بنام خداوند بخشنده مهربان

1. بنام خداوند بخشنده مهربان

2. Epidemiology and biologic aspects in childeren s fractures Dr hosseinakbariaghdamassistant professor orthopedymedical faculty

3. Epidemiology of pediatric Trauma prerequisite optimal care strategies prevention strategies.

4. trend toward surgical intervention

5. Improvements in Technology Percutaneous methods Powered instruments Cannulatedimplants, Radiographic real time images,

9. Rapid Healing minimally stabilized fracture

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

11. The Perfect Result

12. Epidemilogy Of Fracture In Children • Cultural differences • Climatic differences

13. Incidence of Fractures • 0 t 16 years of age:boys 42%;girls27% • Annual 2.6%boys;1.7%girls • 1 to 2 ages high incidence of injuries(not fracture but injuries such laceration) • Fractures show a linear increase with age

14. gender Males predominate in late age groups Frist 2 years no significant gender diffrences

15. Right versus Left upper extermityPredominance of left

16. Season Houres of sunshine Younger age groups unaffected Time of day(2-3 pm)

17. Age variation in fracture location Supracondylarfx first decade,peak at age 7 Femur fx 0 to 3 Fx of physis before skeletal maturity

18. Single bone Most common))Radius Humerus Tibia

19. Specific area Distal radius Hand Elbow area

20. Physalfx 21.7% Open fx 2.9%

21. Etiology of fx Accidental trauma Nonacidental trauma (child abuse) Pathological conditions

22. Accidental trauma fall from height Home environment Social factors

23. School environments Fracture rate is low Peak time in the morning

24. 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

26. Bicycle injury Skates Skate parks icrease the injury rate Suggest Supervision &training

27. Motor Vehicle Accidents • Children twice adult femoral fx struck automobile Recreational all-terrain vehicles (ATVs)

29. Gunshot and Firearm injuries Complication 1.Growth arrest 2.infection

30. Preventive Programs Study of incidence of FX Identify problem area Designedecrese the risk factors National compaigns Local community participation

31. 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

32. physis Metaphyseal ischemia Epiphyseal ischemia

33. Metaphysis Torus fx occur in metaphysis Trabecular,fenestrated,compressible cortex

34. 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

35. diaphysis periosteum-mediated membraneous appositional bone formation Endosteal remodeling No direct muscle attachment diaphysis and metaphisis except medial distal femoral attachment of adductor muscles

36. periosteum Thicker Loosely attached to shaft but attach densely into the physeal periphery(zone of ranvier)

37. Apophysis • Tibialtuberosity Fibrocartilage instead of columnar cartilage Tensile responsive Ossification of secondary ossification center Tend to fail to tension

38. 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

40. Membranous ossification All axial and appendicular skeletal elements Via periosteum