Instructional course lectures
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Review
Fractures of the distal aspect of the radius: changes in treatment over the past two decades.
Fractures of the distal end of the radius are among the most common orthopaedic injuries, and treatment of these fractures has changed over the course of time. Many fractures of the distal radius are in fact relatively uncomplicated and are effectively treated by closed reduction and casting. However, fractures that are either unstable and/or involve the articular surfaces can jeopardize the integrity of the articular congruence and/or the kinematics of these articulations. ⋯ The fracture pattern, degree of displacement, the stability of the fracture, and the age and physical demands of the patient determine the best treatment option. Over the past 20 years, there has been a development of more sophisticated internal and external fixation techniques and devices for the treatment of displaced fractures of the distal radius. The use of percutaneous pin fixation, external fixation devices that permit distraction and palmar translation, low profile internal fixation plates and implants, arthroscopically-assisted reduction, and bone grafting techniques including bone graft substitutes all have contributed to improving fracture stability and outcome.
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Knee injuries commonly occur in children and adolescents who participate in athletic activities. Open growth plates, apophyses, and chondroepiphyses are unique to the skeletally immature knee and account for the differences in injury patterns observed in children and adults. An understanding of anatomy and classification as related to treatment and outcome of fractures in the skeletally immature knee is important.
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Complex elbow fractures are exceedingly challenging to treat. Treatment of severe distal humeral fractures fails because of either displacement or nonunion at the supracondylar level or stiffness resulting from prolonged immobilization. Coronal shear fractures of the capitellum and trochlea are difficult to repair and may require extensile exposure. ⋯ Articular injury to the radial head is commonly more severe than noted on plain radiographs. Fracture fragments are often anterior. Implants applied to the surface of the radial head must be placed in a safe zone.
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In contrast to adult femoral fractures, there are many ways to treat a child's femoral fracture. The differences mainly involve ease of postoperative care and small rates of various complications. The surgeon should be familiar with at least one of the options for each age range and be adept at performing them to provide the best care for children of all ages.