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Know About Fracture of Femur in Children
ABOVE THE AGE OF FIVE YEARS Basic principles of management for fracture of femur at this age are the same as those of the children under the age of five years. Fixed traction on a Thomas splint: Usually no anesthesia is required. Fixed traction is applied on a Thomas splint. The foot end of the bed is elevated. The counter-traction exerted by the body weight corrects the shortening of the limb produced by the fracture. Any rotational or angulatory deformity of the leg is automatically corrected by accurate positioning of the affected limb. Union:This usually takes place within the period of 6 to 8 weeks. After care: Traction is removed after clinical and radiological evidence of union is established. The patient is advised to stay in bed for one week. It is advisable to allow the patient to walk around with the aid of crutches for 2 weeks. SUPRACONDYLAR FRACTURE OF FEMUR Supracondylar fracture of femur is a serious injury. The condition often requires a skillful judgement. The close proximity of the popliteal vessels and sciatic nerve to the site of fracture ca prove to be dangerous but in most cases they are spared from being involved in the process of injury. MECHANISM OF INJURY The injury is produced by severe direct violence. Automobile accident or a fall from a height is likely to produce this type of lesion. NATURE OF FRACTURE The nature of fracture depends upon the severity of trauma. The lesion may vary from the simple undisplaced variety to the displaced and comminuted type. Amongst the compound fractures the bony edge may project outside. TREATMENT In many cases closed reduction may prove to be successful but some require operative intervention. Technique of closed reduction:The procedure is performed under general anaesthesia. Skeletal traction:Arrangement for skeletal traction is done by inserting a pin at the level of the tibial tubercle. Reduction:Posterior displacement of the distal segment is due to pull of the gastrocnemius muscle. Manipulation:Traction is exerted with the knee in a flexed position. This procedure tends to neutralize the pull exerted by the gastrocnemius. While the supports the thigh of the patient, the operator exerts traction towards a slightly upward and anterior direction. This tends to bring the distal segment to a more anterior position than the proximal one. Attempt is then made to alienate the segments by bringing the distal segments into its normal position. Immobilization:Reduction can be maintained with the knee in a flexed position. This is obtained by applying traction on a Thomas splint attached to the flexion piece. Post-reduction management: X-rays are done at intervals. Regular check-up of the traction appliance is done. Union usually takes place after 2 months when the traction is removed. Operative reduction and internal fixation: Internal fixation may be necessary in many cases. Considerable skill is required to perform this procedure. Fixation can be obtained bybone screwsand plate. Screws and nails can be obtained by the orthopedic products manufacturers in India. In selected cases Rush nails can be introduced from below upward through both the condyles. FRACTURE SEPARATION OF DISTAL FEMORAL EPIPHYSIS Amongst the children, fracture separation of distal femoral epiphysis is like supracondylar fracture of femur in adults. The condition should be recognized, and reduction must be maintained properly. Improper management will lead to growth disturbance. NATURE OF INJURY This type of lesion is produced by severe violence. The epiphysis may be displaced either anteriorly or posteriorly. i. Anterior displacement:This is the result of hyperextension injury because of direct violence over the distal end of femur. The femoral shaft is pushed posteriorly while the distal epiphysis is displaced anteriorly. The periosteal sleeve over the anterior part remains intact but there is disruption of the posterior part of periosteum. Popliteal vessels and nerves are liable to be injured when there is delay in proper management of the case. ii. Posterior displacement:The nature of injury which produces this type of lesion is just opposite to that of the one producing the anterior displacement. iii. Lateral displacement:The distal epiphysis is displaced laterally by the abduction injury. The violence is produced over the outer aspect of the distal end of the thigh. DIAGNOSIS Clinical examination: There are swelling, pain, deformity and restricted movement round the knee-joint. The circulatory condition of the limb below the knee must be assessed which in some cases may be found to be impaired. X-ray: The nature of displacement is confirmed by x-ray. TREATMENT Manipulation is done under general anaesthesia. Traction is exerted on the semi-flexed knee while counter-traction is applied by the assistant holding the thigh of the patient. As the traction is maintained, the anterior displacement is corrected by exerting pressure on the distal segment directed posteriorly. In cases of posterior displacement the pressure is exerted anteriorly, while laterally displaced position can be corrected by exerting pressure opposite to the direction of violence. Immobilization:Plater cast is applied with the knee-joint in a state of slight flexion. The cast extends from the upper part of the groin to just above the malleoli. The plaster is removed after 4-6 weeks. Post-immobilization management:After removal of plaster, the patient is advised to perform quadriceps and knee-joint exercises. Patient is allowed out of bed after a period of one week but partial weight bearing with the aid of crutches should be allowed for a period of one month. This information edited and provided by senior content editor at Siora Surgicals. We are one thebest orthopaedic implants importeracross the globe. 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