600 Pediatric and Adolescent Upper Extremity Fractures скачать в хорошем качестве

600 Pediatric and Adolescent Upper Extremity Fractures

Presented by: Mary Lloyd Ireland Professor Dept. of Orthopaedic Surgery and Sports Medicine University of Kentucky Lexington KY www.marylloydireland.com 0:00 Introduction 0:37 Participation: Numbers in Organized Sports •Overall: (Hogan KA, “Overuse Injuries in Pediatric and Adolescent Athletes,” Orthop Clin North Am, 2003 Jul;34(3):405-15.) •30 million adolescents & preadolescents Little League 2007: (www.littleleague.org) •2,227,505 baseball participants •366,780 softball participants •2,640,285 total Little League participants USA Baseball: (www.mlb.mlb.com/usa_baseball) •9 million participants aged 9 to 17 1:53 Introduction •Children participating in sports each year:30 million •3.5 million children less than age 12 treated for sports injuries •50% of injuries are overuse Epidemic injury patterns in youth sports – elbow injuries in pitchers 2:18 Injury Risks •11,840 athletes, 5-17 years old •4,379,000 injuries annually •1,363,000 serious (missed school, surgery) Sport injuries: 36% of all injuries for this age group •Survey included playground equipment and skateboards 2:56 Survey 7-13 Years Old Children •Two playing seasons •Community organized •Injury rates per 1000 athlete-exposures: Soccer 2.1 Baseball 1.7 Football 1.5 Softball 1.0 3:31 Unique Properties of Growing Skeleton •Periosteum thicker •Cartilage thicker, more vascular 4:16 Fracture Healing •Three stages 4:39 Remodeling •Amount of growth •Patient age •Bone / physis involved •Location in bone – ie: proximity to physis •Deformity in plane of motion 5:38 Both Bone Forearm Fractures •Limits of acceptable reduction? •Functional complaints rare 6:45 Displaced fractures •Splint them as they lie •Can apply axial traction as assistant applies splint 7:08 Stress Fractures in Adolescent Competitive Athletes with Open Physis •Stress Fractures, 21 Athletes •7 cases not satisfactory outcome •4 tibial diaphysis •6 athletes burst of speed •Early and thorough investigation •Diagnosis Made •Routine x-rays + MRI scan •1 Surgery Olecranon 8:00 Imaging Studies •Radiographs PlainStress Views •MRI Scan •CT Scan with 3-D reconstruction •Bone Scan 8:39 Unique Aspects •Growth Plate •First line of failures due to stress or falls •Abnormal growth •Rotational adaptation •Physis / Epiphysis / Apophysis •Articular cartilage •Development •Softness 9:37 Appearance and Closure of Secondary Ossification Centers - UPPER EXTREMITY 10:46 Contributions of individual growth regions to overall limb length. 11:44 Which is Safer?Organized Sports or Free Play? 11:59 “Adults are obsolete children.” 12:07 I Am Invincible!