Specific Fractures and Joint injury in Children 耕莘醫院骨科部余文輝

Special Features of Fractures and Dislocation 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 Common

Stronger and More Active Periosteum

More Rapid Fracture Healing

Special Problems of Diagnosis

Spontaneous Correction of Certain Residual Deformities Angulation Incomplete apposition Shortening Rotation

Differences in Complications

Difference Emphasis on Methods of Treatment

Torn Ligaments and Dislocations Less Common

Less Tolerance of Major Blood Loss

Special Types of Fractures in Children Fractures that involve the Epiphseal plate Anatomy Histology Physiology

Special Types of Fractures in Children Fractures That Involve the Epiphyseal Plate Diagnosis of Epiphyseal Plate Injuries Salter-Harris Classification of Epiphyseal Plate Injuries

Salter-Harris Classification of Epiphyseal Injuries Type I Type II Type III Type IV Type V

Prognosis Concerning Growth Disturbance 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 Developmental Displacement of the Hip; Developmental Dysplasia of the Hip Incidence Etiology and Pathology Diagnosis Treatment

Diagnosis of the DDH Physical examination Barlow test Ortolani test Allis’ or Galeazzi’s sign Trendelenburg’s test Radiologic Findings

Treatment 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 Varus

Metatarsus Adductus ( Metatarsus Varus )

Talipes Equinovarus Clubfoot Incidence Etiology and Pathology Diagnosis Treatment

Neoplasms of Musculoskeletal Tissue Neoplasm-like Lesions True Neoplasms

Classification of Neoplasm-like 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 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 of Bone ( III ) D. Angiogenic 1. Angioma of bone 2. Aneurysmal bone cyst E. Uncertain origin 1. Simple bone cyst

Classification of True Primary Neoplasms of Bone ( I ) A. Osteogenic 1. Osteosarcoma 2. Surface osteosarcoma ( parosteal sarcoma; periosteal sarcoma ) 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 Bone ( 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 Consideration Incidence Diagnosis Clinical Features Diagnostic Imaging Laboratory Investigation Biopsy

Diagnosis of Bone Tumor Clinical Features

Diagnosis of Bone Tumor Diagnostic Imaging Plain Radiography Plain ( conventional ) Tomography Computed Tomography ( CT ) Scintigraphy ( Bone Scan )

Diagnosis 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 Surgical Procedures Chemotherapy Radiotherapy

Disorders of Epiphyses and Epiphyseal Growth Idiopathic Avascular Necrosis of Epiphyses ( The Osteochondroses )

Pathogenesis and Pathology of the Osteochondroses 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 (Legg-Perthes’ Disease) Clinical Features Diagnosis Treatment

Osteochondrosis of the Capitellum (Panner’s Disease)

Osteochondrosis of a Metatarsal Head (Freiberg’s Disease)

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

Osteochondrosis of the Tarsal Navicular (Kohler’s Disease)

Osteochondrosis of the Lunate (Kienbock’s Disease)

Osteochondrosis of a Primary Center of Ossification in the Spine (Calve’s Disease)