Department of pediatric fracture surgery Beijing Children's Hospital Wang Qiang

atlantoaxial rotatory subluxationDepartment of surgery, Beijing Children's Hospital, Wang QiangAtlantoaxial rotary subluxationThis disease i

Content

atlantoaxial rotatory subluxation

Department of surgery, Beijing Children's Hospital, Wang Qiang

Atlantoaxial rotary subluxation

This disease is a common cause of torticollis in children. "Atlantoaxial rotatory subluxation" is currently the most widely accepted title, Changbiaoxianwei rotation subluxation and torticollis temporary, so these patients often can be cured or after simple treatment can be cured.

[diagnosis]

(I) symptoms

1 have a clear history of trauma: car accident, crush injury, fall injury and other medical history, history of pelvic trauma.

2 local swelling, pain, deformity.

(two) signs

1 often in the upper respiratory tract infection, mild trauma after the natural onset, and sometimes secondary to severe trauma.

2 torticollis for head tilted to one side, under the chin to rotate on the side, while still mild neck flexion.

3 acute phase, the child refused to take the initiative to turn the head, passive turning can cause significant pain.

(three) auxiliary examination

1 x ray examination: open position.

2.CT scan can clearly diagnose.

[treatment]

1 course of less than 1 weeks, the symptoms are mild when recommended to give analgesics and soft.

2 the course of disease is more than 1 weeks, the symptoms are more obvious should be pillow jaw belt traction, and at the same time to muscle relaxants and painkillers.

3 in the course of the disease in January children, to bed, pillow jaw belt traction, more complete remission.

4 the duration of the disease lasted for 1 months to 3 months, and it was necessary to take the first pelvic ring traction and gradually reset. Atlantoaxial joint instability after the reduction, the need for surgical fusion.

5 the course of disease was more than 3 months, the deformity was significantly fixed. C1 can be moved forward when accompanied by serious damage to the spinal cord, often poor prognosis.

6 chronic dislocation by traction, fixation, even can be effective. Can be used in the first ring on the head of the Ilizarov assembly to gradually traction and rotation, after the restoration of road integration.

[prevention]

Strengthen the education of children and guardians, reduce trauma. Wang Qiang Song Baojian

Dislocation and subluxation of shoulder joint

Dislocation and of shoulder subluxation joint

Shoulder dislocation refers to glenohumeral dislocation in the proximal humeral epiphyseal plate is not closed in children is extremely rare. Especially children under 12 years of age,

[diagnosis]

(I) symptoms

1 have a clear history of trauma.

2 local swelling, pain, deformity.

(two) signs

1 shoulder joint movement disorder, refuse any activity.

2 local tenderness and percussion pain.

3 the ipsilateral elbow should not be close to the chest wall, and the affected side could not reach the contralateral shoulder (Dugas positive).

4 acromion herniation with lateral arm flat for the typical performance.

5 abduction 90 degree fear test (Papprehension test) positive.

(three) auxiliary examination

1 X-ray films can be clearly diagnosed.

2.CT reconstruction may assist in the diagnosis of fracture and displacement.

[type]

1 anterior dislocation of shoulder joint. The most common, and very easy to relapse, more than 50% of children with recurrent seizures, reports can be as high as 80%. Anterior dislocation can be divided into subcoracoid dislocation and infraglenoid dislocation.

2 posterior dislocation of shoulder joint.

3 shoulder joint dislocation.

[treatment]

The treatment of 1 acute traumatic dislocation of the shoulder joint, closed reduction is the only choice, do not use violence traction, rough reduction manipulation, in order to prevent new damage, application of sedation, analgesia, and anesthesia is necessary. Under the appropriate anesthesia often when the onset of anesthesia, the shoulder joint can be automatically reset or apply a gentle external force can be reset, the success rate of 100%. The film confirmed the combined injuries, sling or Velpeau trunk fixed for 4 weeks to 6 weeks.

2 old shoulder dislocation and recurrent shoulder dislocation can be considered surgical intervention.

[prevention]

Strengthen the education of children and guardians, reduce trauma.

Wang Qiang Song Baojian

Clavicular fracture

Fractures of the clavicle

Clavicle fracture usually refers to the fracture of the shaft of the lock. 80% of the clavicle injuries occurred in the backbone. Clavicle fractures accounted for about 8% to 15.5% of children with systemic fractures.

Diagnosis and typing

(I) symptoms

1 history of trauma or dystocia.

2 local swelling, pain, deformity.

3 affected limbs refused to move.

(two) signs

1 limb movement disorder.

2 local tenderness and percussion pain.

3 palpable bone fricative and anomalous activity.

(three) auxiliary examination

1 X-ray films can be clearly diagnosed.

2.CT diagnosis of fracture and displacement.

[type]

The most common type of Allman typing.

I is the most common type of 1/3 fracture, which accounts for about 80% of all fractures;

Type II fracture of the distal to the acromioclavicular ligament;

Type III fracture of medial 1/3.

[treatment]

1 local fixation

The clavicle has strong healing ability, in the absence of external harassment under the condition of almost 100% can be healing, has a strong ability of remodeling after healing children clavicle fracture. Completely displaced fractures generally in 6 ~ 9 months up to more than 2 years can be completely shaping.

The most commonly used method for external fixation of 8 bandage fixation, with erect or chest sitting akimbo, double armpit is lined with cotton pad to protect the axillary nerve and wound on the back side of the bandage to cross the shoulders of 8 words, the tightness of the double radial pulse is not affected, no numbness in hands. Now there is the sale of clavicle belt, the principle of the same 8 bandage, and with a preset elastic pad, easy to use, reliable fixation. Fixed time is usually 4 weeks, that is, continuous external callus, removal of external fixation, the protection of functional training, after a period of 3 months to 4 months after bone healing, before the resumption of sports.

2 surgical indications include open injury need debridement; fracture of neurovascular need exploration; fracture is dangerous to pierce the skin. If the operation is open reduction, it is best to use plate and screw internal fixation.

[complications]

1 neurovascular injury;

2 malunion;

3 delayed union and nonunion.

[prevention]

Strengthen the education of children and guardians, reduce trauma.

Wang Qiang Song Baojian

Humeral shaft fracture

Humeral shaft fractures

The humerus is one of the typical long bones of the human body, composed of the backbone and the ends of epiphysis. Humeral shaft fractures in children are rare, the incidence rate is less than 1/10 of humeral fractures in children, accounting for only 2% to 5.4% of all fractures in children, more common in children under the age of 12 and above.

[diagnosis]

(I) symptoms

1 have a clear history of trauma.

2 local swelling, pain, deformity.

(two) signs

1 elbow joint movement disorder.

2 local tenderness and percussion pain.

3 palpable bone fricative and anomalous activity.

4 with radial nerve injury in children can not take the initiative to lift the wrist and finger extensor.

(three) auxiliary examination

1 X-ray films can be clearly diagnosed.

2.CT diagnosis of fracture and displacement.

[treatment]

Most of the fractures of the humeral shaft in children are single closed fractures. There is no obvious angular displacement of the fracture, only using external fixation for 3 weeks to 6 weeks. For the fracture with obvious angular displacement, the first reduction should be performed. Reset requirements to restore the line to the main, the full shift of the overlap shortening is not more than 1.5cm is acceptable. Acceptable reset reference standard (see Table 1).

