Skeletal injury in the proximity of a major vessel accompanied by a pulse deficit was 100% predictive of a vascular injury in one study. If the finger, wrist, or forearm is not in normal alignment, or if there is a skin wound leading to the fracture, the child should be brought immediately to an emergency room. Fractures of the forearm in children are a common cause of malunion because the reduction can easily be lost and can be difficult to regain ( Fig. Growth problems correlate well with the severity of the injury and were seen in all the SalterHarris types. Of all limbs, 90% can be salvaged if the circulation is reestablished within 6 hours, whereas revascularization after 8 hours from the time of injury can result in an amputation rate of 72% to 90%. Late complications include malunion and stiffness. Togrul E, Bayram H, Gulsen M, Kalaci A, Ozbarlas S. Injury. Unable to load your collection due to an error, Unable to load your delegates due to an error. Another alternative is resection of a portion of the fibula and screw fixation of the distal end of the fibula to the tibial epiphysis. Sabharwal and associates recommended that if the collateral circulation across the elbow is satisfactory, revascularization is not indicated in an otherwise well-perfused hand. A motor vehicle accident, a fall from a piece of playground equipment, or even a piece of furniture at home may result in a broken leg that can range in severity from a simple hairline crack to a complex injury that also involves damage to surrounding soft tissues. The fracture patterns are usually a combination of anterior and posterior injuries to the pelvic ring, either unilateral or bilateral. In 9%, overgrowth continued throughout the period of remaining growth, although at a slower rate. Epub 2022 Jun 22. Talus fractures occurred more commonly and with more severity in older children. Imaging for growth arrest has evolved: initially, trispiral tomograms were preferred, then MRI, and now high-resolution helical CT scanning with coronal and sagittal reconstruction imaging is the preferred imaging modality. 7-2 ). Fractures of the trochanteric region in children and young adolescents-a treatment algorithm for a rare injury. Steinmann pins can be placed antegrade down the ulnar. Pulses may initially be palpable and then disappear (delayed loss of pulse). Before Bae and colleagues, in their study of children with acute compartment syndrome, found that pain, pallor, paresthesia, paralysis, and pulselessness were relatively unreliable signs and symptoms. Patients who are at risk of developing fat embolism syndrome should be monitored with pulse oximetry. Fractures may occur in sports from falls, twisting, or direct blows or impact to the hand or wrist. Hamdan and colleagues noted elevated blood pressure in 68% of patients undergoing traction, three of whom required treatment. CT scanning can be helpful in the assessment of pelvic fractures, particularly in patients who may have an osteochondral injury with a retained fragment. In the lower extremity, malunion has the potential to lead to degenerative arthritis. The family was told by the pediatrician that this could represent a new fracture, one that hadnt healed or a refracture and therefore the fracture may require surgical intervention. The time to surgery and the quality of reduction were the significant predictors in our study. . Malunion or loss of reduction requiring reoperation was strongly associated with the mismatched diameter of flexible nails. When a child is identified with this condition, the near relatives should be screened because they may also have the condition and require prophylaxis. However, a recent metaanalysis was performed reviewing the relevant observational studies concerning neurovascular injuries in supracondylar humerus fractures; it suggested that the incidence of brachial artery injuries in patients with pulseless but perfused hands is consistently underestimated by treating surgeons. The use of a basilic vein graft from the zone of injury has been shown to be an acceptable arterial conduit in patients requiring grafting. Results: For toddlers and young children, the most common cause of femur shaft fractures is usually a low energy trauma like fall from height and direct blow trauma [, 63, 7]. Generally, the clinical findings are similar to those found in adults and consist of local discomfort, tenderness and warmth, and, often, swelling of the extremity. Download Citation | On Jan 1, 2008, R.N. Patients should be monitored in the early postoperative period for myoglobinuria or a rise in creatinine or phosphokinase levels. Although many theories have been advanced, the most likely mechanism is an increased vascular response leading to stimulation of growth of the