Instructional course lectures
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Knee injuries commonly occur in children and adolescents who participate in athletic activities. Open growth plates, apophyses, and chondroepiphyses are unique to the skeletally immature knee and account for the differences in injury patterns observed in children and adults. An understanding of anatomy and classification as related to treatment and outcome of fractures in the skeletally immature knee is important.
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Closed tibial shaft fractures are common injuries that remain challenging to treat because of the wide spectrum of fracture patterns and soft-tissue injuries. Understanding the indications for surgical and nonsurgical treatment of these fractures is essential for good outcomes. Although cast treatment of stable tibial shaft fractures has traditionally been successful and continues to be widely used, recent clinical studies have shown that intramedullary nails may be more advantageous for fracture healing and function than casting. ⋯ Metaphyseal fractures are well suited for plates, although newer intramedullary nail designs provide the option of intramedullary nailing of proximal or distal metaphyseal tibia-fibula fractures. External fixators are well suited for skeletally immature patients with unstable fracture patterns or for patients with unacceptably small intramedullary canals. Interlocking intramedullary nails are the treatment of choice for most unstable tibia-fibula shaft fractures.
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Complex elbow fractures are exceedingly challenging to treat. Treatment of severe distal humeral fractures fails because of either displacement or nonunion at the supracondylar level or stiffness resulting from prolonged immobilization. Coronal shear fractures of the capitellum and trochlea are difficult to repair and may require extensile exposure. ⋯ Articular injury to the radial head is commonly more severe than noted on plain radiographs. Fracture fragments are often anterior. Implants applied to the surface of the radial head must be placed in a safe zone.
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In contrast to adult femoral fractures, there are many ways to treat a child's femoral fracture. The differences mainly involve ease of postoperative care and small rates of various complications. The surgeon should be familiar with at least one of the options for each age range and be adept at performing them to provide the best care for children of all ages.