Table 1 reference standard for reduction of humeral shaft fracture

Age

Angulation

Shift degree

5 years old

Less than or equal to 70 degrees

100%

5 years old to the age of 12

40 degrees to 70 degrees

12 years old

Less than or equal to 40 degrees

50%

1 reduction of humeral shaft fracture is relatively easy to maintain, is relatively difficult, the reduction was fixed in the swelling and external fixation after loosening can lead to angular displacement recurrence, so it should be possible to maintain the first position, after the injury in 1 to 2 weeks after the end of the fiber fracture healing shift may reduce after tightening the replacement of external fixator or further correction of angular deformity, to maintain clinical healing.

Fixing method for humeral shaft fracture in 2 children

(1) the neck strap is fixed to the chest wall, and the upper arm is fixed to the chest wall with a bandage.

(2) distal humeral fractures may be treated with U - shaped plaster splint

(3) proximal humeral fractures can be treated with O - shaped plaster splint.

(4) olecroanon bone traction or upper arm skin traction is also suitable for unstable fractures, but need to stay in bed for 2 weeks, the fracture stability can switch to the other way or fixed.

3 surgical treatment is only suitable for open injury requiring debridement and vascular injury. The fixture can use elastic intramedullary nail (Ender nail) or external fixator, the former has the advantages of simple postoperative nursing for early rehabilitation training. The latter has the advantage of reliable fixation, once infection fixation effect is small.

[complications]

1 nerve injury: the most common radial nerve injury in 1/3 patients showed lower humerus fractures, muscle paralysis, vertical wrist, vertical finger deformity accompanied by sensory disturbance, simple closed fracture and nerve injury combined to pull block pressure caused by epineurium is still in continuity, which can recover automatically.

2 and nonunion or delayed healing: humeral shaft usually takes 4 to 6 weeks to reach clinical healing fracture, if the X-ray examination showed that (1) bone sclerosis, medullary cavity closed; (2) bone atrophy osteoporosis, with large gaps; (3) bone sclerosis, the formation of rod mortar or false joint clinical examination; swelling disappeared but there is still abnormal activity, namely fracture healing. Only surgical treatment.

3 abnormal healing: the residual limb deformity and the angle of less than 30 degrees, the length difference is not more than 2cm, parents and children are difficult to subjective awareness, indicating that the appearance and function of little. Internal rotation deformity of less than 10 degrees will not cause dysfunction.

[prevention]

Strengthen the education of children and guardians, reduce trauma.

Wang Qiang Song Baojian

Supracondylar fracture of humerus

Supracondylar fracture of the humerus

The incidence of supracondylar fractures of the humerus was the second most common in children with limb fractures. The fracture occurred mainly in children under ten years of age, the incidence of condylar fractures occurred in the age of 5 to 10 years old, many falls and other traumatic history. Bone fractures in children with bone growth and development.

[diagnosis]

(I) symptoms

1 have a clear history of trauma.

2 local swelling, pain, deformity.

(two) signs

1 movement disorders.

2 local tenderness and percussion pain.

3 palpable bone fricative.

(three) auxiliary examination

1 X-ray films can be clearly diagnosed.

2.CT may assist in the diagnosis of minor fractures and displacement.

[type]

According to the degree of fracture displacement, Gartland was divided into three types. Type I: fracture without displacement. Type II: there is a clear fracture line, one side of the cortical bone is continuous, and there are angular deformities and / or minor shift. Type III: complete displacement, no contact between the two fracture ends.

[treatment]

1 the treatment of supracondylar fractures of the humerus in children should be based on conservative treatment, such as closed reduction and plaster fixation, upper limb traction (Dunlop traction) and so on. One week later, the position of fracture was observed by X light microscope, and the location of the swelling was found in time. 3 weeks to 4 weeks after injury, the patients were allowed to perform active function under protection. II type of supracondylar fracture can be used to correct the deformity of the angle and the plaster is fixed for 3 weeks to 4 weeks.

2 complete shift (III) method to treat fracture is closed reduction and percutaneous pinning. With two needles from the lateral cross or parallel penetration, and lateral pinning can also use gypsum after supporting protection in 90 degrees of flexion of elbow joint.

3 surgical treatment indications: open reduction surgery may lead to ankylosis and risk of myositis ossificans based on multi object to the use of open method for the treatment of supracondylar fracture. They believe that less than 1% of supracondylar fractures require open reduction.

The absolute indications for surgery were: (1) open fractures; (2) severe vascular damage, especially in the case of a reduction in blood flow caused by the reduction of the procedure.

[complications]

The incidence of complications of supracondylar fracture of humerus is very high.

1, nerve injury:

The total incidence of nerve injury was about 7%, with the most common injury of radial nerve.

2, vascular injury:

Vascular injury is the most serious complication in children with supracondylar fracture. Can cause mild muscle fibrosis, severe gangrene amputation can occur. Signs of vascular damage should be dealt with quickly, such as early detection of the brachial artery.

3, activity disorder:

A slight loss of activity does not have a significant impact on the patient's elbow function. It is not uncommon for the patients with elbow joint dysfunction caused by improper open reduction, and this kind of dysfunction is often permanent.

4, myositis ossificans:

Myositis ossificans after regular treatment with a very low incidence of. Clinical myositis ossificans most violent manipulation caused by delayed surgical open reduction and kneading, is easy to cause one of the important reasons of myositis ossificans, influence on the function of the elbow and upper limbs were very large.

5, angular deformity:

Angular deformity cannot be shape coronal and cubitus varus or cubitus valgus. Cubitus varus is the most common and difficult to accept appearance deformity, the incidence rate from 9% to 58%! Deformity is caused by the angulation and rotation of the distal fracture, not the result of growth and development. Most of the studies have shown that the reduction is the most important factor for cubitus varus deformity.

[prevention]

Strengthen the education of children and guardians, reduce trauma.

Wang Qiang Song Baojian

Fracture of lateral condyle of humerus

The lateral fracture of the condyle humerus

Humeral lateral condyle fractures in children is common in children with fractures of the elbow joint, its incidence and after Monteggia fracture of supracondylar fracture of the humerus in third place. Compared with the supracondylar fracture, there are more opportunities for the diagnosis and treatment of the external condyle fracture.

[diagnosis]

(I) symptoms

1 had a clear history of elbow injury.

2 local swelling, pain, deformity.

(two) signs

1 movement disorders.

2 local tenderness and percussion pain.

3 palpable bone fricative.

4 elbow joint activity limitation.

(three) auxiliary examination

1 X-ray films can be clearly diagnosed.

2.CT and MRI may assist in the diagnosis of minor fractures and displacement.

[treatment]

1 only need to brake the fracture:

No displacement fracture can be used to get good results after the plaster of the back of the brake, and can be used in the forearm neutral position and 90 degrees of elbow flexion. But remember that this treatment is risky! A doctor should have a full understanding of the occurrence of secondary fracture displacement and maintain vigilance at the same time to the parents of children with detailed explanation of secondary displacement problems can be obtained with the above based on the full understanding of the parents! The plaster fixation after third days, 1 weeks and 2 weeks the patient must return to hospital scan to confirm the location of the fracture, such as fracture block secondary dislocation is feasible to take timely measures to ensure open reduction and internal fixation of the fracture location.

2 closed reduction and percutaneous Kirschner wire fixation after manipulative reduction:

A separate application closure method even if reset reset position is hard to maintain satisfactory, by restricting the percutaneous pinning technology by objective conditions (in a clear image of X ray, under) the operation is difficult, it is difficult to achieve anatomical reduction of fractures, and hand therapy operation may cause further damage in order to affect the function of the final results. The treatment of displaced supracondylar fractures should not be treated with closed reduction, which should be immediately followed by surgery and reduction of the fracture and fixation.

