Specific Fractures and JoiSpecific Fractures and Joint injury in Childrennt injury in Children

耕莘醫院骨科部耕莘醫院骨科部余文輝余文輝

Special Features of Fractures and Special Features of Fractures and Dislocation in ChildrenDislocation in Children

• 1. Fractures more common• 2. Stronger and more active periosteum • 3. More rapid fracture healing• 4. Special problems of diagnosis• 5. Spontaneous correction of certain residual deformities• 6. Differences in complications• 7. Different emphasis on methods of treatment• 8. Torn ligaments and dislocations less common• 9. Less tolerance of major blood loss

Fractures More CommonFractures More Common

Stronger and More Active PeriosteumStronger and More Active Periosteum

More Rapid Fracture HealingMore Rapid Fracture Healing

Special Problems of DiagnosisSpecial Problems of Diagnosis

Spontaneous Correction of Certain Spontaneous Correction of Certain Residual DeformitiesResidual Deformities

• Angulation

• Incomplete apposition

• Shortening

• Rotation

Differences in Complications Differences in Complications

Difference Emphasis on Methods of Difference Emphasis on Methods of TreatmentTreatment

Torn Ligaments and Dislocations Torn Ligaments and Dislocations Less CommonLess Common

Less Tolerance of Major Blood Less Tolerance of Major Blood Loss Loss

Special Types of Fractures in ChildrSpecial Types of Fractures in Childrenen

Fractures that involve the Epiphseal plateFractures that involve the Epiphseal plate

• Anatomy

• Histology

• Physiology

Special Types of Fractures in ChildrenSpecial Types of Fractures in ChildrenFractures That Involve the Epiphyseal PlateFractures That Involve the Epiphyseal Plate

• Diagnosis of Epiphyseal Plate Injuries

• Salter-Harris Classification of Epiphyseal Plate Injuries

Salter-Harris Classification of EpiphSalter-Harris Classification of Epiphyseal Injuriesyseal Injuries

• Type I

• Type II

• Type III

• Type IV

• Type V

Prognosis Concerning Growth Prognosis Concerning Growth DisturbanceDisturbance

• 1. Type of Injury

• 2. Age of the Child

• 3. Blood Supply to the Epiphysis

• 4. Method of Reduction

• 5. Open or Closed Injury

• 6. Velocity and Force of the Injury

Dislocation and Subluxation of the Hip Dislocation and Subluxation of the Hip Developmental Displacement of the Hip; DeveloDevelopmental Displacement of the Hip; Develo

pmental Dysplasia of the Hippmental Dysplasia of the Hip

• Incidence

• Etiology and Pathology

• Diagnosis

• Treatment

Diagnosis of the DDHDiagnosis of the DDH

Physical examination • Barlow test • Ortolani test• Allis’ or Galeazzi’s sign• Trendelenburg’s test

Radiologic Findings

Treatment of the DDHTreatment of the DDH

• Birth to Three Months

• Three Months to Eighteen Months

• Eighteen Months to Five Years

• After the Age of Five Years

Metatarsus Primus VarusMetatarsus Primus Varus

Metatarsus Adductus Metatarsus Adductus ( Metatarsus Varus )( Metatarsus Varus )

Talipes EquinovarusTalipes EquinovarusClubfootClubfoot

• Incidence

• Etiology and Pathology

• Diagnosis

• Treatment

Neoplasms of Musculoskeletal TissNeoplasms of Musculoskeletal Tissueue

• Neoplasm-like Lesions

• True Neoplasms

Classification of Neoplasm-like Classification of Neoplasm-like Lesions of Bone ( I )Lesions of Bone ( I )

A. Osteogenic 1. Osteoma

2. Single osteochondroma

3. Multiple osteochondroma

4. Osteoid osteoma

5. Benign ostoblastoma

B. Chondrogenic 1. Enchondroma

2. Multiple enchondromata

Classification of Neoplasm-like Classification of Neoplasm-like Lesions of Bone ( II )Lesions of Bone ( II )

