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C. Physiology
Anatomy
Chondro osseous epiphysis
- Radiolucent
- seperation is difficult
Periosteum :
thick, strong
more readily elevated
Biomechanic
Bone
Growth plate (physeal)
Periosteum
Biomechanic of bone
more Haversian canals
less dense
more flexible
more porous
more vascular channels
Biomechanic of bone
Tolerate more degree of
deformation
Incomplete fracture
Buckle
Bowing
Greenstick
Less comminutive
Biomechanic of bone
Deformation
Biomechanic of bone
Deformation
Biomechanic of bone
Fracture
classification
Bowing (bend)
Buckle (torus)
Greenstick
Complete
Biomechanic of bone
Bowing (Bend)
plastic deformation
elastic recoil minimal
microscopical fracture
no callus formation
no remodeling
fibula, ulna
Biomechanic of bone
Butterfly fracture
force: combination axial and
angulation
blow side : butterfly
fragment
periost rupture on the other
side
unstable
Tx.: small fragment : 3
point fixation
big fragment :
distraction
Biomechanic of growth plate
Poland :
epiphysiolysis vs rupture of
ligament
Bright & Elmore :
traction
Angulation
rotation
Biomechanic of growth
plate Type Frequnecy Reduction Prognosis
Physeal injury ++++ Non Good
1
classification Anatomic
3 ++ Anatomic Fair
4 ++ Anatomic Fair
Overgrowth
Femur fracture heals with some lengthening
Shortening < 2 cm : accepted
Physiology
Progressive deformity
Permanent damage of G.P. Shortening
or angulation
Physiology
Speed of union
Bone Healing Time
SMALL BONES 4 weeks
Phalanges, Metacarpals-tarsals
NERVE PALSY:
POST REDUCTION/OPERATION Careful technique Never repair
PERONEAL PALSY Avoid external pressure Most will recover with time
INFECTION:
OPEN FRACTURE Careful debridement Antibiotics, debridement
POST OPEN REDUCTION Preop antibiotics Antibiotics, drainage
PIN TRACTS Relieve skin pressure Relieve skin, antibiotics
BONY COMPLICATION:
MALUNION Careful reduction Osteotomy if severe
NONUNION Prolonged fixation Fixation and grafting
OVERGROWTH Allow over-ridding Ephiphysiodesis if severe
PHYSEAL COMPLICATION:
BRIDGE FORMATION SHORTENING Anatomic reduction of
ANGULATION type 3 & 4 fractures Bridge resection
Not necessary
Thank you