3 fracture requiring open reduction:

Because of the poor results of the function and appearance of the patients due to the closed reduction method, most of the authors now recommend the method of open reduction. About 70% of the condyle epiphyseal fracture need open reduction treatment, and the original injury displaced condyle epiphyseal fracture immediately underwent open reduction and internal fixation, this point does not exist any dispute. The fixed mode can be of three types, one is using some type of suture; second for the use of smooth steel needles; third types is the choice of cancellous bone screw small nail.

Suture fixation: suture fixation is one of the first to use the method, do not respect this fixed method.

The needle fixed: smooth needle is the most commonly used method to fix the fracture, but also should be the best choice. In order to prevent the bone block rotation at least two needle fixation. Has confirmed that the 2mm below diameter Kirschner smooth through the epiphysis will not cause the growth disturbance, parallel or cross shaped needle fixed bone block. Fresh fractures with open reduction and internal fixation after 3 weeks usually has enough stability, allowing the removal of external fixation and plaster to encourage patients to start protecting the elbow of active exercise, 6 weeks after operation scan confirmed the Kirschner wires were removed after fracture healing.

The screws: you can use a fine cancellous bone screw fracture by metaphyseal part fixed to the near metaphyseal fracture segment, preferably without tapping pre drilled nail. Because the screw only through the metaphysis, rarely have secondary growth disorder.

[complications]

1 delayed union, nonunion, malunion.

2, ischemic necrosis of epiphysis block and lateral overgrowth, angular deformity.

3 nerve injury (acute and delayed).

4, block myositis ossificans and tail deformity.

[prevention]

Strengthen the education of children and guardians, reduce trauma.

Wang Qiang Song Baojian

Fracture of medial condyle of humerus

Medical condyle of the fracture humerus

Humeral condylar fractures involving the articular and extra articular part two, IV type Salter-Harris epiphysis injury.

[diagnosis]

(I) symptoms

1 have a clear history of trauma.

2 local swelling, pain, deformity.

(two) signs

1 movement disorders.

2 local tenderness and percussion pain.

3 palpable bone fricative.

(three) auxiliary examination

1 X-ray films can be clearly diagnosed.

2.CT may assist in the diagnosis of minor fractures and displacement.

[treatment]

1 non displaced fractures can be fixed with functional plaster.

2 displaced fractures should be the first choice of open reduction and internal fixation. The posterior medial incision can reveal the fracture block, and can be used to observe the fracture site and ulnar nerve. It is absolutely necessary to have a relatively strong fixation, and a satisfactory result can be obtained by using smooth Kirschner wire. Must be fixed with two needles. It is very difficult not to try to reduce the fracture block. Even if the fracture block be reduced, because the forearm flexor pull effect is also very easy to shift again.

[complications]

1 fracture nonunion.

2 cubitus varus deformity.

[prevention]

Strengthen the education of children and guardians, reduce trauma.

Wang Qiang Song Baojian

Dislocation of elbow joint

Dislocation of elbow joint

Dislocation of elbow joint in children is rare, because the anatomical characteristics of the distal humerus and flat was a thin sheet, and in the past 10 years, a large part is composed of a distal humeral epiphysis and epiphyseal cartilage, bone is relatively weak, in contrast, the elbow ligament is relatively strong, so small children in the elbow injury, usually caused by fracture of epiphysis injury and rare dislocation of elbow. The incidence of elbow joint dislocation was 3%~6%. The age of onset of dislocation of the elbow in children is usually 10 years old to the age of 14, and it is very rare to have an elbow dislocation before the age of 10.

[type]

Posterior dislocation of elbow joint

[diagnosis]

(I) symptoms

1 have a clear history of trauma.

2 local swelling, pain, deformity.

(two) signs

1 elbow joint movement disorder.

2 local tenderness and percussion pain.

3 palpable bone fricative.

The 4 eagle beak is obviously backward, and the skin covered in the eagle beak can be depressed. If it is a posterolateral dislocation, the radial head may protrude from the posterolateral part of the elbow and easily reach the radial head.

(three) auxiliary examination

1 X-ray films can be clearly diagnosed.

2.CT reconstruction in the diagnosis of fracture and displacement.

[treatment]

1 closed reduction

Generally do not need anesthesia, two assistant in the forearm and elbow deformity of upper arm along the direction against the traction, patients with both hands holding the elbow from the elbow after the first correction of lateral displacement, double thumb forward pushing down the olecranon, can appear snapping feeling that the elbow has been reset, reset. After the reduction with long arm cast back support 90 degree of elbow flexion and forearm pronation, neutral position fixation for 3 weeks.

2 open reduction

It is easy to reset the elbow joint, and it is stable after reduction. If the closed reduction is not successful or the reset is unstable, there is an object embedded in the joint. If the fresh elbow joint dislocation was closed successfully, the emergency operation was performed by open reduction. With the elbow medial incision, elbow exploration, remove the influence of reduction factor, reset after the elbow position in plaster for 3 weeks.

[complications]

1 nerve injury.

2 vascular injury.

3 ossificans.

4 feet of proximal radial displacement and Volkman ischemic contracture, but are rare.

Two, anterior dislocation of elbow joint

Anterior dislocation of the elbow is very rare. Its incidence is lower than 2%. In most cases, the distal end of the ulna and radius is the medial dislocation. The reset method is the elbow flexion, while the proximal and downward push the forearm, usually can be reset, reset after the elbow position in plaster for 3 weeks.

Three, lateral dislocation of elbow joint

Very rare in children elbow lateral dislocation, can be divided into complete dislocation and subluxation. In subluxation, ulnar trochlear notch and humeral head pulley groove joint. The complete dislocation can be divided into two kinds: medial dislocation and lateral dislocation. For lateral dislocation of elbow, closed reduction and easy success in traction, with lateral compression can be reset on the dislocation of the distal.

[prevention]

Strengthen the education of children and guardians, reduce trauma.

Wang Qiang Song Baojian

Subluxation of radial head

Subluxation of theradial head, pulled elbow

The average age of the patients was 2 years old and the youngest patient was only about 2 months, and the children over the age of 7 were rarely seen in this disease. The disease was less than 3 years old. There was no significant difference in gender, and about 70% of cases were left upper limb involvement. Radial head subluxation is a common injury, the disease recurrence rate as high as 30%.

[diagnosis]

(a) is critical in determining the history of radial head subluxation, there are usually of children elbow a sudden longitudinal stretch, some children fall history for limb pressure behind.

(two) symptoms

1 lateral elbow pain, the children do not want to use the limb.

2 upper limbs hanging in the lateral forearm pronation and mild.

(three) signs

1 rotation of forearm or elbow flexion can cause pain and resistance.

The 2 part of the radial head and the annular ligament have limitation tenderness, in some cases the pain to the distal spread and relates to the wrist.

(four) there was no radial head displacement in the auxiliary examination, and MRI could assist in the diagnosis.

[treatment]

If the diagnosis is clear, the doctor should adopt various methods to transfer the attention of the children, and then complete the repairing action with a gentle technique. The surgeon to seize the distal end of the humerus pulled back, the other hand hold children with hand pull downwards, supination of the elbow and can complete reduction; reduction can increase the difficulty of supination. At the same time to squeeze down thumb radial head can be successfully reset. When an annular ligament is restored, it is heard or felt.

