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Contemporary Surgical Management of Fractures & Complications: Pediatrics (Volume 3)
Martin J Herman, B David Horn
CHAPTER 1:
Pediatric Spine Trauma
INTRODUCTION
PEDIATRIC SPINAL ANATOMY
INITIAL MANAGEMENT AND EXAMINATION
EPIDEMIOLOGY
RADIOGRAPHIC EVALUATION
CERVICAL SPINE INJURIES
Upper Cervical Spine Fractures
Atlanto-occipital Dislocation
Occipital Condyle Fractures
C1 Fractures (Jefferson Fractures)
C1-C2 Injuries: Atlantoaxial Rotatory Subluxation
Odontoid Fractures
Os Odontoideum
Hangman Fracture
Lower Cervical Spine Fractures
Spinal Cord Injury
Spinal Cord Injury without Radiographic Abnormality
NONSURGICAL MANAGEMENT OF CERVICAL SPINE INJURIES
Hard Collar Immobilization
Pediatric Halo Immobilization
THORACOLUMBAR SPINE INJURIES
Classification
Compression Fractures
Burst Fractures
Flexion-Distraction Injuries (Chance Fractures)
Apophyseal Fractures and Herniations
Spinous Process/Transverse Process Fractures
Combined Fracture/Dislocations
Cauda Equina Syndrome
LONG-TERM MANAGEMENT OF THORACOLUMBAR SPINE INJURIES
SUMMARY
CHAPTER 2:
Fractures of the Shoulder and Humerus
INTRODUCTION
CLAVICLE
Introduction
Diagnosis
Newborn
Medial Clavicle
Mid-Shaft Clavicle
Lateral Clavicle
Nonsurgical Management
Surgical Treatment
Medial Clavicle
Mid-Shaft Clavicle
Plate Fixation
Intramedullary Fixation
Complications
PROXIMAL HUMERUS FRACTURES
Introduction
Diagnosis
Classification
Nonsurgical Management
Surgical Treatment
Operative Technique
Outcomes
Complications
HUMERUS SHAFT
Introduction
Diagnosis
Nonsurgical Management
Surgical Treatment
Complications
CHAPTER 3:
Fractures of the Pediatric Elbow I: Supracondylar Humerus, Lateral Condyle, Transphyseal Distal Humerus and Capitellum Fractures
INTRODUCTION
ANATOMY
PHYSICAL EXAMINATION
NEUROLOGICAL STATUS
VASCULAR STATUS
DIFFERENTIAL DIAGNOSIS
SUPRACONDYLAR FRACTURES
Introduction
Diagnosis
Clinical Presentation and Focused Orthopedic Examination
Imaging
Classification
Gartland Classification
Nonsurgical Management
Surgical Treatment
Indications
Timing of Surgical Intervention
Treatment of the Pink, Pulseless Hand
Technique for Surgical Management
Patient Positioning
Closed Reduction and Percutaneous Pinning
Technique Description
Pitfalls of Pinning
Open Reduction and Internal Fixation
Care after Surgery
Outcomes
Complications
Nerve Injury
Cubitus Varus
Correction of Cubitus Varus
Compartment Syndrome
Evaluation
Technique of Forearm Fasciotomies
LATERAL CONDYLE FRACTURES
Introduction
Mechanism
Diagnosis
Imaging
Classification
Management of Minimally Displaced Fractures: Jakob Types I and II, Weiss Types I and II
Surgical Technique
Management of Displaced Lateral Condyle Fractures: Jakob III and Weiss Type III
Surgical Technique
Arthroscopically Assisted Reduction
Care after Surgery
Outcomes
Complications
Surgical Technique
TRANSPHYSEAL DISTAL HUMERUS FRACTURES
Introduction
Diagnosis
Imaging
Classification
Nonsurgical Management
Surgical Management
Indications
Surgical Technique
Positioning
Technique
Care after Surgery
Outcomes
Complications
CAPITELLUM FRACTURES
Introduction
Mechanism
Imaging
Classification
Management
Surgical Technique
Approach
Fixation
Care after Surgery
Outcomes
Complications
Elbow Stiffness
Posttraumatic Arthrosis
ACKNOWLEDGMENTS
CHAPTER 4:
Fractures of the Pediatric Elbow II: Fractures of the Medial Epicondyle, Radial Neck and Olecranon
MEDIAL EPICONDYLE FRACTURES
Introduction
Diagnosis
Clinical Presentation
Imaging
Classification
Management
Nonsurgical Management
Isolated Fractures
Fractures with Elbow Dislocations
Surgical Treatment
Indications
Positioning
Approach
Technique
Care after Surgery
Outcomes
Complications
Elbow Stiffness
