[Conservative treatment of fractures of the long bones during the growth phase]

[Traumatic physeal separations of the distal tibia. Occurrence, forms, treatment strategies]

Traumatic physeal separations (SH I/II) of the lower extremities are rare. Complications are reported in 2.2-39.6%. The current study is intended to provide recent data concerning epidemiology and treatment decisions in physeal separation of the distal tibia. All patients who suffered a physeal separation of the distal tibia in a 36-month period were included in a multicenter study. Age, gender, mechanism of injury, classification, therapeutic decision, and early complications were recorded online. There were 150 cases (64.6% male, 35.4% female, average age 11.8 years). The most frequent mechanism of injury was sportive activity (42%); 76% of cases needed reduction. Antecurvation was tolerated up to 10° (p=0.0021) and valgus up to 7° (p=0.0155). Tolerance ranges up to 5° of retrocurvation and varus were not statistically significant. The investigation confirmed epidemiological data of former studies. For the first time data concerning the treatment reality of physeal separations of the distal tibia were recorded. They consistently follow the recommendations of the appropriate literature.

The treatment of upper limb fractures in children and adolescents

BACKGROUND

The treatment of fractures in children and adolescents must be based on an adequate knowledge of the physiology of the growing skeleton. Treatment failures usually do not result from technical deficiencies, but rather from a misunderstanding of the special considerations applying to the treatment of fractures in this age group.

METHODS

We selectively reviewed recent publications on the main types of long bone fracture occurring in the period of skeletal development.

RESULTS

Alleviating pain is the first step in fracture management, and due attention must be paid to any evidence of child abuse. The goals of treatment are to bring about healing of the fracture and to preserve the function of the wounded limb. The growth that has yet to take place over the remaining period of skeletal development also has to be considered. Predicting the growth pattern of fractured bones is a basic task of the pediatric traumatologist. During the period of skeletal development, conservative and surgical treatments are used in complementary fashion. Particular expertise is needed to deal with fractures around the elbow, especially supracondylar humeral fractures, displaced fractures of the radial condyle of the humerus, radial neck fractures, and radial head dislocations (Monteggia lesions). These problems account for a large fraction of the avoidable cases of faulty fracture healing leading to functional impairment in children and adolescents.

CONCLUSION

The main requirements for the proper treatment of fractures in children and adolescents are the immediate alleviation of pain and the provision of effective treatment (either in the hospital or on an outpatient basis) to ensure the best possible outcome, while the associated costs and effort is kept to a minimum. Further important goals are a rapid recovery of mobility and the avoidance of late complications, such as restriction of the range of motion or growth disorders of the fractured bone. To achieve these goals, the treating physician should have the necessary expertise in all of the applicable conservative and surgical treatment methods and should be able to apply them for the proper indications.