[prevention]

Strengthen the guardian's education, reducing traction injury.

Wang Qiang Song Baojian

Fracture of ulna and radius

Fractures of and ulna in radius children

No matter in the treatment of ulnar and radial fracture with prognosis and adult fractures are very different, children have great growth shaping ability, conservative treatment is the preferred method of treatment of ulnar and radial fractures of ulnar and radial distal epiphysis injury is related to the growth mechanism of the injury, and will lead to the secondary growth of improper deformity.

[diagnosis]

(I) symptoms

1 have a clear history of trauma.

2 local swelling, pain, deformity.

(two) signs

1 movement disorders.

2 local tenderness and percussion pain.

3 palpable bone fricative.

(three) auxiliary examination

1 X-ray films can be clearly diagnosed.

2.CT may assist in the diagnosis of minor fractures.

[treatment]

1 preferred closed reduction, plaster or splint external fixation.

2 of ulna and radius bone or bone fracture to single completely closed reduction in good muscle relaxation under anesthesia.

Open reduction and internal fixation of 3 radial and ulnar fractures.

Open reduction and internal fixation should follow the following principles: (1) severe open fractures. (2) bone growth will stop, growth potential is not sufficient to correct residual deformity shaping. (3) closed reduction failure. (4) due to the fracture of the end of the tissue can not be reset. (5) multiple fractures in the short term. (6) the deformity was significantly increased after re fracture. (7) pathological fracture.

The most commonly used method is the internal fixation of steel screws and intramedullary nail fixation, in addition to the use of external fixator.

[complications and treatment]

1: the fracture healing process has occurred even successfully re fracture may. Often occurred in 6 months, and then after the fracture is often significantly increased deformity.

2 limb ischemia: after reduction and plaster external fixation of oppression, post-traumatic stress muscle interval increased, at the same time with vascular injury, fracture, are the cause of limb ischemia. The reduction of limb pain (early ischemic pain, loss of feeling or activity ability of late loss,) were swollen, pale or bruising, fingers feel loss of ability or activities are loss of limb ischemia, especially when the passive finger when pain is an early muscle membrane interval syndrome Volkman ischemic contracture.

3 nerve injury: children with forearm ulnar and radial fractures combined with the median nerve, ulnar nerve, dorsal interosseous nerve injury cases have been reported, most of them are transient nerve injury, after more than can be restored.

Fusion of 4 feet radius: This is one of the most serious complications of forearm fractures, the injury itself may lead to the healing of the radius and ulna, open reduction is also possible causes.

5: open reduction and pollution during infection is caused by the most common cause of infection, trauma can cause local ischemia lead to stagnation, traumatic osteomyelitis.

[prevention]

Strengthen the education of children and guardians, reduce trauma.

Wang Qiang Song Baojian

Monteggia fracture in children

Monteggia fracture in children

Is a composite of Monteggia fracture injury of forearm and elbow, 1814 Italy doctor Monteggia first associated with anterior dislocation of the radial head is described on the ulna proximal 1/3 fracture, after people called this kind of injury for Monteggia fracture.

[diagnosis]

(I) symptoms

1 have a clear history of trauma.

2 forearm and elbow joint swelling, pain, deformity.

(two) signs

1 limited to the fracture tenderness and humeroradial joints.

2 can reach the dislocation of the radial head.

3 elbow flexion and extension and forearm rotation were restricted.

(three) auxiliary examination

Positive side X-ray film can be clearly diagnosed.

[type] Monteggia fracture with the injury mechanism can be divided into four types

Type I (extensional): about 73%, as to the ulna fractures with volar angulation, with forward dislocation of radial head.

Type II (flexion): about 3%, for the ulnar shaft fracture with dorsal angulation with backward dislocation of radial head. This type is more common in adults than children.

Type III (endoduction type): about 23% feet, for metaphyseal fractures to the lateral angle, with radial head to the lateral or anterolateral dislocation. This type is often associated with radial nerve injury.

Type IV: very rare, accounting for only 1% of the radius and ulna fracture with radial head dislocation.

[treatment]

In 1, fresh Monteggia fracture:

(1) there are two methods for closed reduction. One is the first of the ulna, ulnar deformity correction, recovery of forearm length, radial head part can be reset. The two is the first reduction of radial head dislocation recovery of forearm length, ulna deformity can be corrected. The application of long arm cast I type and III type of Monteggia fracture after reduction of elbow flexion after care, less than 90 degrees and forearm supination fixation. Application of II type support arm before and after Monteggia fracture after reduction, elbow extension and forearm pronation fixed.

(2) open reduction surgery indications: (1) the radial head failure of closed reduction; (2) the ulnar oblique fracture is extremely unstable after reduction easily in the process of displacement in plaster.

2, the treatment of old Monteggia fracture

Monteggia fracture more than two weeks, is no longer closed reduction, should be done as soon as possible open reduction of radial head, annular ligament reconstruction surgery.

[prevention]

Strengthen the education of children and guardians, reduce trauma.

Wang Qiang Song Baojian

Thoracolumbar injury

Injuries of thoracic and lumber the spine

Spinal fractures in children accounted for only 2% to 5% of all spinal injuries, the vast majority of cervical spine injury, and thoracolumbar injury is more likely to cause serious consequences. The fracture site and the mechanism of injury may vary with age. Baby thoracolumbar injury can occur due to the abuse of babies, children under the age of 10 for traffic injury or fall injury, children over the age of 10 is often due to traffic accident (40%) and sports (bicycle, motorcycle, bobsledding) injury (37%), casino injury or firearm injury.

[diagnosis]

(I) symptoms

1 have a clear history of trauma: car accident, crush injury, fall injury and other medical history.

2 pain, swelling, deformity of the spine.

(two) signs

1 can not walk, muscle spasm.

2 damaged spine tenderness.

3 limb movement disorder. Delayed paraplegia occurred 2 hours to 4 days after injury, suggesting that vascular injury of the nutrient spinal cord.

(three) auxiliary examination

1 x ray examination: flexion compression fracture of vertebral body obvious wedge-shaped change, violence, vertebral ring rupture.

2.CT scan can clearly diagnose the location and nature of fracture, and the displacement of fracture block.

3.MRI can clearly show the spinal cord or cauda equina injury in children. But MRI still has false positive and false negative, and the application of metal fixation is a relative contraindication to MRI examination.

[treatment]

1 flexion injury

(1) simple compression fracture patients, short term bed rest or support and even plaster fixation.

(2) the kyphosis deformity caused by the injury of the vertebral cartilage endplate must be corrected by surgical treatment.

2.Chance fracture

(1) closed reduction and recovery of lumbar lordosis, plaster fixation.

(2) the operation of ligament injury needs to be reduced and the vertebral body fusion.

(3) the choice of internal fixation depends on the age of the child: the young children use wire binding, plaster fixation; young people can use pressure fixation devices.

3 stretch and shear damage

(1) unstable injury such as vertebral subluxation or fracture dislocation, treatment as well as adults must be reset, to acute symptoms disappeared after considering surgical reduction and fixation.

(2) the dislocation of children with nerve injury needs immediate reduction.

(3) in the early stage of burst fracture, Harrington and Lugue should be used to restore the dislocation and maintain the stability of the fracture end. At the same time, it is necessary to carry out the posterior spinal fusion.

(4) the indications of decompression surgery in pediatric emergency patients were the same as those in adults: A. open injury; B. spinal injury with progressive nerve injury; C. unstable fracture dislocation.