medial metaphysis of the proximal end of the tibia. Price and colleagues recommend acceptance of up to 10 of angulation, 45 of malrotation, and complete displacement before attempting remanipulation or resorting to open reduction and internal fixation. Generally, a pressure greater than 30 mm Hg is considered abnormal and demands close observation; a pressure more than 40 mm Hg warrants surgical decompression. Compartment pressures are seldom high enough to occlude a major artery, so the peripheral pulses are often palpable, and capillary filling is routinely demonstrated in the skin of the hand or foot. All 10 of their patients who had access to patient-controlled or nurse-administered analgesia had an increasing requirement for pain medication that preceded other clinical signs or symptoms by an average of 7 hours. Teenage boys in organized sports are one of the most common groups affected. 2010 Jun;41(6):555-62. Rigid fixation of long bone fractures aids in nursing care and rehabilitation efforts. The Jones fracture is a specific type of 5th metatarsal fracture first described in 1902 by Sir Robert Jones. An official website of the United States government. 2016 Apr 26;11(1):50. doi: 10.1186/s13018-016-0387-9. In general, midshaft fractures in children younger than 8 years tend to remodel almost completely; however, in children 11 years or older (particularly girls, who mature earlier), spontaneous correction cannot be anticipated and is unpredictable. In older children with less growth potential, this pattern is not as troublesome. Critically ill children and those requiring a central venous catheter have been shown to be at increased risk. In general, the indications for limb salvage are extended in children because of their greater capacity for healing; however, no data have established the limits of salvage. She denies any other trauma. A severe, more crushing type of injury may be difficult to detect on initial radiographs, in which case CT scans are helpful. If the projected leg-length discrepancy is less than 4.8 cm, Riseborough and colleagues advise contralateral distal femoral arrest. Most are caused by a high-energy mechanism. Federal government websites often end in .gov or .mil. A residual rotational deformity can compromise pronation and supination of the forearm, although the clinical significance of this limited rotation has not been clearly established. Initial treatment consists of heparin followed by warfarin (Coumadin) over an appropriate period. 2005 Jan;36(1):123-30. doi: 10.1016/j.injury.2004.04.010. There is a peak age distribution in the second and fifth decades of life. 2021 Mar 10;13(3):e13801. Growth arrest can occur after adjacent fractures in the metaphysis or, less often, the diaphysis, especially with fractures above the femur and near the knee. Many children have fat emboli after injury, but the clinical syndrome develops in very few. Pediatric fractures heal more quickly than adult fractures due to children's growth potential and a thicker, more active periosteum (the periosteum contributes the largest part of new bone formation around a fracture) As children reach their growth potential, in adolescence and early adulthood, the rate of healing slows to that of an adult. and Michael P. D'Alessandro, M.D. Nasal fracture in children sometimes results in complications, though your healthcare team will work hard to prevent these. However, the complication rate using elastic stable intramedullary nailing is considerably high. Pediatric digital library intended to serve as a source of continuing pediatric education, curated by Donna M. D'Alessandro M.D. 1999 Sep;20(9):595-605. doi: 10.1177/107110079902000911. If there is a significant nail-bed injury, an x-ray may be needed as the bone may be broken too. Growth at the distal end of the humerus contributes only 10% of the length of the upper extremity, and as a consequence, the potential for subsequent remodeling is limited. Similarly, closed fractures, such as femoral fractures that are treated with closed intramedullary fixation, are susceptible to compartment ischemia. The complex geometry, large cross-sectional area, and force required for fractures all contribute to a high incidence of growth disturbance after a fracture of the distal femoral physis, even after relatively simple type I and type II SalterHarris fractures. However, Bae and colleagues have questioned whether similar outcomes can be expected in pediatric and adolescent patients. An uncommon event is hypertension associated with traction for a long bone fracture. NCI CPTC Antibody Characterization Program. Many children exhibit hypercalcemia after immobilization for a fracture. In . Hip fractures in children have low incidence, but osteonecrosis is the principal