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Treatment of fractures in children: overview

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The main objective is to achieve fracture union (osseous union) with an acceptable alignment. Remodeling capacity of deformities, arising from the presence of the physis, causes the “perfect” reduction to be desirable but not necessary.

 

Orthopaedic treatment

This means treatment without surgery. If the fracture is displaced or angulated, reduction by manipulation under anesthesia and containment in a cast may be required (Fig. 7A).

CMI

Figure 7A. Plaster used to contain the fracture of the distal radius and ulna after reduction in the operating room.


The need for reduction of the fracture depends on several factors, primarily age and location.

In children, surgery is needed less frequently for the following reasons:
a) The thick periosteum helps stabilize the fracture
b) Faster bone union
c) Less tendency to joint stiffness after immobilization
d) Ability to remodel
 


Surgical treatment

As the age of the patients increase, surgical treatment and use of implants are more often necessary.

There are several surgical techniques to secure the bone according to the fracture and the age of the patient (Fig 7B). It is cCalled osteosynthesis implants are most often used Kirschner needles, screws, plates, screws and intramedullary nailing.

 

CMI 

Figure 7B. Different types of implants to fix fractures after reduction: Kirschner wires for a supracondylar fracture of the elbow, screws and plate and elastic intramedullary needles metteizeau type for a diaphyseal fracture of the radius and finally, screw for fracture of a metacarpal.

Indications:
a) Fractures involving the joint. The fracture line passes through the articular cartilage. Joint surface irregularities can lead to joint arthrosis in the future
b) Failure of nonoperative treatment (irreducible fractures, unstable or secondary displacement)
c) Open fractures. With associated skin wound.
d) Fractures with vascular injury (damage to the artery)

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