[complications]

1 growth retardation.

2 nerve injury.

3 spinal deformity.

[prevention]

Strengthen the education of children and guardians, reduce trauma.

Wang Qiang Song Baojian

Pelvic fracture in children

Pelvic fracture in children

Pelvic fracture is a serious trauma, often combined with abdominal viscera, blood vessels, nerve injury or other parts of the fracture. A large number of bleeding in the internal iliac artery and the injury of the sciatic nerve after fracture, pelvic vascular plexus and pelvic internal iliac vein often lead to early shock, which seriously threatens the life of the patient. Treatment should be stable as soon as possible to prevent bleeding, shorten bleeding time, reduce bleeding. So as to improve the success rate of rescue.

[diagnosis]

(I) symptoms

1 have a clear history of trauma: car accident, crush injury, fall injury and other medical history, history of pelvic trauma.

2 local swelling, pain, deformity.

(two) signs

1 common perineal subcutaneous blood stasis and swelling, deformity of pelvis.

The 2 part has apparent tenderness, percussion pain.

3 pelvic compression test and separation test positive.

4 can't stand and walk.

(three) auxiliary examination

1 x - ray examination: X - ray examination consists of three standard images of the pelvis, and inlet, outlet and anterior and posterior images.

2.CT scan is valuable for the diagnosis of pelvic fractures, and can clearly show the posterior sacroiliac complex.

3 three dimensional CT scan: three-dimensional CT can greatly improve the diagnostic rate of pelvic fractures in children, and it is important to determine the extent of injury and the treatment plan for traumatic pelvic fractures or acetabular fractures.

4 diagonal measurement of the pelvis: ordinary anteroposterior pelvic X-ray film, from the lower edge of the sacroiliac joint to the medial side of the medial side of the acetabulum, the normal diagonal length of both sides of the same or less than 4mm.

[type]

(a) Torode Zieg classification: type I: avulsion fracture. It is mostly the avulsion injury of cartilage plate. Fracture of iliac wing. Is directly caused by violence, violence may be caused by lateral iliac crest fracture or iliac bone fracture. Single ring fracture. Fracture of pubic symphysis or pubic symphysis separation. Fracture of pelvic ring. The separation of fracture or joint produced pelvic instability, including a: bilateral pubic ramus fractures (straddle injury); one side of the b: fracture of pubic rami or pubic symphysis separation involving the posterior pelvic fracture or sacroiliac joint; fracture involving the anterior acetabular ring and C. (two) Tile classification: similar to the classification of adult pelvic fractures. 1 stable fracture (1) of the two ossification center avulsion: more common in adolescent athletes, can occur in any of the two ossification center. More common are the anterior superior iliac spine, the sartorius muscle starting point avulsion; the anterior inferior iliac spine, the starting point of the rectus femoris avulsion; sciatic nodules, hamstring avulsion starting point. (2) stable fracture of pelvic ring: this kind of fracture is stable after pelvic tension. Before and after the crush injury (open book): a diastasis of pubic ramus fractures see; crush injury of lateral ("Y" shaped cartilage injury): lateral crush injuries of "Y" shaped cartilage, the injury has the potential early closure of epiphyseal plate, can lead to acetabular dysplasia. 2 unstable fractures of unstable pelvic fractures (double longitudinal fractures) and adults, can damage ahead of pubic symphysis separation and fracture of pubic rami or two damage often exist at the same time, posterior dislocation of sacroiliac joint, with sacral or iliac fracture. More severe posterior injuries were bilateral. Bilateral sacroiliac joint dislocation without anterior injury, children are more common than adults, the damage is mostly caused by extrusion or violence in front. [treatment]

The therapeutic effect of pelvic fractures depends on the site and type of injury. Treatment requires accurate reduction and stable fixation of pelvic fractures. Fixation of unstable and displaced fractures in children. Most authors tend to use external fixation. (a) avulsion fracture

1 non operative treatment of anterior superior iliac spine and anterior inferior iliac spine.

2 more displacement, open reduction and internal fixation to restore the sartorius and rectus femoris position.

(two) stable fracture of pelvic ring

1 before and after the crush injury (open book type): the separation of the symphysis pubis in children after anesthesia supine position, the use of bilateral hip "person" word plaster fixation. After the treatment of adolescent patients with anterior external fixator, can restore the stability of the pelvis, early ground movement, can get good results, but in recent years, children also have external fixator. Crush 2 lateral ("Y" shaped cartilage damage): if the fracture through the "Y" shaped cartilage that acetabular fracture under general anesthesia to trial reset, then underwent tibial tubercle traction 3 to 4 weeks until the "Y" shaped cartilage healing. If the reduction fails, open reduction and internal fixation. Crush 3 lateral (semi pelvic shift): anesthesia reduction, complete healing in infants with moderate extorsion hip spica fixed until. Older children with external fixation in the semi pelvic outside rotation, recovery of pelvic bones arranged and early activities. (three) unstable pelvic fractures

With the general condition and injury stability after fracture reduction should be done as early as possible. Bone traction through tibial tubercle. If it cannot be reset, the posterior injury should be treated with open reduction and fixation of the sacroiliac joint dislocation and fracture with Kirschner wire. If the reduction fails, it can cause malunion, pelvic obliquity, and shortening of the lower limb. [prevention]

Strengthen the education of children and guardians, reduce trauma.

Wang Qiang Song Baojian

Traumatic hip dislocation in children

Traumatic hip dislocation in children

Traumatic hip dislocation in children is not common, the age of less than 14 years old accounted for only about 5%, the age of onset in the age of 12 to 15 years old. Unilateral dislocation was most common, bilateral dislocation was less than 1%. Most of the posterior dislocation, about 5 times before the dislocation of ~ ~ 10 times. The incidence of hip fracture is low when there is traumatic hip dislocation. Gender distribution of boys is about 66% ~ 78%.

[diagnosis]

(I) symptoms

1 have a clear history of trauma.

2 local swelling, pain, deformity.

(two) signs

1 limb movement disorders, loss of hip function.

2 hip has apparent tenderness, percussion pain.

3 palpable bone fricative and anomalous activity.

4 contracted external rotation.

5 can't stand and walk.

(three) auxiliary examination

1 X-ray films can be clearly diagnosed.

2.CT diagnosis of fracture and displacement.

[type]

1 posterior dislocation

Hip flexion, adduction, internal rotation, limb was significantly shortened, the greater trochanter backwards on the shift, often in the gluteal uplift of the femoral head.

2 anterior dislocation

Hip extension, abduction, external rotation, the affected limb is longer than the healthy side, sometimes in front of the hip can be seen local uplift, or touch the dislocation of the femoral head.

3 dislocation

The hip joint is excessively flexed, the thigh is attached to the lower abdomen, the body is parallel to the long axis of the body, the knee joint is buckled, and there is no thigh abduction or external rotation. This is also known as the vertical dislocation of the femur (or dislocation of the acetabulum).

[treatment]

First of all, it should be in the appropriate anesthesia (intravenous sedation or general anesthesia) and painless conditions, as soon as possible to achieve a closed reduction, which can reduce the incidence of ischemic necrosis.

(a) posterior dislocation of hip joint, closed reduction method is the use of hip flexion relaxation of iliofemoral ligament and joint capsule of hip muscles, the femoral head to the acetabular rim hole near to reset, the following three methods commonly used:

1.Stimson method: patients prone, since the end of lower limb surgery in ptosis, sacral region and trochanter major downward pressure to fix the pelvis, then at 90 degrees, in the posterior leg close to the popliteal fossa under pressure, gently swing and rotation of the limb, and the femoral head to assist direct pressure reduction.