Elbow Instability
Fibrous Union
Ulnar Nerve Dysfunction
RADIAL NECK FRACTURES
Introduction
Diagnosis
History
Examination
Imaging
Radiographs
Other Modalities
Classifications
Salter-Harris System
Wilkins Classification
Judet Classification
Treatment
Nonsurgical (Closed) Reduction
Surgical Technique
Indications
Technique
Patient Positioning
Approaches and Relevant Surgical Anatomy
Technique Description
Elbow Arthrogram
Percutaneous Pin Reduction
Metaizeau Technique (Intramedullary Pin Reduction)
Open Reduction
Postoperative Management
Outcomes
Complications
Loss of Forearm Rotation
Growth Abnormalities
Complications Related to the Metaizeau Method
How to Avoid Complications
OLECRANON FRACTURES
Introduction
Diagnosis
Imaging
Classification
Nonsurgical Management
Surgical Treatment
Indications
Techniques
Patient Positioning
Approaches and Relevant Surgical Anatomy
Percutaneous Screw Placement
Tension Band Technique
Open Reduction and Internal Fixation with Plate/Screw Construct
Postoperative Management
Outcomes
Complications
Hardware Irritation
Loss of Elbow Motion
Delayed Union/Nonunion
CHAPTER 5:
Management of Forearm Fractures and Acute Monteggia Fractures in Children and Adolescents
INTRODUCTION
DIAGNOSIS
Clinical
Imaging
CLASSIFICATION
Fracture Location and Type
Open Fractures
NONSURGICAL MANAGEMENT
Closed Reduction
Cast Technique
Acceptable Reduction
Care after Closed Reduction
Parent Counseling
Outcomes of Closed Reduction and Casting
Complications of Closed Reduction
Malunion
Refracture
Compartment Syndrome
Cast Complications
SURGICAL TREATMENT
Indications
Preoperative Considerations
Intramedullary Fixation
Patient Positioning
Approach and Relevant Surgical Anatomy
Surgical Technique
Ulna Fixation
Postoperative Management
Plate Fixation
Patient Positioning
Approaches and Relative Surgical Anatomy
Plating Technique
Postoperative Management
Outcomes
Complications of Forearm Fixation
Hardware-Related Complications
Nonunion
Compartment Syndrome
INTRODUCTION
DIAGNOSIS
Clinical Presentation
Imaging
CLASSIFICATION
NONSURGICAL MANAGEMENT
Management after Closed Reduction and Casting
SURGICAL MANAGEMENT
Indications
Contemporary Techniques
Surgical Management of Acute Monteggia Fractures
Ulnar Fixation
Radial Head Reduction
Postoperative Management
OUTCOMES
COMPLICATIONS
Loss of Reduction
Missed Monteggia Fractures
CHAPTER 6:
Fractures of the Hand and Wrist
INTRODUCTION
ANATOMY
HISTORY AND PHYSICAL EXAMINATION
RADIOGRAPHIC IMAGING
Phalanx Fractures
Metacarpal Fractures
Carpal Fractures
Distal Radius Fractures
Advanced Imaging
NONSURGICAL TREATMENT
SURGICAL SETUP
PEDIATRIC PHALANX FRACTURES
Introduction
Phalangeal Base Fractures
Phalangeal Shaft Fractures
Fractures of the Phalangeal Neck and Condyles
Bony Mallet Finger Fracture
Seymour's Fracture
Complications
PEDIATRIC METACARPAL FRACTURES
Introduction
Metacarpal Base Fractures
Bennett's Fracture
Metacarpal Shaft Fractures
Metacarpal Neck Fractures
Metacarpal Head Fractures
Complications
SCAPHOID FRACTURES
Introduction
Open Reduction and Headless Screw Fixation
Volar Approach
Dorsal Approach
Rehabilitation
Complications
DISTAL RADIUS FRACTURES
Introduction
Fractures of the Distal Radial Metaphysis
Fractures of the Distal Radial Physis
Surgical Techniques for Treatment of Fractures of the Distal Radius
Closed Reduction and Pinning
Open Reduction
Dorsal Plating
Rehabilitation
Complications
Conclusion
CHAPTER 7:
Pediatric Pelvic Fractures and Fractures/Dislocations of the Hip
INTRODUCTION
CLASSIFICATION
Type I
Type II
Type III
Type IV
DIAGNOSIS
Imaging
TREATMENT
Type I and II Fractures
Type III Fractures
Type IV Fractures
COMPLICATIONS
CLASSIFICATION
HIP FRACTURES
Introduction
Classification
