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DISTAL FRACTURES OF THE FEMUR NEI BOTTER MONTENEGRO DISCIPLINA DE ORTOPEDIA PEDIÁTRICA

DISTAL FRACTURES OF THE FEMUR NEI BOTTER MONTENEGRO DISCIPLINA DE ORTOPEDIA PEDIÁTRICA HOSPITAL DAS CLÍNICAS DA FACULDADE DE MEDICINA DA USP. PHYSEAL INJURIES FRACTURES OF THE DISTAL SHAFT. PHYSEAL INJURIES. COMPLICATIONS BONY BRIDGE RESECTION INCIDENCE. ANATOMY. A X I A L.

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DISTAL FRACTURES OF THE FEMUR NEI BOTTER MONTENEGRO DISCIPLINA DE ORTOPEDIA PEDIÁTRICA

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  1. DISTAL FRACTURES OF THE FEMUR NEI BOTTER MONTENEGRO DISCIPLINA DE ORTOPEDIA PEDIÁTRICA HOSPITAL DAS CLÍNICAS DA FACULDADE DE MEDICINA DA USP

  2. PHYSEAL INJURIESFRACTURES OF THE DISTAL SHAFT

  3. PHYSEAL INJURIES

  4. COMPLICATIONSBONY BRIDGE RESECTION INCIDENCE

  5. ANATOMY A X I A L LESS THAN 1% OF CHILDREN’S FRACTURES

  6. PHYSEAL INJURYPARADOXAL RESISTENCE WIDENESS PLATE SHAPE TRACTION – SOFT TISSUES

  7. MECHANISM OF INJURY ANGULARFORCE – VARUS, VALGUS SAGITAL – ANTERIOR HIPEREXTENTION YOUNG CHILD – ARTROGRIPOSYS, INFECTION, LEUKEMIA, RICKETS, SCURVY

  8. TREATMENTSALTER – HARRIS TYPE I • YOUNG CHILD • REDUCTION UNDER ANESTHESIA • LONG WELL-MOLDED PLASTER CAST

  9. ASSOCIATED NEUROVASCULAR INJURIES

  10. TREATMENT • SMOOTH K-WIRES (2 mm) • 3 WEEKS

  11. TREATMENTSALTER – HARRIS TYPE II • MOST COMMON (2/3) • THURSTON HOLLAND (COMPRESSION) • OVER TEN YEARS

  12. TREATMENTREDUCTION AND CAST SALTER – HARRIS II DISTAL FEMUR VERY UNSTABLE LEE - 1977

  13. TREATMENTREDUCTION (CLOSED / OPEN) - OSTEOSINTHESIS

  14. TREATMENT9 YEARS OLD GIRL / CLOSED REDUCTION AND PERCUTANEOUS SCREWS

  15. TREATMENT6 YEARS P.O.

  16. INTRAARTICULAR FRACTURES

  17. SALTER – HARRIS III AND IV INTRAARTICULAR: • DISPLACED AT THE TRAUMA OR AFTER IMOBILIZATION • DUE TO COMPRESSION FORCES

  18. OPEN REDUCTION OSTEOSINTHESIS PHYSEAL ARREST (BONY BRIDGE) STILL POSSIBLE

  19. TREATMENT AS SOON AS POSSIBLE. • FIBROUS ATTACHMENT IN FEW DAYS • TYPES I AND II (3 TO 5 DAYS) • IF CLOSE REDUCTION IS DIFICULT: • PERIOSTEAL FLAP • OPEN REDUCTION – RESECT IT • III AND IV • OPEN INJURIES – OPEN REDUCTION

  20. PHYSEAL ARRESTPRE DETERMINED FACTORS • TRAUMA ENERGY • OPEN FRACTURES / INFECTION • SALTER-HARRIS • AGE

  21. PHYSEAL ARRESTWHERE TO INTERFERE • TIME BEFORE REDUCTION • ANATOMIC REDUCTION • FRACTURE ESTABILITY

  22. PARTIAL PHYSEAL ARRESTTYPE IIIVALGUS

  23. PHYSEAL ARRESTTYPE IIIFEMORO PATELLAR INCONGRUENCE

  24. PHYSEAL PARTIAL GROWTH ARREST • RESECTION • AT LEAST 2 YEARS OF PREDICTED GROWTH • 33% OF THE PHYSIS • NO INFECTION • OVER 15O – OSTEOTOMY • OVER 1/3 – OSTEOTOMY

  25. SALTER – HARRIS TYPE IIEPIPHYSIODESIS / OSTEOTOMY

  26. BONY BRIDGE VALGUS

  27. BONY BRIDGE OSTEOTOMY / RESECTION

  28. THANK YOU

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