6th-8th APRIL 2017

CYBERJAYA UNIVERSITY COLLAGE OF MEDICAL SCIENCES

DATO DR ZULKIFLEE OSMAN
JABATAN ORTHOPEDIC
HOSPITAL PULAU PINANG
 THE CHANGING STRUCTURE AND
FUNCTION,BOTH PHYSIOLOGIC AND
BIOMECHANIC,OF IMMATURE BONES MAKE
THEM SUSCEPTIBLE TO DIFFERENT PATTERN
OF FAILURE
 CORRELATES WITH PROGRESSIVE ANATOMIC
CHANGES OF EPIPHYSIS,PHYSIS,METAPHYSIS
AND DIAPHYSIS AT MACROSCOPIC AND
MICROSCOPIC LEVEL
 The proximal femoral epiphyseal secondary
ossification centre appears at about four
months. The ossification centres gradually
enlarges until the cartilaginous (blue) area is
almost completely replaced by bone at
skeletal maturity.
 Fracture supracondylar humerus
common in paediatric
 Anatomical configuration of
supracondylar area predispose to
fracture
 Fracture more common than
dislocation
 Bone weaker than soft tissue
 PAEDIATRIC BONE
 Immature bone
 Ossification centre
 Physis
 Periosteum
 remodeling
Epiphysis
Reserve Zone
Proliferative Zone
Hypertrophic Zone
– Maturation
– Degenration
– Calcification

Metaphysis
Classification
 Poland (1898)
 Aitken (1936)
 Salter & Harris (1963)
 Ogden (1981)
 Peterson (1994)
 Peak incidence: 8-13 (girls)
12-16 (boys)
 Male > females
 Harris line
 Normal
phenomenon
 Parallel
 Normal growth
 Central growth
arrest
 Avulsion fracture
 Lateral epicondyle
 Medial epicondyle
 Osgood –schlatter
disease
 Angular deformity
 Cozen fracture
 Proximal tibia
 Metaphyseal
 Central
 Peripheral
 Ischemia transient
 Epiphyseal
 Epiphyseal vassel
 Ischemia permenant
 Internal splint in
close reduction
 Subperiosteal
callus formation
 Origin for most
muscle fibre
 Spiral fracture
 Twisting force
 Periosteal hinge
 Child bone
 Osteoid density less
 More haversian
canal
 More porous
 Common in distal
metaphysis
 Porosity is greatest
 Ulna
 Monteggia-fracture
dislocation
 Missed radial head
dislocation
 RAMBO

 fibula
 COMMON IN RADIUS
AND ULNA
 Haematoma
 Inflammatory response
 Callus - woven bone, lamellar bone
 Remodeling - Wolff’s law
 Inflammatory phase (duration: hours–days):
Broken bones result in torn blood vessels and the
formation of a blood clot or haematoma. The
inflammatory reaction results in the release of
cytokines, growth factors and prostaglandins, all of
which are important in healing. The fracture
haematoma becomes organised and is then
infiltrated by fibrovascular tissue, which forms a
matrix for bone formation and primary callus.
 Reparative phase (duration: days-weeks): A
thick mass of callus forms around the bone ends,
from the fracture haematoma. Bone-forming
cells are recruited from several sources to form
new bone, which can be seen on radiographs
within 7-10 days after injury (Figure 9). Soft
callus is organised and remodelled into hard
callus over several weeks. Soft callus is plastic
and can easily deform or bend if the fracture is
not adequately supported. Hard callus is weaker
than normal bone but is better able to withstand
external forces and equates to the stage of
"clinical union", i.e. the fracture is not tender to
palpation or with movement
 Remodelling phase (duration: months-
years): This is the longest phase and may last
for several years. During remodelling, the
healed fracture and surrounding callus
responds to activity, external forces,
functional demands and growth. Bone
(external callus) which is no longer needed is
removed and the fracture site is smoothed
and sculpted until it looks much more normal
on an x-ray (Figure 9). The epiphyses
gradually realign and residual angulation may
be slowly corrected, in accordance with the
rules of remodelling, outlined above
 Plane of joint motion
 Fracture stimulate growth
 Bone become longer
 Excentric growth in proximal tibia
 Cozen fracture
 genuvalgum
 Paediatric bone susceptible to various type
of deformation
 Growth plate injury can lead to various type
of deformity.
 In general paediatric fracture heal well
 Fracture in long bone in paediatrc can lead
to lengthening.
 Physeal injuries
 Distal metaphyseal
-torus
-greenstick
-complete
 Galeazzi #
 CUBITUS VARUS
 SUPRACONDYLAR
FRACTURE
 MEDIAL CONDYLE
FRACTURE
 CUBITUS VALGUS
 LATERAL CONDYLE
 NON-UNION
OF LATERAL
CONDYLE OF
HUMERUS