2.Allis method: the patient supine, the anterior superior iliac spine compression with fixed pelvis, hip and knee flexion of 90 degrees each, mild thigh adduction and internal rotation of the forearm, direct vertical traction in rear knee, lift the femoral head across the posterior acetabular margin that, through the joint capsule hole into the acetabular fossa, then hip and knee gradually straight, occasionally encountered soft tissue resistance, as long as the increase of hip adduction and internal rotation angle can be reset after relaxation, such as hip extension may not easily, soft tissue embedding, re trial a closed reduction.

3.Bigelow method: patient supine, patients in the affected side, one hand holding the other side of the forearm in patients with ankle, patients with popliteal fossa, first along the longitudinal axis of the thigh traction method, while maintaining traction, will in turn hip adduction, internal rotation, extreme flexion, abduction and external rotation and then straight. In the reset process, such as feel or hear the ring, the limb straight after the deformity disappeared, that has been reset.

(two) anterior dislocation of hip joint

Closed reduction generally without too much difficulty, the patients supine, a proximal leg hold assistant patients, keep the knees, along the original direction of deformity, forced to lower traction and internal rotation operation by hand to push the acetabular direction of the femoral head, at the same time, the assistant in the continuous traction adduction limb, often can hear or feel the femoral head into the acetabulum snapping, deformity disappeared, when reset.

The indication of open reduction is: closed reduction attempt 2 ~ 3 after failure. Combined with obvious fracture of acetabular cartilage. The surgical approach and the dislocation direction: posterior dislocation with posterior approach, anterior dislocation by anterior approach, from the joint space occupying organization, as far as possible joint capsule repair torn, large bone block by Kirschner wire or screw, but can not damage the Y cartilage.

[complications]

1 ischemic necrosis

Ischemic necrosis after traumatic dislocation of the hip is a serious complication, which has a significant effect on the results.

2 femoral head epiphyseal disruption

Can cause the femoral neck longitudinal growth retardation plate damage growth, resulting in metaphyseal widening, special damage growth plate, in shortening at the same time, there will be a corresponding angle change, resulting in varus medial epiphyseal plate injury, resulting in valgus lateral epiphyseal plate injury. In older children, showed dilated (coxa magna), hip and femoral head diameter difference than 2mm, resulting in severe acetabular disproportion.

3 recurrent dislocation

Recurrent dislocation of children than adults, prone to joint disease and relaxation in children with Down syndrome. Statistical data showed that the age of the patients with dislocation was almost 8 years old, with very few exceptions.

4 heterotopic ossification

Is a rare complication in patients with a combination of fractures, resulting in the development of hip pain and varying degrees of activity is limited, the timing of surgery must wait until the lesion is fully mature before, otherwise easy to relapse.

[prevention]

Strengthen the education of children and guardians, reduce trauma.

Wang Qiang Song Baojian

Femoral neck fracture

Fractures of the femoral neck

Femoral neck fracture in children was significantly less than that in adults, and only 1% of the fractures were similar.

[diagnosis]

(I) symptoms

1 have a clear history of trauma.

2 local swelling, pain, deformity.

(two) signs

1 limb movement disorder.

2 hip has apparent tenderness, percussion pain.

3 palpable bone fricative and anomalous activity.

4 contracted external rotation.

5 can't stand and walk.

(three) auxiliary examination

1 X-ray films can be clearly diagnosed.

2.CT diagnosis of fracture and displacement.

[type]

Dellbert classification of hip fractures in children:

I type: the type of epiphysis, epiphysis separation, relative to the Salter-Harris type of the first type.

Type II: cervical type, fracture line in the middle of the femoral neck.

Type III: basal type, fracture line located in the femoral neck.

Type IV: rotor type, located in the size of the fracture between the rotor.

[treatment]

(a) the epiphyseal fracture

1 did not shift or shift is very small after epiphyseal fracture, conservative application after inmobilized with plaster for 6 weeks. The shift should as soon as possible under general anesthesia during closed reduction of fracture after inmobilized with plaster, reset after percutaneous penetration of 2 ~ 3 Steinmann pin fixation, and hip spica brake for 6 weeks.

2 for closed reduction fails, or to the acetabular epiphysis of femoral head prolapse cases, open reduction is the only effective method, can achieve the basic traction or poking reduction cases, do not easily open reduction.

(two) fracture of neck

1 treatment of stable cervical fracture

Pauwels according to the angle between the broken line and the vertical line of the femoral shaft (Linton angle) to distinguish the size of the shear stress at the end of the fracture, if less than 30 degrees, it is a stable fracture.

There are different opinions on the treatment of stable cervical fracture. A view is not the main problem of fracture healing, reduce secondary iatrogenic injury, should take the conservative treatment can be sustained traction or after traction after inmobilized with plaster. The other is that whether or not should fracture displacement, percutaneous pin fixation, and then after inmobilized with plaster treatment. The author thinks that the double hip spica plaster fixation, simple and quick and reliable effect.

Treatment of 2 displaced cervical fractures

Under anesthesia before trial reset, reset in the C - arm fluoroscopy guided percutaneous penetration of 2 ~ 3 Steinmann pins internal fixation. For children over the age of 12 years, the use of 2 or 3 thin hollow nail fixation.

Bone round needle or hollow nail, should be given continuous traction or after inmobilized with plaster for 6 weeks. If after 1 to 2 times closed reduction failure, it is recommended to open reduction, to avoid multiple trauma.

(three) cervical fracture

1 there is no obvious shift of the femoral neck fracture is often embedded abduction fracture, generally more stable. Satisfactory results can be obtained in the treatment of persistent skeletal traction.

2 pairs of displaced femoral neck fractures, generally advocated closed reduction cannulated screw fixation.

3 cases of improper treatment or closed reduction can be treated with open reduction and internal fixation.

(four) intertrochanteric fractures

1 percutaneous traction or bone traction for 3 weeks to 4 weeks and hip spica cast immobilization for 6 weeks, the general can get satisfactory results.

2 young intertrochanteric fractures, especially the accident of multiple trauma patients in recent years, advocates the priority of internal fixation, but as far as possible to avoid the damage of rotor epiphysis.

[complications]

1 ischemic necrosis

Avascular necrosis of the femoral head is a common and serious complications of femoral neck fracture in children, other complications such as nonunion, hip varus and epiphyseal plate closure, through the two stage surgical correction, but in the event of ischemic necrosis, especially severe ischemic necrosis, no effective treatment method for selection and joint function is almost impossible then return to normal. The incidence of avascular necrosis of the femoral head was as high as 30% ~ 50%. The rate of ischemic necrosis is closely related to the bleeding caused by the fracture and the degree of joint cyst expansion. The removal of the blood pressure and the reduction of the incidence of ischemic necrosis.

Ratliff was divided into three types of avascular necrosis of the femoral head after hip fracture:

Type I: the density of femoral head increased (sclerosis) with the complete collapse of the femoral head.

Type II: the femoral epiphysis part density increased, accompanied by the collapse of the femoral head is very light.

Type III: the femoral neck fracture from the line to the epiphyseal growth plate density increased, the femoral head epiphysis involvement.

The classification describes the range of ischemic necrosis, and has certain significance in determining prognosis. Type I femoral head involvement, serious condition, the worst prognosis. II type, III type relatively the best results, but also on the femoral neck width increased shorter, short hip obvious deformity.

