بنام خداوند بخشنده مهربان

مهربان بخشنده خداوند بنام

DR HOSSEIN AKBARI AGHDAM

ASSISTANT PROFESSOR ORTHOPEDYMEDICAL FACULTY

Epidemiology and biologic aspects in childeren s

fractures

Epidemiology of pediatric Trauma prerequisite

optimal care strategies prevention strategies.

trend toward surgical intervention

Improvements in Technology

Percutaneous methods

Powered instruments

Cannulated implants,Radiographic real time images,

Rapid Healing

minimally stabilized fracture

Minimal Hospitalization

The rising costs of hospitalization have created a trend to mobilize children to an outpatient setting as soon as possible.

The Perfect Result

Epidemilogy Of Fracture In Children

Cultural differencesClimatic differences

Incidence of Fractures

0 t 16 years of age:boys 42%;girls27%Annual 2.6%boys;1.7%girls1 to 2 ages high incidence of injuries(not

fracture but injuries such laceration)Fractures show a linear increase with

age

gender

Males predominate in late age groups

Frist 2 years no significant gender diffrences

Right versus Left

upper extermity Predominance of left

Season

Houres of sunshine

Younger age groups unaffected

Time of day(2-3 pm)

Age variation in fracture location

Supracondylar fx first decade,peak at age 7

Femur fx 0 to 3

Fx of physis before skeletal maturity

Single bone

Most common))Radius

Humerus

Tibia

Specific area

Distal radius

Hand

Elbow area

Physal fx 21.7%

Open fx 2.9%

Etiology of fx

Accidental trauma

Nonacidental trauma (child abuse)

Pathological conditions

Accidental trauma

fall from height

Home environmentSocial factors

School environments

Fracture rate is low

Peak time in the morning

Play and Reccreational Activities

Monkey bar Supracondylar FX risk

Hardness of the playground surface

Impact-absorbing surface such bark risk

head injury But long bone FX risk

Bicycle injury

Skates

Skate parks icrease the injury rate

Suggest Supervision &training

Motor Vehicle Accidents

Children twice adult

femoral fx struck automobile

Recreational all-terrain vehicles

(ATVs)

Gunshot and Firearm injuries

Complication 1.Growth arrest

2.infection

Preventive Programs

Study of incidence of FX

Identify problem area

Designe decrese the risk factors

National compaigns

Local community participation

The biologic aspects of childern s FX

Epiphysis

At brith, each epiphysis (except the distal femur)completely cartilaginous

Secondery center of ossification Only articular cartilage remain at maturity

physis

Metaphyseal ischemia

Epiphyseal ischemia

Metaphysis

Torus fx occur in metaphysis

Trabecular,fenestrated,compressible

cortex

Transverse lines of Park and Harris

After trauma,general illness or local such osteomyelitis

Temporary slowdown of normal longitudinal

Growth

Symmetrical in rapidly growing bone

diaphysis

periosteum-mediated membraneous appositional

bone formation

Endosteal remodeling

No direct muscle attachment diaphysis and

metaphisis except medial distal femoral

attachment of adductor muscles

periosteum

Thicker

Loosely attached to shaft but attach densely into

the physeal periphery(zone of ranvier)

Apophysis Tibial tuberosity

Fibrocartilage instead of columnar cartilage

Tensile responsive

Ossification of secondary ossification center

Tend to fail to tension

Mechanisms of bone growth

Endochondral ossification

Physis

Temporary cartilaginous tissue between primery and secondery ossification

centers of long bone

7-9 w gestational age to skeletal maturity 15-17y

Membranous ossification

All axial and appendicular skeletal elements

Via periosteum