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A-1214 Paediatric
Pernille Leicht, Denmark
Thursday, June 14, 2018 · 10:35 a.m. · 10m 55s
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the invitation to come and give this talk
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the question is what is the parametric and factor it's a
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fracture in a child who still have all vices
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when you're talking about paid yeah that's right hand
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factors yeah special considerations regarding to immobility station
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re modelling artifacts aside and surgical indications you have to be aware of
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if the factor in was suffices is the limit for
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a safe close to adoption for only five days
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and then it is important to remember one thing children on not small adults
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uh_huh in the chip europe bones there typically is a grove played in both ends
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but in the hand the grove played only exist in the proximal part
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of the fount is and in the proximal part of the first letter cobble bone
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and in the distal part of the second two fifties to meet a couple phone
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the closing of suffices goes from that used to go to the proximal direction
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devices close in goes when they are fourteen and a half ago out
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and in voice when they're sixteen and a half years so
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the treatment of the children will hand factors can in some way
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p. yep proper when the children come to the emergency room
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yeah they can't it can't be a great challenge us to examine them
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the child is often a freight he or she currents are you what has happened
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and they are not cooperative and often the parents are anxious to which doesn't help you
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then it is very important just to observe the chart tried to gives the child some
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toys to play with it and see how he or she uses the fingers
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it can be very hard to get the child activity to
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demonstrate how he or she flex or extend the fingers
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so examine a rotational deformity can't be
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it it still when you have to examine the ex uh the rotational deformity you can be useful
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to use the timit pieces effect to see if there are a
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rotation of deformity of the fingers when they passively flicks
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after the examination of the child we must have an x. ray
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and normally it is sufficient to have x. ray into
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planes one in the a. t. plan and one in the latter right plan
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and in fact has often involve suffices and the factors
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can be classified after the sorta here is type
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five types and here you can see an example of a sorta
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harris type one and that's sorta here is type two factor
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eighty to ninety percent of the fractures in
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children can be treated conservatively without operation
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the conservative treatment consist of a finger
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splint body taping or a cost
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pretty abstract bone grows occur through the fire so plate
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following fracture differential grow at the phi says and re modelling
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in the tire prices can correct for substantial in each other fact churches placement
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even if the fact is far away from the phi says as you can see in the pictures
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this occur most reliable in the pain of motion that's is fiction and
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action extension why it is less reliable in the cornell plan
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the operative treatment is iowa close treat
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auction combined with upper continue spinning
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all and open would auction compiled will combined with an
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internal fixation depending on the fact that type
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and some fractures in children require special attention as they
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have a high risk for sub optimal outcome
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it is the articulate fractures the distal feller and get a few
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still fractures the fellow until nick factors and the open factors
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the seymour fracture is air displaced
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the style fell aren't yeah love for use your
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factor a complaint on overlying nate but laceration
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and because of the laceration it is technically an open factor
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it is often a result of a crash injury
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the injury courses of flexed position of the distal
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phalanx bellcore tone of the to stuff airlines
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because of the imbalance between the flex a and that extends so tendons
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the extends the tendon inserts into the e. p. five says of the distant fairness
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and the flex a tendon insert into the meat suffices of the distal phalanx
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this results in a typically flexed position off the finger
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which often i misinterpreted as a mallet finger
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the treatment of the seymour factors into you know it can't be be operates you all non operative
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however most of the seymour factors should be treated objectively
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will open with auction and pinning across the t. i. p. join repay a of the native bit
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and replacement of the nail and of course antibiotics
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seymour fractures are often seen in children below the age of four to five years
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and then it is often advisable to put on a not powell go circular
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sort of cost including the high the higher entire hand after the operation
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it prevents the children to remove the bandage and it is
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also easier for them to play it because they are
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they and the parents don't have to take special care for
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the operated finger and complications to uh see more factor
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especially if they aren't treated correctly can't be a native strove yeah
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grow pretty close disturbances of that is that if
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airlines and the navy secondary fractured displacement
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if it isn't step last work a wire and chronic calls to me lights is
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and flexion and extension deformity in the t. i. p. u. joint
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and all that type of fact uh it's with a
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special interest in children other feller until nick factors
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the factors can be classified regarding to
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help transcends classification in three types
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type one can be treated with a splint and type two and three
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can be treated with closed or open with auction and fixation with k. y. s.
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this slide show a fellow anterior neck fracture type three
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you can see there is no bone contact in the lever
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plan at the time for the x-ray this factor
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was eleven days old and the girl is two years
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old she was primarily treat it with a splint
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after we saw her be gotten be didn't operation and it was an open adoption and
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fixation with the k. wires and the fact to heat but you can see at
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there is a an austin across is in the latter are uh in the radio part of
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the con time and it is this is because maybe because of the late operation
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another lakes radio show a proximal phalanx fact uh in a six years old boy
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in the a. p. plane you can see that you mean you would fracture in an acceptable position
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the picture in the lateral plan how they are is not acceptable
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you can see the fracture clearly because you know well a from ordeal fingers
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he was primarily treat it with the splint for three
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weeks without and x. rays check during this time
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after three weeks lisp impose removed and then you x. ray was taken
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and now we can see there's no regular colour healing and that is now a
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true level x-ray where we can see that is location of the factor
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he was operated with the right option open the toxin an internal fixation with k. y. us
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and after one yeah he had no complaining he has a normal range of motion
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in his finger and the x. ray show a complete remote link of the pool
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and finally i will give you some take home messages
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paid yeah track and factors are common and conservative treatment is
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usually sufficient if it is in the th it early
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see more factors should be diagnosed will accord lower on x. ray
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and treated will your occasion to put mime reduction of
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the fact you're painting and replacement of me
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finger mel rotation inmates a couple and for a long tail factors
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must be assessed clinically as x. rays to not reviewed the deformity
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it is very important to have x. rays into planes and
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with out overlap from the all the thing goes
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x. ray chick is important with the conservative
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traded commute fractures and in staple fractures
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late presentation of displaced used to control of fat failings factors
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maybe manage conservatively if they are well aligned in the coronal x. ray
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because the set itself melon i'd men can re model even in the older children
Conference Program
A-1214 Paediatric
Pernille Leicht, Denmark
June 14, 2018 · 10:35 a.m.
121 views
A-1214 Paediatric - Q&A
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