orthopedics notes

Apr 16th, 2015
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Basic Principles in theAssessment and Treatmentof Fractures in SkeletallyImmature PatientsK.Lakati,FCS Ortho.Created March 2004; Revised August 2006Anatomy Unique to SkeletallyImmature Bones Epiphysis, physis,metaphysis, diaphysis Physis - growth plate Periosteum - thicker,osteogenic, attachesfirmly at periphery ofphyses Bone - more porous,ductilePeriosteum Osteogenic More readily elevated fromdiaphysis and metaphysisthan in adults Often intact on the concave(compression) side of theinjury - may be helpful as ahinge for reduction, promoterapid healing Periosteal new bonecontributes to remodelingFrom The Closed Treatment ofFractures, John CharnleyPhyseal Anatomy Gross - secondarycenters of ossification Histologic zones Vascular anatomySecondary Centers ofOssification Primary ossification center - diaphyseal Secondary ossification centers - epiphyseal Secondary ossification centers occur atdifferent stages of development(ossification usually occurs earlier in girlsthan boys)Physeal Anatomy Reserve zone - matrix production Proliferative zone - cellular proliferation,longitudinal growth Hypertrophic zone - subdivided intomaturation, degeneration, provisionalcalcificationExamination of the Injured Child Assess location of deformity or tenderness Carefully assess and document specificallydistal neurologic and circulatory function Radiographic evaluationR

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