1. دکتر اکبری اقدم استادیار دانشکده پزشکی اصفهان

3.  Common 12 to 16y  Most common site for refracture  Fx suspected >>child has not returned all normal arm function within 1 to 2 days of injury

4.  Practical classification 2 bones 3 levels 4fracture patterns (Bow,Greenstick,Compelet&Comminuted)

6.  Closed Reduction still remains the gold standard for closed isolated pediatric forearm fractures

7.  Non or minimally displace Long arm cast(except above 4 y with stable distal third fx) 1 and 2 week visit 6-8 week cast After that splint until union compelet

8.  Displaced fractures Manipolation with sedation Contorol with fluroscopy Sugar tong splint(7-10 layers 3inch plaster) Next week x-ray and change splint to cast 2 next weeks follow up 4 weeks after reduction can chang short cast Except under 4 y Return to sport now if…

9.  Distal third< 20 degree  Middle third< 15 degree  Upper third <10 degree  100% translation with <1cm shortening  Rotation< 45 degree.difficult to measure Bicipital tuberisity and radial styloid

10.  Open fracture  Fracture with unacceptibale reduction  Fx in assosiated supracodylar fx(to avoid risk of compartement syn)

11.  Interamedullary fixation is preferred If one bone fixation Fix ulna If both bone should be fix,radius first 2-2.5 mm nail brace or cast 6-12 mo nail removal

13.  Redisplacement  Forearm stiffness  Refracture  Malunion  Nonunion  Cross union(synostosis)  Infection  …

15.  Type 1  Ant dis radial head associated with ulnar diaphyseal fx at any level(most common)

17.  Ant radial head dislocasion (include pulled elbow) No plastic deformity of ulna  Ant dis radial head with radial neck fx  Ant dis radial head with fx of radial diaphyseal fx proximal to ulnar fx  ….

18.  direct blow theory  Hyperpronation theory  Hyperextention theory

19.  Fusiform swelling elbow  Pain &limit ROM elbow

20.  Three steps:  Correcting the ulnar deformity  Stable reduction of radial head  Maintaining ulnar length and fx stability

21.  A bivalved long arm cast 4-6 w slight supination and elbow 90 to 110 flex  Radiography every 1 to 2 w  Hardware remove

22.  Congenital Posterior Bilateral Can be associated with various syndromes  Traumatic Isolated ant. Or ant lateral dislocation Unless congenital or systemic difference

23.  Posterior monteggia fx dx  Rare in children usully older patient  Mechanism Direct force,sudden rotation and supination Suddenly loaded in longitodinal direction elbow at 60 flex

24.  Incomplete fx ulna>>close reduction casting in extension  If doubt>>interamedullary fixation  Comminuted or very proximal ulnar fx>>open reduction plate screw

25.  Lat swelling,varus,significant limitation of ROM  Mechanism>>hyperextesion of elbow combined with pronation

27.  Incomplete or plastic deformation of ulna Close reduction >> Elbow in extension longitudinal traction valgus sterss test Long arm cast elbow 70 to 80 flex

28.  Ant dis with fx both radius and ulna Radial fx level same or distal too ulnar fx  Fx unstable fixation

30. Chronic Monteggia Injury Under 12 years old MRI Determine congruency radial head and capitellum

31.  Surgery Radial nerve identify Anconeous-extansor carpiulnaris interval Repair or reconsteraction of annular lig Radius head unreduceable >>ulnar osteotomy After radial head redauction>>anullar lig repi

32.  Fracture of the distal radius with DRUJ disruption  Mechanism >>axial load,forearm rotation  Signs &symptoms>>pain,limitation of forearm rotation,wrist flex ext

33.  Type 1 dorsal (apex volar)displacment  Type 2 volar(apex dorsal)displacment  Galeazzi equivalent Distal radius fx with distal ulnar physis disruption

35.  Volar apex Radius fx greenstick or incomplete Close reduction and long arm cast in supination Complete fx Open reduction and fix with plate

36.  Incompelet radius fx Close reduction  Compelet fx Open reduction