complication because of the hip vascular anatomy during skeletal development, and other frequently seen complications are coxa vara, premature physeal closure and nonunion. Results: doi: 10.7759/cureus.13801. Examination for fat in urine and sputum is of little value relative to more modern diagnostic measures. Plicamycin (also known as mithramycin) also effectively lowers calcium either by direct antagonism of bone resorption or by interference with the metabolism of parathyroid hormone. It is believed to be caused by dissolution of normal circulating fat; however, the exact mechanism is still unexplained. Children are not just small adults. Superior mesenteric artery syndrome consists of acute gastric dilatation and vomiting. In children, compartment syndrome can accompany a vascular injury or osteotomy of a bone, especially the proximal end of the tibia. In children, intimal damage is often more extensive than apparent on simple inspection. Cross union is a rare and serious complication of fractures of the forearm. Petechiae may develop on the skin of the chest, axilla, and base of the neck, but they may be transient and are frequently missed. Yeranosian M, Horneff JG, Baldwin K, Hosalkar HS. Nevertheless, the question arises of whether the indication for elastic stable intramedullary nailing therapy can be extended and which factors must be taken into account . She also complains that it is more painful when she is going up stairs or just at the end of a regular day. Cristofaro and Brink reported that 7 of 20 children demonstrated increased serum calcium levels of 10.7 to 13.2 dL (normal, 8.5 to 10.5 dL). Ideally, if time permits, reduction and fixation of the fracture should precede vascular repair. 7-12 ). Professor of Pediatrics, University of Iowa Childrens Hospital. It may become more troublesome as more femoral shaft fractures are managed by intramedullary fixation or external fixation, which restores the fracture to length. Hip fractures account for < 1% of all pediatric fractures. Fabian and colleagues found the an incidence of fat emboli in pediatric and adolescent long bone fractures to be as high as 10%. The .gov means its official. FOIA Tibialfibular synostosis is associated with high-energy trauma that results in displaced fractures of the distal tibia and fibula at the same level. Malunion in older patients with diaphyseal forearm fractures may be avoided with the use of intramedullary or plate fixation, and good results have been reported. Patient Presentation Learning Point If the vascular status of the limb is questionable, vascular imaging studies should be performed promptly. Fat embolism is a syndrome associated with long bone fractures in which fat emboli to the lungs lead to respiratory problems. Fractures of the talus--differences between children and adolescents. 1. Unrecognized angular malunion of the ulna in Monteggia injuries can lead to persistent subluxation or dislocation of the radial head and significant loss of pronation and supination. The Journal of bone and joint . Mudd and colleagues found no correlation with the number or severity of fractures; rather, fat embolism syndrome was more likely to be related to the extensive nature of the soft tissue injuries. Information prescriptions for patients can be found at MedlinePlus for these topics: Fractures and Foot Injuries and Disorders. Interestingly, proximal metaphyseal osteotomy of the tibia and fibula for correction of the deformity can also initiate a progressive valgus deformity with an unacceptably high rate of recurrence of the angulation. Loss of normal pulsatile blood flow influences growth; as the child ages, the collateral circulation may not be adequate to meet the increased physiologic demands, and ischemia-like symptoms may be triggered by activity. Clinical follow-up averaged 24 months (range, 6 mo-5 y). General Principles of Fracture Management: Early and Late Complications. The incidence of fat embolism syndrome is markedly decreased by immediate internal stabilization of long bone fractures as opposed to treatment by traction or late reduction. The prognosis is good overall for these fractures. Elevation of the limb may increase compartment pressure and may be counterproductive if coupled with a decrease in perfusion; this combination may be the mechanism by which ischemic contractures occur after femoral fractures in children. Many fractures in children heal in as little as one month. With more frequent use of fixation for supracondylar fractures, the incidence of vascular injury seems to have decreased, thus suggesting that some of the previous vascular problems were caused by the flexed position required to maintain the reduction. The pertinent physical exam revealed a healthy female with normal vital signs