1. DISTAL FRACTURES OF THE FEMUR
NEI BOTTER MONTENEGRO
DISCIPLINA DE ORTOPEDIA PEDIÁTRICA
HOSPITAL DAS CLÍNICAS DA FACULDADE DE MEDICINA DA USP

2. PHYSEAL INJURIES FRACTURES OF THE DISTAL SHAFT

3. PHYSEAL INJURIES

4. COMPLICATIONS BONY BRIDGE RESECTION INCIDENCE

5. ANATOMY A X I L
LESS THAN 1% OF
CHILDREN’S FRACTURES

6. PHYSEAL INJURY PARADOXAL RESISTENCE
WIDENESS
PLATE SHAPE
TRACTION – SOFT
TISSUES

7. MECHANISM OF INJURY ANGULAR FORCE – VARUS, VALGUS YOUNG CHILD –
SAGITAL – ANTERIOR
HIPEREXTENTION
YOUNG CHILD –
ARTROGRIPOSYS, INFECTION,
LEUKEMIA, RICKETS, SCURVY

8. TREATMENT SALTER – HARRIS TYPE I
YOUNG CHILD
REDUCTION UNDER ANESTHESIA
LONG WELL-MOLDED PLASTER CAST

9. ASSOCIATED NEUROVASCULAR INJURIES

10. TREATMENT
SMOOTH K-WIRES (2 mm)
3 WEEKS

11. TREATMENT SALTER – HARRIS TYPE II
MOST COMMON (2/3)
THURSTON HOLLAND (COMPRESSION)
OVER TEN YEARS

12. TREATMENT REDUCTION AND CAST
SALTER – HARRIS II
DISTAL FEMUR
VERY UNSTABLE LEE

13. TREATMENT REDUCTION (CLOSED / OPEN) - OSTEOSINTHESIS

14. TREATMENT 9 YEARS OLD GIRL / CLOSED REDUCTION AND PERCUTANEOUS SCREWS

15. TREATMENT 6 YEARS P.O.

16. INTRAARTICULAR FRACTURES

17. SALTER – HARRIS III AND IV
INTRAARTICULAR:
DISPLACED AT THE TRAUMA OR AFTER IMOBILIZATION
DUE TO COMPRESSION FORCES

18. PHYSEAL ARREST (BONY BRIDGE) STILL POSSIBLE
OPEN REDUCTION
OSTEOSINTHESIS
PHYSEAL ARREST (BONY BRIDGE) STILL POSSIBLE

19. TREATMENT AS SOON AS POSSIBLE. FIBROUS ATTACHMENT IN FEW DAYS
TYPES I AND II (3 TO 5 DAYS)
IF CLOSE REDUCTION IS DIFICULT:
PERIOSTEAL FLAP
OPEN REDUCTION – RESECT IT
III AND IV
OPEN INJURIES – OPEN REDUCTION

20. PHYSEAL ARREST PRE DETERMINED FACTORS
TRAUMA ENERGY
OPEN FRACTURES / INFECTION
SALTER-HARRIS
AGE

21. PHYSEAL ARREST WHERE TO INTERFERE
TIME BEFORE REDUCTION
ANATOMIC REDUCTION
FRACTURE ESTABILITY

22. PARTIAL PHYSEAL ARREST TYPE III VALGUS

23. PHYSEAL ARREST TYPE III FEMORO PATELLAR INCONGRUENCE

24. PHYSEAL PARTIAL GROWTH ARREST
RESECTION
AT LEAST 2 YEARS OF PREDICTED GROWTH
33% OF THE PHYSIS
NO INFECTION
OVER 15O – OSTEOTOMY
OVER 1/3 – OSTEOTOMY

25. SALTER – HARRIS TYPE II EPIPHYSIODESIS / OSTEOTOMY

26. BONY BRIDGE
VALGUS

27. BONY BRIDGE
OSTEOTOMY / RESECTION

28. THANK YOU