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Metaphysis
Classification
Poland (1898)
Aitken (1936)
Salter & Harris (1963)
Ogden (1981)
Peterson (1994)
Peak incidence: 8-13 (girls)
12-16 (boys)
Male > females
Harris line
Normal
phenomenon
Parallel
Normal growth
Central growth
arrest
Avulsion fracture
Lateral epicondyle
Medial epicondyle
Osgood –schlatter
disease
Angular deformity
Cozen fracture
Proximal tibia
Metaphyseal
Central
Peripheral
Ischemia transient
Epiphyseal
Epiphyseal vassel
Ischemia permenant
Internal splint in
close reduction
Subperiosteal
callus formation
Origin for most
muscle fibre
Spiral fracture
Twisting force
Periosteal hinge
Child bone
Osteoid density less
More haversian
canal
More porous
Common in distal
metaphysis
Porosity is greatest
Ulna
Monteggia-fracture
dislocation
Missed radial head
dislocation
RAMBO
fibula
COMMON IN RADIUS
AND ULNA
Haematoma
Inflammatory response
Callus - woven bone, lamellar bone
Remodeling - Wolff’s law
Inflammatory phase (duration: hours–days):
Broken bones result in torn blood vessels and the
formation of a blood clot or haematoma. The
inflammatory reaction results in the release of
cytokines, growth factors and prostaglandins, all of
which are important in healing. The fracture
haematoma becomes organised and is then
infiltrated by fibrovascular tissue, which forms a
matrix for bone formation and primary callus.
Reparative phase (duration: days-weeks): A
thick mass of callus forms around the bone ends,
from the fracture haematoma. Bone-forming
cells are recruited from several sources to form
new bone, which can be seen on radiographs
within 7-10 days after injury (Figure 9). Soft
callus is organised and remodelled into hard
callus over several weeks. Soft callus is plastic
and can easily deform or bend if the fracture is
not adequately supported. Hard callus is weaker
than normal bone but is better able to withstand
external forces and equates to the stage of
"clinical union", i.e. the fracture is not tender to
palpation or with movement
Remodelling phase (duration: months-
years): This is the longest phase and may last
for several years. During remodelling, the
healed fracture and surrounding callus
responds to activity, external forces,
functional demands and growth. Bone
(external callus) which is no longer needed is
removed and the fracture site is smoothed
and sculpted until it looks much more normal
on an x-ray (Figure 9). The epiphyses
gradually realign and residual angulation may
be slowly corrected, in accordance with the
rules of remodelling, outlined above
Plane of joint motion
Fracture stimulate growth
Bone become longer
Excentric growth in proximal tibia
Cozen fracture
genuvalgum
Paediatric bone susceptible to various type
of deformation
Growth plate injury can lead to various type
of deformity.
In general paediatric fracture heal well
Fracture in long bone in paediatrc can lead
to lengthening.
Physeal injuries
Distal metaphyseal
-torus
-greenstick
-complete
Galeazzi #
CUBITUS VARUS
SUPRACONDYLAR
FRACTURE
MEDIAL CONDYLE
FRACTURE
CUBITUS VALGUS
LATERAL CONDYLE
NON-UNION
OF LATERAL
CONDYLE OF
HUMERUS