2 coxa varus

Treatment options affect the incidence of hip varus in children with femoral neck fracture. Whether conservative treatment after inmobilized with plaster or traction treatment, the highest incidence of hip varus, statistics up to 32%.

3 fracture nonunion

Nonunion of femoral neck fractures in children was significantly less than that in adults, with a statistical value of 3%.

4 early closure of epiphysis

Femoral neck fracture after epiphyseal plate closure, can occur in the epiphyseal fracture, or by fixing needle, needle, thread hollow improper application too thick nail damage to the epiphyseal growth plate. Avascular necrosis of the femoral head is the cause of early closure of epiphysis.

[prevention]

Strengthen the education of children and guardians, reduce trauma.

Wang Qiang Song Baojian

Femoral shaft fracture

Fractures of the femoral shaft

Fracture of femoral shaft in children is a common trauma of the lower extremity, accounting for all pediatric fractures and epiphysis injury 2%, accounting for lower limb fracture 10%, male to female ratio was 2:1, the age of onset of the peak at the age of 5.

[diagnosis]

(I) symptoms

1 have a clear history of trauma.

2 local swelling, pain, deformity.

(two) signs

1 limb movement disorder.

2 local tenderness and percussion pain.

3 palpable bone fricative and anomalous activity.

(three) auxiliary examination

1 X-ray films can be clearly diagnosed.

2.CT diagnosis of fracture and displacement.

[treatment]

(a) treatment of femoral shaft fractures

1, skin traction

According to the traction direction, the skin traction was divided into direct traction (Buck traction), traction force (Russell traction) and vertical suspension traction (Bryant traction).

2, bone traction

The utility model has the advantages that the corresponding problem of the skin traction interface is avoided, and the traction force can be provided. Bone traction is more suitable for older patients with larger traction.

Tibial distraction: tibial tubercle traction is rarely used in children because of the possibility of knee flexion in the presence and absence of growth and development of the tibial tubercle. Feasible upper tibia bone traction, traction needle should avoid the tibial tubercle and proximal tibial epiphysis.

Femoral bone traction: distal femoral epiphyseal plate in the horizontal direction, traction in supracondylar, needle placement in suprapatellar one finger, to avoid the growth plate of distal femoral epiphysis injury. Entrance and exit of the skin should be small needle knife stabbed a small opening, to prevent the skin against oppression.

3, plaster fixation

A hip spica cast should include limb length and contralateral thigh, used to call the hip spica cast 1. After two weeks of traction and hip spica cast shift shortened small age femoral shaft fracture in children.

4, surgical treatment

(1) open the fracture end with direct reduction, and then use the plate screw or intramedullary nail fixation.

(2) external fixation or intramedullary nailing in the treatment of fracture reduction and fixation.

Treatment of fractures of the femoral shaft (two)

1, open fracture

Open fractures of the femoral shaft are rare in children, but the incidence has increased in recent years. The treatment in addition to the above principles, should be thoroughly debridement, infection prevention, timely treatment of antibiotics.

2, birth trauma fracture

Birth fracture can get satisfactory results by Pavlik harness or early after inmobilized with plaster, postural moderate hip abduction of 45 degrees, 90 degrees of flexion, and external rotation of 45 degrees, the extreme flexion of the hip, trunk flexion fixation is more simple.

3, supracondylar fracture

Special muscle forces lead to fracture of the far posteriorly displaced supracondylar fracture, the traction in flexion, or after closed reduction and percutaneous pinning, cross fixation after cast immobilization. Supracondylar fracture has the possibility of damage to the blood vessels and nerves.

4, pathological fracture

Pathological fracture usually occurs in osteoporosis or bone damage based on the fracture healing, bone connection always appear disorder or deformity, although it does not affect the function, but the parents are very difficult to accept, but also very easy to fracture, so these fractures should be fixed as long as possible. General than the conventional fixed 2 weeks to 3 weeks.

Pathological fracture of bone defect caused by the common in the proximal femur of solitary bone cyst, bone fibrous dysplasia, dry non ossifying fibroma metaphyseal tumors, eosinophilic granuloma, aneurysmal bone cyst, congenital osteogenesis imperfecta, such as a wide range of lesions, or re fracture may, intramedullary fixation is a feasible method, it can be long-term retention in the medullary cavity, to prevent re fracture.

[complications]

1, shortening healing:

Shortening healing is the most common problem in children with femoral shaft fractures. Our goal is to be shortened during treatment within 1cm, in most cases, the children and their parents on the shortening of 1cm or less is not aware, and will pay attention to the shortening of 1C ~ 2cm, shorter and more than 2cm will appear limp, and scoliosis back pain, etc..

2, angular deformity healing

Angular deformity and disability of the relationship depends on the patient's age, potential growth depends on the remodeling of the. Neonates and infants in the sagittal plane angle up to 45 degrees, is also acceptable, especially on the 1/3 fracture of femur, and the distal femoral fracture for adolescent even if it is 10 degrees of lateral angular deformity is not acceptable.

3, rotational deformity healing

In clinical treatment, it is difficult to grow through the rotation shaping gain correction. Do not display mild rotation deformity and abnormal gait obvious, obvious rotational deformity not only abnormal gait, there will be dysfunction, should pay attention to prevention, there was dysfunction of rotational deformity surgery rotation osteotomy.

4, nonunion or delayed healing

The general closed femoral shaft fractures can include fracture healing, embedded soft tissue fracture, nonunion or delayed union cases, open fracture occurred or inappropriate surgical treatment of fracture, infection or improper internal fixation materials is the main reason.

5, limb ischemia

Femoral shaft fracture in children with vascular injury, the probability is very low, the occurrence of vascular injury and injury of femoral shaft fracture and upper femoral epiphysis has a direct relationship, we can be diagnosed by touching the artery pulse or angiography, if encountered vascular injury should be timely treatment.

Limb ischemia caused by traction has also been reported, if encountered such a situation should be immediately removed traction, if necessary, to reduce the muscle interval.

6, shock

Closed fractures of the femoral shaft rarely occurred shock, shock occurred in multiple injury or severe infection in children.

7, superior mesenteric artery syndrome

This is due to a hip spica cast fixation, caused by the oppression of the superior mesenteric artery after a group, may have gastrointestinal reaction and autonomic symptoms, relieve the oppression or change the position, can alleviate.

8, tibial epiphysis injury:

By using tibial tubercle traction caused by the tubercle of tibia epiphyseal plate closure after knee, so we do not advocate the use of tibial tubercle traction.

9, needle infection

When the needle through the little cortex can also be caused by direct pull in the subcutaneous cortex gaping, caused by infection, a lot of needle tract infection and bone traction needle position on.

10, coxa valgus

Common placed intramedullary needle damage the trochanteric epiphysis, hip valgus can occur.

11, fever

Idiopathic fracture fever in children with femoral shaft fractures is very common, body temperature of 38 degrees or more, the children's group of children most, but need to exclude any cause of fever, to make this diagnosis.

12, fracture hematoma infection

Fracture hematoma infection is a rare complication, which usually occurs on the basis of local and systemic infection.

13, peroneal nerve paralysis

Often occurs in the peroneal compression performance of ankle dorsiflexion, extensor digitorum, extensor hallucis, valgus, weakness, should relieve the oppression in time.

