1. Plenary session Module 1.4: promote understanding of modeling capacity
Warm up cases: reevaluation of current treatment and knowledge
Editors: Theddy Slongo, CH / Jon Dwyer, UK
Faculty note:
The purpose of this session is to reevaluate the existing knowledge of the important principles of managing fractures in children as compared to adults at the end of the module.
Ask the participants to revote.
Compare the initial voting with the new voting
You have now a short time to discuss the case!
AOT Course—Managing Pediatric Musculoskeletal Injuries
AOTrauma Pediatric
Education Taskforce

2. Case 1 11-year-old boy, small stature; X-ray 6 weeks post injury!
What will you recommend
the parents?
Wait and see, I am completely convinced that it will remodel within 6 months
re-manipulation and some kind of fixation
Wait and see but advise the parents there might be a requirement for future corrective osteotomy
Faculty note:
The purpose of this session: stimulate audience participation, revisit principles of growth and modelling
Positive modeling factors:
Age (growth remaining 5 years or more)
Segment
Location (rapidly growing physis)
Modeling in the plane of deformity
Note; the next slide asks for these responses
 Discuss if the strategy was correct

3. Case 1 11-year-old boy, small stature; X-ray 6 weeks post injury!
6 weeks post injury 12 weeks 15 months
Faculty note:
The purpose of this session: stimulate audience participation, revisit principles of growth and modelling
Positive modeling factors:
Age (growth remaining 5 years or more)
Segment
Location (rapidly growing physis)
Modeling in the plane of deformity
Note; the next slide asks for these responses
 Discuss if the strategy was correct

4. Why did this deformity correct so well?
Case 1
11-year-old boy, small stature; X-ray 6 weeks post injury!
At 15 months
Why did this deformity correct so well?
What are the important factors that influence the ability for modeling?
Faculty note:
Positive modeling factors:
Age (growth remaining 5 years or more)
Segment
Location (rapidly growing physis)
Modeling in the plane of joint motion

5. Case 2 What do you say to the parents next morning?
11-year-old boy, normal stature; injury film; no nerve injury
Treatment; plaster cast splint, no active reduction
What do you say to the
parents next morning?
This is a simple fracture; at this level we expect full modeling
We should reduce and fix this fracture
Wait and see but advise the parents there might be a requirement for future corrective osteotomy
Faculty note:
The purpose of this session is to reevaluate the existing knowledge of the important principles of managing fractures in children as compared to adults at the end of the module.
Ask the participants to revote.
Compare the initial voting with the new voting
You have now a short time to discuss the case!
modeling factors:
Age (growth remaining 5 years or more)
Segment
Location
Modeling in the plane of joint motion
Pediatric

6. Case 1 11-year-old boy, small stature; X-ray 6 weeks post injury!
Faculty note:
The purpose of this session is to reevaluate the existing knowledge of the important principles of managing fractures in children as compared to adults at the end of the module.
Ask the participants to revote.
Compare the initial voting with the new voting
You have now a short time to discuss the case!
Why modeling is different?
modeling factors:
Age (growth remaining 5 years or more)
Segment
Location
Modeling in the plane of joint motion the majority of axis realignment occures at the epiphysis ( only 25% in the diaphysis)
8 weeks post injury weeks

7. Case 1 11-year-old boy, small stature; X-ray 6 weeks post injury!
27 months
Would you recommend
the same management?
Yes No
Faculty note:
The purpose of this session is to reevaluate the existing knowledge of the important principles of managing fractures in children as compared to adults at the end of the module.
Ask the participants to revote.
Compare the initial voting with the new voting
You have now a short time to discuss the case!
Why modeling is different?
modeling factors:
Age (growth remaining 5 years or more)
Segment
Location
Modeling in the plane of joint motion the majority of axis realignment occures at the epiphysis ( only 25% in the diaphysis)

8. Case 3 2-year-old girl, normal stature; injury film; no other lesions
Treatment; over head traction no active reduction
What will you recommend?
This is a simple fracture; at this level we expect full modeling
We should reduce and fix this fracture
Wait and see but advise the parents there might be a requirement for future corrective osteotomy
Faculty note:
The purpose of this session is to reevaluate the existing knowledge of the important principles of managing fractures in children as compared to adults at the end of the module.
Ask the participants to revote.
Compare the initial voting with the new voting
You have now a short time to discuss the case!
modeling factors:
Age (growth remaining 5 years or more)
Segment
Location
Modeling in the plane of joint motion the majority of axis realignment occures at the epiphysis ( only 25% in the diaphysis) 

9. Case 3 2-year-old girl, normal stature; injury film; no other lesions
Treatment; over head traction no active reduction
4 weeks post injury
What will you recommend now?
This healing is satisfactory The patient is now free to mobilize
Continuing immobilization for 2 more weeks
Wait and see but advise the parents there might be a requirement for future corrective osteotomy
Faculty note:
The purpose of this session is to reevaluate the existing knowledge of the important principles of managing fractures in children as compared to adults at the end of the module.
Ask the participants to revote.
Compare the initial voting with the new voting
You have now a short time to discuss the case!
modeling factors:
Age (growth remaining 5 years or more)
Segment
Location
Modeling in the plane of joint motion the majority of axis realignment occures at the epiphysis ( only 25% in the diaphysis) 

10. Case 3 2-year-old girl, normal stature; injury film; no other lesions
Treatment; over head traction no active reduction
Follow up: 3 months  1 year
Faculty note:
The purpose of this session is to reevaluate the existing knowledge of the important principles of managing fractures in children as compared to adults at the end of the module.
Ask the participants to revote.
Compare the initial voting with the new voting
You have now a short time to discuss the case!
Why modeling is different?
modeling factors:
Age (growth remaining 5 years or more)
Segment
Location
Modeling in the plane of joint motion
 Discuss how to manage rotation

11. Summary Good remodeling potential in a 2y old
Case 3
Good remodeling potential in a 2y old
Can accept some angulation and translation
Should maintain proper rotation
Slight shortening is acceptable in this age group
Faculty note:
Give a short summary of this case why we see such a good modeling and referring to the lecture about modeling

12. Case 4 10-year-old boy, fall from a tree What will you recommend?
This is a simple fracture; at this level we expect full modeling
We should reduce and fix this fracture
Wait and see but advise the parents there might be a requirement for future corrective osteotomy
Faculty note:
The purpose of this session is to reevaluate the existing knowledge of the important principles of managing fractures in children as compared to adults at the end of the module.
Ask the participants to revote.
Compare the initial voting with the new voting
You have now a short time to discuss the case!  Why modeling is different?

13. Case 4 10-year-old boy, fall from a tree Are you happy with this?
Faculty note:
The purpose of this session is to reevaluate the existing knowledge of the important principles of managing fractures in children as compared to adults at the end of the module.
Ask the participants to revote.
Compare the initial voting with the new voting
You have now a short time to discuss the case!  Why modeling is different?
This is a metaphyseal fracture close to a slow growing physis
Discuss which plane must be perfect reduced
Advice: the sagittal offset greater than varus/valgus
Rotation doesn't models
Be aware of combinations of angulation with rotation
Medial- lateral view
Anterior-posterior view
Lateral –medial view

14. Case 4 10-year-old boy, fall from a tree Faculty note:
This is an example of a deformity that cannot completely model
Be aware of combinations of angulation with rotation