• types of epiphyseal fractures
• 5 Types
• Types I & II often heal on their own
• Types III-V often require surgery
• usually occur in long bones
• most are trough the zone of hypertrophy 

• seen in younger kids
• injury occurs directly across growth plate
• surrounding bone not involved
• Xrays often normal
• rapid healing

• Starts across growth plate, but continues up through shaft of the bone (away from the joint)
• Most common growth plate fx
• often seen in older kids

• Starts through growth plate, but turns and exits through the end of the bone and into the adjacent joint
• Cartilage is disrupted

• Starts above growth plate, crosses growth plate and exits through the joint cartilage (bone fractured on both sides of plate)
• Can impair normal growth
• surgery usually needed

• Growth plate is crushed
• poor prognosis
• bone alignment and length can be affected
• later surgery may be needed to restore alignment of the limb

• "chip", small fracture near a joint
• usually has ligament or tendon attached

fx without an open wound in skin 

aka closed fx

• ends of the fx are separated
• fx can displace (angulate, shorten, etc.), they do NOT dislocate

• incomplete fx
• usually in kids

• clinical condition suggests a fx, but it does not show up on Xray in the ER
• may show up in 2-3 weeks when new bone formation appears as a"line"

• open fx
• fx with an open wound in the skin

• fx when a weak bone is stressed normally (insufficiency fx), or...
• when a normal bone is stressed excessively (fatigue fx)
• most often caused by bone tumor, other causes: infection, cyctic lesions of bone and Paget's dz

• buckle fx cause by compression of the cortex
• usually in distal portion of radius of child

• poor bone healing
• soft tissue has grown around it to produce a false joint

• partial disruption in continuity of joint
• not completely dislocated

Describe:

• type
• place in bone
• amount of displacement
• angulation

• thick layer of cotton rolled on extremity
• form plaster splint
• wrap it all with elastic bandage
• used if definitive tmt of the fx is delayed

1. align bones in angular/rotational planes

2. Restore correct length

3. Properly appose bone ends

4. Immobilize enough for healing to happen

epiphyseal or colles fx: push reduction

Transverse fx: simple traction

Oblique fx: complicated manipulation

• Impacted surgical neck HUMERUS: shoulder immobilizer
• RADIAL head fx: sling
• OLECRANON fx: sling
• PATELLA fx: knee immobilizer
• FIBULAR shaft fx: crutches
• Base of 5th METATARSAL: hard sandal
• Stress fx: stop activity causing it
• Toe PHALANGES: tape to next toe
• CALCANEUS: crutches

1. Open or closed with internal fixation
2. Continuous traction followed by cast immobilization
3. Closed reduction with external skeletal fixation
4. Closed reduction followed by cast immobilization

• pins are inserted through the skin into bone above and below fx site
• held in place by an external frame (incorporated into outrigger or cast)
• usual indications: open fx (tibial) which req dressings or attention to a wound or flap
• also used for closed fx (ie unstable radius/colles fx)
• most successful in superficial bones (ie tibia)
• avoid in deeper bones (femur or humerus), b/c greater risk of pin tract sepsis

• Closed tmt preferred: healing much quicker, less chance for infection
• Open useful in: 
  • displaced joint fx (esp wt bearing joints, or when want pt to move joint early to avoid stifness)
  • when unable to reduce or hold the fx by any closed method
  • elderly: lower extremity fx
  • young: epiphyseal fx (growth disturbance)

• often used in fxs that are comminuted or unstable
• helps align the bone ends
• maintains reduction
• applied by skeletal traction pin: skin traction over time can cause blisters (except in very young)
• apply cast once healed enough

• most common fxs treated by manual reduction and immobilization (transverse or short oblique fxs (stable))
• will not work with long oblique, spiral or very comminuted fxs
• periosteum on side opposite the direction of displaced bone ruptures: allowing it to angulate and rotate 
• tissue on opposite side is usually kept intact (hinge); is used to guide displaced distal fragment into placement and maintain its placement
• cast is applied to hold the position and molded to keep tension on soft tissue hinge

• always correct rotational deformity
• adults: angular deform. must be completely corrected
• children: 15-20 degrees of angular deformity will correct itself
• do not always need perfect apposition for normal healing
• need exact reduction for fx of wt bearing joints
• slight shortening in the UE is ok, but NOT in the LE

• local anesthetic usually used: 5-10 ml injected into fx hematoma on extensor side soon after injury
• Regional anesthesia can be used
• Digital or metacarpal blocks good for finger fx
• general: used sometimes, but not often  

• Cast
• Partially immobilizes ends of fx
• allow ambulation
• hold position of reduction enough to heal

• the site of attachment of ligament or tendon to bone. 
• the root word used in the description of terms commonly used to describe inflammatory arthritides
• primary pathologic site in the spondyloarthropathies (enthesitis, enthesopathy, enthesophyte)
• enthesitis may lead to erosion or formation of reactive new bone

• ventral or anterior surface
• plantar, palmar or volar

lining of a joint.

produces fluid for joint nutrition

curvature of the spine with posterior convexity

• mild form normally present in the dorsal and sacral spine

Curvature of the spine with anterior convexity

• mild form normally present in the cervical and lumbar spine

backward bending or hyperextension 

loose-jointedness

"double-jointed"

the distal part angulates away form the midline of the body

• genu valgum: feet angled away from body so, knees bend inward 

the distal part angulated toward the midline of the body

• genu varum: feet angle toward midline of body so, knees are bowed out

• Develops when nerve and muscle perfusion is so minimal they cannot sustain themselves
• the P inside the natural fascia compartments of arm/leg rise (from fracture bleeding)
• this obstructs venous outflow
• further increases P = necrosis within hours
• Suspect if: 1. pain on passive stretching of muscle of affected compartment. 2. paralysis or sensory loss   3. tenseness of involved compartment

• after removal pt should expect: stiffness for several weeks, swelling, callous bumps, ↑ hair growth on extremities in kids, temporary limp. 
• 4-6 weeks ↓ activity until strength is back
• repetitive exercises done at home 
• swimming great to restore strength, mobility
• PT not usually needed
• Gentle bathing, mild skin lotion, support hose for swelling in LE
• 2 months before resuming sports
• bone scan can be + for 2 years