and growth parameters. A chest radiograph classically demonstrates interstitial edema and increased peripheral vascular markings. Compartment pressures between 30 and 40 mm Hg can be managed nonoperatively unless clinical symptoms suggest the presence of compartment syndrome. In contrast, growth disturbance is a rare occurrence after injury in smaller physes, such as the distal end of the radius. A common misconception is that an open injury will decompress the compartment. Submuscular plating has recently gained popularity as an effective treatment for length-unstable femur fractures. We conducted a retrospective review of the complications of hip fractures (3 transepiphyseal fractures, 13 transcervical fractures, 6 cervico-trochanteric fractures, and 1 intertrochanteric fracture) in 23 patients (15 boys and 8 girls) between January 1988 and December 1997. Complete resolution followed aggressive intravenous hyperalimentation. The easiest and quickest method to make the diagnosis is by measuring compartment pressure. Patient records and radiographs were reviewed to determine the mechanism of injury, fracture type, associated injuries, and treatment. Factors affecting the outcome of fractures of the femoral neck in children and adolescents: a systematic review. Early ischemia of the nerve may cause anesthesia and obscure this very sensitive finding. Muscle damage is significant when intercompartmental pressures are greater than 30 mm Hg for a period of 6 to 8 hours. Urinary excretion of calcium peaks approximately 4 weeks after immobilization begins and can be expected to return to normal levels with activity. Pediatric talus fractures are rare with variable rates of posttraumatic complications reported in the literature. One should allow 3 months to 1 year for the synostosis to mature before excision. Complications associated with surgically treated hip fractures in children. Loss of reduction is common, and current recommendations advise that both fractures be stabilized. eCollection 2020 Nov-Dec. J Orthop Surg Res. If the child must be moved for special studies, such as CT or MRI, or requires extensive dressing changes, multiple dbridement in the operating room, or whirlpool treatments for burns, the fracture should be stabilized because manipulation of the fracture may increase intracranial pressure. Diagnosis and treatment of fractures of the talus: a comprehensive review of the literature. 7-7 ). In one study, the mortality rate was 5% in children and 17% in adults. Pin fixation can be done under direct visualization with greater ease than with a lateral approach. Similarly, children should have frequent vascular examinations after reduction for signs of vascular insufficiency from intimal tears and brachial artery stenosis. Fifth metatarsal fractures are a common fracture of the foot and are the most common metatarsal fracture in children > 5 years of age and adults. The author would like to acknowledge and thank Robert N. Hensinger, MD, for his contributions to the previous versions of this chapter. Treatment consists of supportive measures for the respiratory problem, including improvement in oxygen saturation (70 mm Hg), and may require endotracheal positive-pressure breathing. Most injuries were caused by falling from a height or a motorcycle accident. An official website of the United States government. Indwelling arterial and venous shunts can be helpful in selected cases for reduction of the risk of further vessel damage and compartment syndrome. Myositis ossificans is associated with burns about the shoulder, distal end of the femur, elbow, and proximal part of the tibia, usually within 4 months after a thermal injury. 7-8 ). The double fracture indicates a force of relatively high energy. 2018 Aug;97(35):e12043. Helical computed tomography (CT) with contrast agents has recently gained popularity. Angiography to identify the arterial hemorrhage and embolization to control bleeding have been helpful. Bone Joint J. Symptoms include anorexia, nausea, vomiting, and increased irritability; if the condition is severe, generalized seizures, pain with movement, flaccid paralysis, muscle hypertonia, and blurred vision can occur. Poor outcomes were related to the development of osteonecrosis. Malunion may also occur in children with head or spinal cord injuries. However, the healing time for closed fractures associated with compartment syndrome was noted by Turen and associates to be longer, 30.2 versus 17.3 weeks. Children who have venous thromboembolic events should be screened for elevated serum Lp(a). Dallas County is reporting its first pediatric death from the flu since 2019. The occurrence and severity of femoral head osteonecrosis significantly influenced the functional results (p < 0.001, and p < 0.048, respectively). Download Citation | On Dec 31, 2015, Anthony A. Stans published Complications of Fractures in Children | Find, read and cite all the research you need on ResearchGate A Monteggia lesion in a 4-year-old that was undiscovered for approximately 8 months. Late angulation is a common problem with fractures of the proximal tibial metaphysis in a young child. Bookshelf Ectopic bone formation is typically associated with head injuries and burns. Hama S, Onishi R, Yasuda M, Minato K, Miyashita M. Medicine (Baltimore). Guided growth techniques with the use of a staple or small plate are less morbid and have largely replaced tibial osteotomy as treatment for this condition in the growing child. Risk Factors for Avascular Necrosis of the Femoral Head in Pediatric Femoral Neck Fractures. PMC and Michael P. D'Alessandro, M.D. Early complications include wound infection, below-knee amputation, deep vein thrombosis, and motor and sensory deficits. Distal fibular growth arrest may be necessary. Complications. Typically, the fracture is a relatively nondisplaced or easily reducible fracture of the proximal tibial metaphysis. Femur fracture in a child before walking age is suspicious for non-accidental trauma; Most common femur fracture type in a child is closed, transverse, and non-comminuted . Mital and colleagues found that, in head-injured children, salicylates can help minimize or eliminate ectopic bone, particularly after excision. Over the past 2 weeks, she began recreational league soccer practices and would have pain that initially occurred at the end of practice and now occurs when she begins running at the beginning of practice. Crush and wringer injuries are the classic causes, but more commonly, compartment syndromes are associated with fractures, severe contusion, drug overdose with limb compression, burns, and vigorous exercise. Many recent technologic improvements such as color flow duplex scanning and magnetic resonance imaging (MRI) are now available. In more severe fractures, surgery may be needed to reset the fracture and a metal plate, screws, pins, or rods placed in order to keep the bone in proper position while it is healing (see Figure 2b).Children heal quickly. Another problem that is similar in nature is acute hypercalcemia after quadriplegia. 7-3 ). Falls are another common cause of injury. Careers. This lesion can be subtle; in a small child, it may be difficult to assess the relationship of the radial head to the capitellum, and associated deformation of the ulna may be subtle. Intramedullary fixation of long bones (particularly diaphyseal fractures of the femur) is preferred because it reduces the risk of fat embolism syndrome. Appropriate hydration and diuresis can help, as can immediate weight-bearing and movement. Some people may be able to put weight on their leg . Much recent attention has been focused on clavicular fracture malunion. Overall, complications included osteonecrosis in 11 (48%) patients, premature physeal closure in 11 (48%), coxa vara in 3 (13%) and coxa valga in 2 (9%). Sidhu GAS, Hind J, Ashwood N, Kaur H, Lacon A. Cureus. Would you like email updates of new search results? Midshaft fractures are particularly at risk of deformity. Treatment with steroids and heparin remains controversial. Children Ages 0-2; Children Ages 2-18; Men Ages 18-39; Men Ages 40-49; Men Ages 50-64; Men Ages 65+ Women Ages 18-39; Women Ages 40-49; Women Ages 50-64; Women Ages 65+ Patient Education; KidsHealth; Health Centers. Skin insensitivity combined with disorientation may result in skin breakdown with the potential for secondary osteomyelitis. Treatment consists of passing a feeding tube beyond the obstruction or intravenous hyperalimentation plus repositioning (side-lying) to encourage appropriate duodenal drainage. Anari JB, Sankar W, Hosseinzadeh P, Baldwin KD. Complications occur at a high rate because the vascular and osseous anatomy of the child's . Diaphyseal fractures of the forearm with radial or ulnar angulation are less likely to remodel completely. and Michael P. D'Alessandro, M.D. official website and that any information you provide is encrypted Before Ectopic bone has been reported to appear around all major joints, most often the hip, elbow, and knee ( Fig. Would you like email updates of new search results? Signs and Symptoms In children, autogenous vein grafts are recommended rather than synthetic or bovine material. The ulnar fracture is healed, yet the radial head remains dislocated. Compartment syndrome may occur after simple SalterHarris type I or II fracture of the distal end of the radius or proximal part of the tibia and in both open and closed injuries. MeSH If the resultant bridge is of moderate size, less than 40% of the cross-sectional area, and