non operative

LC-1:  pubic rami fracture with sacral fracture

Ossification

3 - 5 years old

Management

Undisplaced

- manage in plaster in extension

Displaced > 3 mm

- ORIF

Patella sleeve fracture

- usually small inferior fragment seen on xray

- patella high riding on xray / alta

- is actually large cartilaginous fragment avulsed with retinaculum

- can be osteochondral

Definition

Rockerbottom foot / Persian Slipper Foot

Epidemiology

Uncommon

50% bilateral

Doesn't delay walking

- may present in toddler with callus under talus head

Associations

Congenital anomalies

- CNS disorders

- spina bifida & diastematomyelia ~10%

- arthrogryposis

- neurofibromatosis 

Non operative Management

Indications

< 20^o sagittal

< 30^o coronal

< 3 cm of shortening

Options

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