMA OR AFTER IMOBILIZATION • DUE TO COMPRESSION FORCES

OPEN REDUCTION OSTEOSINTHESIS PHYSEAL ARREST (BONY BRIDGE) STILL POSSIBLE

TREATMENT AS SOON AS POSSIBLE. • FIBROUS ATTACHMENT IN FEW DAYS • TYPES I AND II (3 TO 5 DAYS) • IF CLOSE REDUCTION IS DIFICULT: – PERIOSTEAL FLAP – OPEN REDUCTION – RESECT IT • III AND IV • OPEN INJURIES – OPEN REDUCTION

PHYSEAL ARREST PRE DETERMINED FACTORS • TRAUMA ENERGY • OPEN FRACTURES / INFECTION • SALTER-HARRIS • AGE

PHYSEAL ARREST WHERE TO INTERFERE • TIME BEFORE REDUCTION • ANATOMIC REDUCTION • FRACTURE ESTABILITY

PARTIAL PHYSEAL ARREST TYPE III VALGUS

PHYSEAL ARREST TYPE III FEMORO PATELLAR INCONGRUENCE

PHYSEAL PARTIAL GROWTH ARREST RESECTION • AT LEAST 2 YEARS OF PREDICTED GROWTH • 33% OF THE PHYSIS • NO INFECTION • OVER 15 O – OSTEOTOMY • OVER 1/3 – OSTEOTOMY

SALTER – HARRIS TYPE II EPIPHYSIODESIS / OSTEOTOMY

BONY BRIDGE VALGUS

BONY BRIDGE OSTEOTOMY / RESECTION

THANK YOU