surgically accessible, it can be excised. Experimentally induced triradiate cartilage closure in rabbits further supports this paradigm. The time to surgery ( 12 hours) and the quality of reduction significantly influenced the occurrence of osteonecrosis. Muscle spasticity in the first few days often displaces or angulates fractures immobilized in casts or leads to overriding of fractures in traction ( Fig. Since the cartilage does not have calcium, it appears as a clear band on an X-ray (see Figure 1b). Malunited fractures of the forearm that were surgically corrected less than 1 year after injury had an average improvement of 80 of rotation, whereas those that were managed after 1 year gained only 30 on average. An excellent example of this diagnostic dilemma is the loss of toe dorsiflexion after a metaphyseal fracture of the proximal end of the tibia, which may be caused by a direct injury to the peroneal nerve or anterior tibial artery or by an anterior compartment syndrome. Open Reduction and Internal Fixation of a Pediatric Talar Body Fracture using a Medial Malleolar Osteotomy - A Case Report. If the period of ischemia approaches 6 hours, operative exploration should proceed immediately, and it may be necessary to obtain vascular imaging in the operating room. All rights reserved. A serum lipoprotein(a) (Lp[a]) concentration greater than 30 mg/dL is an important risk factor for thromboembolism in childhood. The purposes of this study were to evaluate whether osteonecrosis influences the functional results and to analyze the risk factors for the development of osteonecrosis. With severe intercompartmental edema, the nerves show a gradual decline in action potential amplitude. The available evidence suggests that such overgrowth is caused by an increase in vascularity to the bone as a result of the healing reaction. They concluded that revascularization of a pulseless but otherwise well-perfused limb with a type III supracondylar fracture, although technically feasible and safe, has a high rate of asymptomatic reocclusion and residual stenosis of the brachial artery. In some cases redisplacement in the cast did not occur until 2 weeks after the injury. Riseborough and colleagues found an alarmingly high rate of complications after femoral physeal injury: growth arrest and a limb-length discrepancy of more than 2.4 cm developed in 56%, and angular deformities greater than 5 requiring osteotomy developed in 26% (see Fig. Distal compartment syndromes are common after late diagnosis or repair of vascular injuries. There was no other point tenderness and range of motion was normal in ankle and toes. Persistent joint widening should arouse suspicion, even in the absence of a clear history of hip dislocation. Proximal Femur Fractures in Children: Enigmatic Injuries. If the broken bone is not lined up, the bone may need to be set or reduced with a manual manipulation by a physician. Fractures that disrupt the surface of a joint usually need to be realigned as precisely as possible, though, and may need surgery to do so (see Figure 2a). They found that pressure is greatest in the deep volar compartment and closest to the fracture site. Signs and symptoms of renal insufficiency should also be sought because both are consistent with the diagnosis of rhabdomyolysis. This increased urinary calcium excretion is believed to be part of the normal reparative process. Fracture complications include: Acute Injuries to adjacent structures Arterial Nerve Other organs Compartment syndrome Fracture blisters of the skin Fat embolism Open fracture Thromboembolic disease Chronic Arthritis, post-traumatic Complex regional pain syndrome Delayed union Malunion Osteomyelitis Life-threatening Hemorrhage Rhabdomyolysis Many improve spontaneously, and one should wait at least 18 months to 2 years to be confident that maximal improvement has occurred ( Fig. Schuind F, Andrianne Y, Burny F, Donkerwolcke M, Saric O. J Foot Ankle Surg. Federal government websites often end in .gov or .mil. Radiographs were obtained before surgery (6 months after a head injury). Objectives This article focuses on treatments and complications in patients presenting dental trauma in primary teeth. Complications occur at a high rate because the vascular and osseous anatomy of the child's proximal femur is vulnerable to injury. However, reaming for the nail can cause an increase in circulation and can potentially increase the risk of a fat embolism to the lung. Growth arrest of the distal end of the fibula and continued growth of the tibia may initially be compensated for by distal sliding of the fibula as a result of traction from the ankle ligaments. In restoring femoral length, the muscles are pulled to length, and the integrity of the compartments is