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بنام خداوند بخشنده مهربان. Epidemiology and biologic aspects in childeren s fractures. Dr hossein akbari aghdam assistant professor orthopedy medical faculty. E pidemiology of pediatric Trauma prerequisite optimal care strategies prevention strategies. - PowerPoint PPT Presentation
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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