14, re fracture

Re fracture is uncommon in children. It usually occurs in the larger or adolescent children with pathological fracture, or due to long-term bed after osteoporosis, or because of the steel plate screw fixation of the stress barrier. In case of the complications of traditional traction treatment or to make feasible range of internal fixation for the treatment of incision.

[prevention]

Strengthen the education of children and guardians, reduce trauma.

Wang Qiang Song Baojian

Patella fracture

Fractures of patella

Patella fractures rarely occur in children. For children of all fractures accounted for 1 per thousand, 6 per thousand of all lower extremity fracture. Avulsion fracture of the patella is classified according to the site, and the pole avulsion fracture is extremely rare. Misdiagnosis or delay of patella fractures in children is common, and sometimes can be delayed until several days after injury.

[diagnosis]

(I) symptoms

1 have a clear history of trauma.

2 local swelling, pain, deformity.

(two) signs

1 limb movement disorder.

2 local tenderness and percussion pain.

3 palpable bone fricative and anomalous activity.

4 touch can find the position of patella and high gap after the collapse.

(three) auxiliary examination

1 X-ray films can be clearly diagnosed.

2.CT diagnosis of fracture and displacement.

[treatment]

1 patients with non displaced fractures, especially in patients with active knee extension, closed reduction is a better treatment. Joint puncture can reduce pain. From groin to ankle is less than 5 DEG flexion with plaster cast or brake. The majority of children with patellar fracture is not displaced, after the joint puncture, pressure bandage fixation can be.

2 patients with greater than 3mm and active knee extension limited knee devices should be treated surgically. Children and adolescents should not be treated with patella excision. Methods of fixation include circumferential wire suture, longitudinal suture, suture, AO tension band technique, screw or Kirschner wire fixation. The treatment should be treated seriously. Patella reduction will lead to improper deformity, extensor lag and dysfunction.

[complications]

1 high patella, knee extension, and four head muscle atrophy.

2 infection.

To strengthen the education of children and guardians, reduce trauma.

Wang Qiang Song Baojian

Fracture of tibia and fibula

Fractures of shafts of tibial and the the fibula

According to the injury, it was divided into closed fracture and open fracture. Of the 30% cases of fracture of the lower limb in children, the fracture of tibia was single, and the other was complete fracture of tibia and fibula in 70%.

Diagnosis and typing

Closed fracture

(I) symptoms

1 have a clear history of trauma.

2 local swelling, pain, deformity.

(two) signs

1 limb movement disorder.

2 local tenderness and percussion pain.

3 palpable bone fricative and anomalous activity.

4 with tibial nerve injury in children can not take the initiative to lift the foot, toe, toe extensor.

(three) auxiliary examination

1 X-ray films can be clearly diagnosed.

2.CT diagnosis of fracture and displacement.

3 fractures of the diaphysis and vascular injury of the dorsal and posterior tibial arteries were weakened or disappeared.

Two, open fracture

On the classification of open fractures: first degree, caused by low energy damage fracture, pierce the skin, wound length is less than 1cm; second, the skin and soft tissue contusion, but no bone and muscle tissue of wound length is greater than 1cm; A high energy injury, wound length more than 10cm wide soft tissue contusion, muscle necrosis and periosteal destruction, comminuted fracture; B III, III A + bone defect and nerve injury; III C with vascular injury; special type fractures: gunshot wounds, agricultural machinery injury, segmental fractures and segmental bone defect.

[treatment]

(1) conservative treatment

Conclusion: most of the fractures of the tibia and fibula are non displaced fractures, which can be treated by simple manipulative reduction and plaster external fixation. For displaced fractures, it is possible to relax the muscles under anesthesia, and to repair them under fluoroscopy. Reset: standard alignment, fracture at least to reach more than 50% reduction; on line, any direction angle is not greater than 5 DEG to 10 DEG; due to fracture of tibia fracture due to stimulation caused excessive growth of the tibia is less, so the reset should pay attention to maintaining the length. For girls over the age of 10 should be as far as possible to achieve anatomical reduction. In order to make the two legs to be fully equal, any form of shortening should be avoided. Short amount of closed reduction of fracture of tibia and fibula after children acceptable is generally 1 ~ 5 years old children in 5 mm ~ 10mm, 5 ~ 10 years old children from 0 mm to 5mm.

The fix: after fracture reduction, with fixed support legs before and after the paste. For unstable fractures, the fixation of the knee should be fixed at 45 degrees of flexion to control rotation, and this position will also help prevent early weight-bearing. Newborns need to be fixed for 2 weeks to 3 weeks; preschool children need to be fixed for a period of about 4 weeks to 6 weeks; children aged from 6 to 10 years need to be fixed for about 6 weeks to 12 weeks, and those who are over the age of 11 should be fixed for about 8 weeks to.

(2) surgical treatment

Children with leg fracture without displacement of a greenstick fracture can be seen, the general conservative treatment. Only a small part of the need for surgical treatment.

Closed fracture

Surgical indications: multiple fractures of tibia and fibula; instability of older children fracture, comminuted fracture or difficult fracture; reduction fixation after unstable fracture complicated with compartment syndrome; fracture; other injury or other special circumstances of the fracture, such as hemophilia. Open reduction and internal fixation is a relative indication, only the stability of the fracture can reduce the fracture with repeated hemorrhage, brain injury or cerebral palsy patients after surgery for patient care.

Application of external fixation for the treatment of tibia and fibula is difficult to reset or multiple damage fracture is gradually in recent years is a fixed method more and more doctors are willing to use, its biggest advantage is not to interfere with the blood supply of bone fracture, debonding fracture mechanism into the periosteum and reset tool improvement and design with the outside the fixed frame of the process, the fracture is not difficult to achieve anatomical reduction made after closed reduction. However, the external fixator is the same as the steel plate screw fixation, which is eccentric and has the problem of stress shielding.

Elastic intramedullary nail (Anderson 's Nail) can solve the problem of eccentric fixed stress shielding, but should choose the appropriate model, skilled technology, certain equipment conditions, such as G - arm two-way X-ray machine.

Can choose the internal fixation screw fixation and plate fixation, but less used.

Open fracture

A method of debridement, irrigation, primary closure of wound, closed reduction and plaster fixation was used in the first degree injury and partial second degree injury.

Injury degree above: debridement, irrigation and the use of antibiotics; the solid external fixation of mandibular fracture in maintenance; the injured limb blood circulation is poor, if necessary, measurement of intraoperative angiography and compartment stress relaxation technique; not to close the wound in the operation, cover the wound with gauze and the cotton pad after operation; the lower limb suspension; every 24 hours to 72 hours in the operation room regularly debridement, removal of necrotic tissue to generate good granulation tissue; the delayed wound closure, including skin flap and skin graft; and if the bone defect with cancellous bone 9 If tibia fibula fracture nonunion, and soft tissue healing, try the body weight of gypsum; other non stress fractures can continue to use the external fixation and bone grafting, until healing.

If the skin avulsion injury but the skin itself does not crush and lose its vitality, with the cutting drum dermatome in full thickness skin, wound back limb replanting, primary wound closure. Open fracture fixation is the first choice because of its external fixation, and to observe the wound dressing. Second, the use of steel or calcaneal bone traction.

[complications]

1 delayed union, nonunion, malunion.

2 infection.

3 compartment syndrome and early closure of epiphysis.

4 fracture site pain.

5.23% having the ability to move, especially the ability to exercise.

6.64% of the children had limb length inequality.

[prevention]

Strengthen the education of children and guardians, reduce trauma.

Wang Qiang Song Baojian

 

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