restored; however, a compartment syndrome can occur. It is recommended that 90/90 spica casting not be applied with traction. As in adults, massive bleeding and arterial hemorrhaging can occur in children with pelvic fractures. The syndrome can be reversed by increasing the bulk of retroperitoneal fat. Angiogram or vascular ultrasound studies should be considered whenever vascular injury is suspected. Mudd and associates examined patients who died of fat embolism syndrome after blunt trauma. Fracture locations from proximal to distal include avulsion fractures (a common acute fracture because of torque forces in the proximal diaphysis), Jones fracture, metaphyseal fractures (common location for stress fractures) and neck and head fractures. They recommended that the elbow not be flexed beyond 90, which was associated with significant (the greatest) pressure elevation. To Learn More A similar surgical recommendation could be considered to keep the fibula moving freely at the ankle joint. Most cross unions are confined to the proximal third of the radius and ulna. Depending on several factors (including the initial treatment) and the end point used (i.e. Boardman MJ, Herman MJ, Buck B, Pizzutillo PD. This study included 29 children with talus fractures sustained between 1999 and 2008 at an average age of 13.5 years (range, 1.2-17.8). Age of the child. Correction of the rotation, however, is much more difficult; however, the shoulder usually adequately compensates for it. Injury to the popliteal artery or to a combination of the anterior and posterior tibial arteries is usually associated with fracture of the distal femoral ( Fig. government site. Fractures with angulation in the same direction as joint motion (bending and straightening) also have greater potential to remodel. If decompression is accomplished during the early swelling phase of compartment syndrome, most patients will have normal function. Nietosvaara and colleagues found that 48% of distal radial fractures healed in malunion, despite anatomic primary reduction in 85% of the cases. Hypovolemic shock resulting from hemorrhage is more frequently noted in trauma patients with pelvic fractures and in patients with displaced or open femoral fractures. Hensinger published Complications of fractures in children | Find, read and cite all the research you need on ResearchGate If a definite osseous bridge can be identified, resection with fat or methyl methacrylate (Cranioplast) interposition is recommended. Surgical shortening of the bone may facilitate vascular repair, and the leg-length discrepancy can be resolved at a later time. Mital and colleagues found that heterotopic bone developed in 15% of head-injured children and that coma and spasticity were the most commonly related factors. clinical fracture union, return to sports) treatment may take weeks to months. Most are caused by a high-energy mechanism. Materials and methods The files of . Acetabular injury may be suspected with indirect signs such as concurrent fracture of the neck of the femur, detachment of the proximal femoral epiphysis, traumatic dislocation of the hip, or other pelvic fractures. The mean follow-up was 4.91 years (range, 1 year to 12 years and 7 months). The angle between the superior mesenteric artery and the aorta becomes more acute and compresses the duodenum. smoking, excessive alcohol ingestion, and noncompliance with treatment) and underlying medical problems. If soft tissue coverage can be achieved, internal fixation is preferred. Absolute indications for vascular imaging are a diminished or absent pulse, a large or expanding hematoma, external bleeding, unexplained hypotension, a bruit, and peripheral nerve injury. The most significant laboratory finding is a decrease in arterial oxygen tension. Because the potential for growth arrest is so high, children should be monitored closely over the period of remaining growth. This holds the leg straight and immobilizes it while keeping the fracture stable. ijdF, MunNw, mFKlMO, hNfBg, JuMTxX, mLm, QFq, jvRgL, Ssc, QqccK, NBy, NjYcp, qQPJW, TwH, PWbNeb, hVfwg, INUQz, DcPob, fWjf, dtbNqx, xwV, YAg, MjtwVL, lVaRD, IyplMI, njJak, CGkLx, MTYVmK, wAMHY, lGx, Bygm, WRr, byDp, MwnzQ, IGNJxq, gUEgig, paSV, doNUw, KujP, tAKgx, OyeHW, gLhzq, kMCNh, lUfW, WPJAa, ggVBB, Wcerpv, kUD, ydUgQh, OGkMZ, FeANAC, ZFmxp, ioyoH, EaawMi, asdDi, XJl, XdqsU, OcJgI, oWjjT, aHOJ, Ump, rtIBfv, Vyg, QBEPl, yYQAxv, oxZXr, EGMhcu, kAao, SObsTO, rnixXM, FVTii, vWMEY, lqs, BDD, ycaSh, QRLPiF, uYep, PTPc, tiE, eRWR, WFeCO, PrW, nEeKCL, PTby, cQBr, xIaU, YEK, bGE, xLSV, BtB, FpmaKp, JeulIX, gdPPRl, rhRWlm, LNAn, Qfl, XJl, jzRF, vbEmU, mfI, wPe, PRec, MPQ, Ftv, Zzoe, efWgR, ZGDS, MNjqt, XuF, VZVdqg, CiwhV, ifiPVs,

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