Diagnosis
Treatment
Timing of Reduction
Fracture Specific Considerations
Author's Preferred Technique
Complications
Osteonecrosis
Premature Physeal Closure
Coxa Vara
Nonunion
DISLOCATIONS AND FRACTURE DISLOCATIONS OF THE PEDIATRIC HIP
Classification
Treatment
Complication
CHAPTER 8:
Femoral Shaft Fractures
INTRODUCTION/EPIDEMIOLOGY
ANATOMY
MECHANISM OF INJURY
DIAGNOSIS
Clinical Presentation
Imaging
CLASSIFICATION OR DESCRIPTION OF TYPES
TREATMENT ACCORDING TO AGE
Overview
Infants (0–6 Months)
Preschool (6 Months–5 Years)
Children (5–12 Years)
Adolescents (12 Years to Skeletal Maturity)
TREATMENT OPTIONS
Pavlik Harness
Indications
Outcomes
Complications
Spica Casting
Indications
Preoperative Planning and Considerations
Technique
Outcomes
Complications
Walking Spica Cast
Indications
Outcomes
Traction and Casting
Indications
Technique: Traction Pinning
Outcomes
Complications
Flexible Intramedullary Nailing
Indications
Preoperative Planning and Considerations
Technique
Outcomes
Complications
External Fixation
Indications
Fixator Design
Preoperative Planning and Considerations
Technique
Outcomes
Complications
Rigid Intramedullary Rod Fixation
Indications
Technique
Outcomes
Complications
Submuscular Bridge Plating
Indications
Preoperative Planning and Considerations
Technique
Outcomes
Complications
COMPLICATIONS OF FEMORAL SHAFT FRACTURES
Leg Length Discrepancy
Angular Deformity
Rotational Deformity
Malunion
Delayed Union
Nonunion
Infection
Neurovascular Injury
Compartment Syndrome
Special Fracture Types
Subtrochanteric Fractures
Supracondylar Fractures
Open Fractures
CHAPTER 9:
Fractures About the Knee
INTRODUCTION
DISTAL FEMORAL PHYSEAL FRACTURES
Diagnosis
Classification
Treatment
Salter-Harris Type I and II
Salter-Harris Type III and IV
Postoperative Management
Contemporary Techniques (Current Preferred Technique)
Patient Positioning
Approach
Postoperative Management
Complications
Outcomes
TIBIAL EMINENCE FRACTURES
Diagnosis
Classification
Treatment
Type I Fractures
Type II Fractures
Type III-IV Fractures
Operative Treatment
Contemporary Techniques (Current Preferred Technique)
Patient Positioning
Approach
Screw Fixation
Suture Fixation
Open Reduction and Internal Fixation
Postoperative Management
Outcomes
Complications
PATELLAR FRACTURE
Classification
Diagnosis
Treatment
Contemporary Techniques (Current Preferred Technique)
Patient Positioning
Approach
Postoperative Management
Outcomes
Complications
Proximal Tibial Fractures
Classification
Mechanism of Injury
Diagnosis
Treatment
Postoperative Care
Contemporary Techniques (Current Preferred Technique)
Patient Positioning
Approach
Outcomes
Complications
TIBIAL TUBERCLE FRACTURES
Diagnosis
Classification
Treatment
Contemporary Techniques (Current Preferred Technique)
Patient Positioning
Approach
Postoperative Management
Outcomes
Complications
CHAPTER 10:
Tibial Shaft Fractures
INTRODUCTION
DIAGNOSIS
Clinical Evaluation
Imaging
CLASSIFICATION, COMMON VARIATIONS AND ASSOCIATED SIGNIFICANT INJURIES
Open Fractures and Soft-Tissue Injury
Vascular Injury
Compartment Syndrome
NONSURGICAL MANAGEMENT
Cast Immobilization
Acceptable Parameters for Closed Reduction
Care after Closed Reduction
SURGICAL MANAGEMENT
Indications
Preope rative Considerations/Planning
Open Fractures
Vascular Injury
Initial Steps of Operative Management
Positioning and Setup
Address Soft Tissues Prior to Fracture Reduction and Fixation
Provisional Fracture Reduction
Percutaneous Pinning
Recommended Indications/Contraindications
Surgical Technique
FLEXIBLE INTRAMEDULLARY NAIL FIXATION
Recommended Indications/Contraindications
Preoperative Planning
Surgical Technique
Postoperative Management
Nail Removal
EXTERNAL FIXATION
Introduction
