fractures

Anatomy

Radial bow radius

- important for rotation

Interosseous membrane

- Z pattern

- proximal radius to distal ulna

Mechanism

Direct blow

- ulna / night stick

Ossification

Primary

- 8 / 52 gestation radius & ulna

Secondary

- distal radius age 1

- distal ulna age 5

Non Operative Management

Unacceptable Position

< 10:  > 15^o malalignment

> 10:  > 10^o malalignment

Postreduction Positionin / Rule of Thirds 

Displaced Tibial Shaft Fractures

Acceptable reduction

- varus / valgus < 5^o

- anterior / posterior < 5^o

- rotation 5^o

- shortening 10 mm

Poor remodelling potential

- valgus 

- apex posterior angulation  / recurvatum

- rotational alignment does not remodel

- shortening / in 2-10 year old average overgrowth is only 5mm

Anatomy

Bones more elastic and malleable

- absorb much more energy

Very thick periosteum

- can be periosteal sleeve fracture

Ossification

Triradiate cartilage fuses 13-16

Iliac / Ilium / ASIS apophysis

- appear as teenager

- fuse a couple of years later

- can confuse with fracture

Classification Key & Conwell 1951

Defect

Abnormality of type 1 collagen

- amino acid substitution of glycine with another amino acid

- prevents triple helix formation

Many many deformities described

- some 286 mutations of Type 1 collagen described

Sillence Classification

There are actually now 7 

Type I

- mild

- AD

- blue sclera

Definition

Fracture with break in skin communicating with fracture haematoma or fracture

- contamination with micro-organisms

- coupled with damage to ST and vascular supply

- leads to increased risk in infection and healing problems

Gustillo Classification

Grade I

- low velocity / wound < 1cm

- minimal contamination & minimal tissue injury

Grade II

Definition

A HLA B27 positive, seronegative spondyloarthropathy with sacroiliac joint & spine involvement

Mainly affects the cartilaginous joints of the axial skeleton

Diagostic Criteria (1966 New York)

1. Positive X-ray Sacroiliitis