C. Fibrogenic 1. Subperiosteal cortical defect

2. Nonosteogenic fibroma

3. Monostotic fibrous dysplasia

4. polyostotic fibrous dysplasia

5. Osteofibrous dysplasia

6. “ Brown tumor “

Classifiction of Neoplasm-like Lesions Classifiction of Neoplasm-like Lesions of Bone ( III )of Bone ( III )

D. Angiogenic 1. Angioma of bone

2. Aneurysmal bone cyst

E. Uncertain origin 1. Simple bone cyst

Classification of True Primary NeoplasClassification of True Primary Neoplasms of Bone ( I )ms of Bone ( I )

A. Osteogenic 1. Osteosarcoma 2. Surface osteosarcoma ( parosteal sarcoma; periosteal sarc

oma )

B. Chondrogenic 1. Benign chondroblastoma 2. Chondromyxoid fibroma 3. Chondrosarcoma

C. Fibrogenic 1. Fibrosarcoma of bone 2. Malignant fibrous histiocytoma of bone

Classification of True Neoplasms of BoClassification of True Neoplasms of Bone ( II )ne ( II )

D. Angiogenic 1. Angiosarcoma of bone

E. Myelogenic 1. Myeloma of bone 2. Ewing’s sarcoma 3. Hodgkin’s lymphoma of bone 4. Non-Hodgkin’s lymphoma 5. Skeletal reticuloses 6. Leukemia

F. Uncertain origin 1. Giant cell tumor of bone

General ConsiderationGeneral Consideration

• Incidence

• Diagnosis

Clinical Features

Diagnostic Imaging

Laboratory Investigation

Biopsy

Diagnosis of Bone TumorDiagnosis of Bone Tumor

• Clinical Features

Diagnosis of Bone TumorDiagnosis of Bone Tumor

• Diagnostic Imaging• Plain Radiography• Plain ( conventional ) Tomography• Computed Tomography ( CT )• Scintigraphy ( Bone Scan )

Diagnosis of Bone TumorDiagnosis of Bone Tumor

• Laboratory Investigations Complete blood count ( CBC )

Erythrocyte sedimentation rate ( ESR )

Serum calcium

Serum phosphorus

Serum alkaline phosphatase

Serum acid phosphatase

Prostatic specific antigen ( PSA )

Serum protein electrophoresis

Urinary Bence-Jones protein

Treatment of Bone Tumor Treatment of Bone Tumor

• Surgical Procedures

• Chemotherapy

• Radiotherapy

Disorders of Epiphyses and Epiphyseal Disorders of Epiphyses and Epiphyseal GrowthGrowth

Idiopathic Avascular Necrosis of Epiphyses

( The Osteochondroses )

Pathogenesis and Pathology of the OstPathogenesis and Pathology of the Osteochondroseseochondroses

• Early Phase of Necrosis ( The phase of Avascularity )

• Phase of Revascularization with Bone Deposition and Resorption

• Phase of Bone Healing

• Phase of Residual Deformity

Osteochondrosis of the Femoral Head Osteochondrosis of the Femoral Head (Legg-Perthes’ Disease)(Legg-Perthes’ Disease)

• Clinical Features

• Diagnosis

• Treatment

Osteochondrosis of the Capitellum Osteochondrosis of the Capitellum (Panner’s Disease)(Panner’s Disease)

Osteochondrosis of a Metatarsal HeadOsteochondrosis of a Metatarsal Head(Freiberg’s Disease)(Freiberg’s Disease)

Osteochondrosis of Secondary Centers Osteochondrosis of Secondary Centers of Ossification in the Spineof Ossification in the Spine(Scheuermann’s Disease)(Scheuermann’s Disease)

Osteochondrosis of the Tarsal NaviOsteochondrosis of the Tarsal Navicularcular

(Kohler’s Disease)(Kohler’s Disease)

Osteochondrosis of the LunateOsteochondrosis of the Lunate(Kienbock’s Disease)(Kienbock’s Disease)

Osteochondrosis of a Primary CentOsteochondrosis of a Primary Center of Ossification in the Spineer of Ossification in the Spine

(Calve’s Disease)(Calve’s Disease)