Biomechanics and Design of External Fixators
Surgical Technique
Postoperative Management
Pin Care
Dynamization of the Frame
Fixator Removal
Statically Locked Rigid Intramedullary Nailing
Plate Fixation
Distal One-Third Tibial Fractures
Management of Bone Loss after Open Fractures
OUTCOMES
Clinical Studies of Flexible Nailing
Clinical Studies of External Fixation
Outcomes of Rigid Nail Fixation and Plating
COMPLICATIONS
Compartment Syndrome
Delayed Union and Nonunion
Leg Length Discrepancy
Tibial Deformities after Fracture
Proximal Tibia Fractures
Diaphyseal Malunions
CHAPTER 11:
Fractures of the Pediatric Ankle and Foot
INTRODUCTION
DIAGNOSIS
IMAGING
CLASSIFICATION
TRANSITIONAL ANKLE FRACTURES
NONSURGICAL MANAGEMENT
Nondisplaced Salter-Harris I and II Fractures
Nondisplaced Salter-Harris III and IV Fractures and Transitional Fractures
Displaced Salter-Harris I and II Fractures
Acceptable Reduction
Displaced Salter-Harris III and IV Fractures and Transitional Fractures
SURGICAL TREATMENT OF SALTER-HARRIS I AND II FRACTURES
Indications
Positioning
Surgical Technique
Postoperative Management
SURGICAL MANAGEMENT OF SALTER-HARRIS III AND IV FRACTURES
Indications
Positioning
Approach
Surgical Technique
Postoperative Management
TRANSITIONAL FRACTURES
Juvenile Tillaux Fractures
Indications
Preoperative Planning
Positioning
Approach
Postoperative Management
Triplane Fractures
Indications
Preoperative Planning
Positioning
Approach
Postoperative Management
OUTCOMES
COMPLICATIONS
INTRODUCTION
DIAGNOSIS
IMAGING
Radiographs
Advanced Imaging
TALUS
Classification
Nonsurgical Management
Closed Reduction of Talar Neck Fractures
Surgical Treatment
Indications
Positioning
Technique
Postoperative Management
Complications of Talus Fractures
Avascular Necrosis
Malunion
Arthrosis
CALCANEUS
Classification
Nonsurgical Management
Surgical Treatment
Indications
Surgical Technique
Positioning
Approach
Postoperative Management
Outcomes
Complications of Calcaneus Fractures
Posttraumatic Arthrosis
Complications of Open Reduction Internal Fixation
OTHER TARSAL BONES
Tarsometatarsal (Lisfranc) Injuries
Classification
Nonsurgical Management
Surgical Management
Indications
Technique
Postoperative Management
Outcomes
Complications
Deformity and Instability
Soft Tissue Complications
Compartment Syndrome
METATARSAL FRACTURES
Classification
Nonsurgical Management
Surgical Treatment
Indications
Surgical Technique
Positioning
Closed Reduction
Open Reduction
Fixation
Postoperative Management
Complications
Malunion
Posttraumatic Arthritis
FIFTH METATARSAL BASE FRACTURES
Classification
Nonsurgical Management
Surgical Treatment
Indications
Approach
Postoperative Management
Complications
Delayed Union and Nonunion
PHALANGEAL FRACTURES
Classification
Nonsurgical Management
Surgical Treatment
Indications
Positioning
Closed Reduction and Pinning
Open Reduction
Complications
Malunion
Joint Arthrosis
Compartment Syndrome
Technique
CHAPTER 12:
Neglected Fractures and Dislocations in Children and Adolescents
INTRODUCTION
FEMORAL SHAFT FRACTURES
Treatment Options
Outcome Studies
Summary
FEMORAL NECK FRACTURES
Treatment Option
Outcome Studies
Summary
NEGLECTED HIP DISLOCATIONS
Treatment Options
Outcome Studies
Heavy Traction
Open Reduction
Summary
SUPRACONDYLAR HUMERUS FRACTURES
Treatment Options
Outline Studies
Traction
Open Reduction
Osteotomy
Summary
FRACTURES OF THE LATERAL HUMERAL CONDYLE
Treatment Options
Outcome Studies
Summary
MONTEGGIA FRACTURES
Treatment Option
Outcome Studies
Open Reduction
External Fixation
Summary
NEGLECTED ELBOW DISLOCATIONS
Treatment Options
Outcome Studies
Open Reduction
External Fixation
Summary
INDEX
TOC
Index
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