Lecture 8 Management of Pediatric Foot and Ankle Fx Dr. Dayton

Question 1

What bone type if predominant in children?

Answer 1

Woven bone. It is more porous than lamellar with the same mineral content.

however the periosteum is thicker.

Question 2

What is the weakest spot in the physis?

Blood supply?

Answer 2

Weakest spot is between the zones of hypertrophy and ossification.

Blood is supplied from three sources.

Question 3

What blood supplies the epiphysis?

Answer 3

Capsular soft tissues

Question 4

What blood supplies the metaphysis?

Answer 4

Endosteal vessels

Question 5

What blood supplies the physis?

Answer 5

Epiphyseal arteries
Metaphyseal arteries
Perichondral arteries.

Note this is unique in that it is supplied by three different arteries.

Question 6

When looking at the epiphysis and the metaphysis, do they share the same blood supply?

Answer 6

No the blood supply to these two structures is different.

Question 7

Pressure physis

Answer 7

Secondary ossification center that forms a joint.

Question 8

Traction physis

Answer 8

Secondary ossification center that serves as an attachment site for tendon (os tibiale)

Question 9

When comparing compression and tension in pediatric bone, which is weaker?

Answer 9

Pediatric bone is weaker to compression pressure compared to tension.

It is able to undergo plastic deformation and rarely comminutes.

Question 10

What force is the physis most resistant to and what is it least resistant to?

Answer 10

Most resistant to traction.

Least resistant to torsion.

Question 11

Why is it possible to reduce pediatric patient with less precision than adults?

Answer 11

Children undergo angular remodeling allowing for less than perfect reduction as the position will improve with time secondary to growth and external forces.

Must stay less than 15 degrees of angulation outside the plane of motion though!!

Question 12

what is a Salter harris type 1 fracture pattern?

Answer 12

Salter haris type 1 is when the physis is shifted alone.

Question 13

What is a salter harris type II fracture pattern?

Answer 13

The fracture line is through the metaphysis.

Question 14

What is a salter harris type III fracture pattern?

Answer 14

Fracture line is through the epiphysis.

Question 15

What is a salter harris type IV fracture pattern?

Answer 15

Fracture line is through the epiphysis and the metaphysis.

Question 16

What are the principle of physis fracture ORIF?

Answer 16

Gaps >2mm increased incidence of growth disturbance.

Do not disturb the physeal periosteum.

Only SMOOTH PINS USED DO NOT CROSS PHYSIS

Keep the pins parallel its safer than crossing and remove them early.

Question 17

Salter Harris V

Answer 17

Crush of the physis typically by axial load.

there is no physis slip or visible fracture apparent but there is HIGH RISK for growth interuption.

Question 18

Rang’s Type VI fracture?

Answer 18

Following blunt trauma
There is damage to the perichondral ring causing osseous bridging of one side of the physis.

this leads to angular deformities due to partial physeal closure.

Question 19

Salter Haris VI

Answer 19

Damage to periosteum or perichondral ring with resultant bony bridge formation external to the growth plate.

Question 20

What are the Dias-Tachdjian classifications based on?

Answer 20

Foot position and direction of rotation of the talus.

typically a combination of salter harris and the lauge hansen classifications.

Question 21

Whatg are the two transitional fractures?

Answer 21

These are the tilaux fractures and tri-plane fractures.

Question 22

What is a triplane fracture?

Answer 22

A transitional fracture (age 12-13) due to an external rotation force.

Because the anterolateral tibial physis is not yet closed it breaks off into three fractures one in each planes.

also effects the epiphysis, metaphysis, and physis.

Question 23

Which physis closes first in pediatric patients during the transitional phase?

Answer 23

the antero medial.

followed by the middle and the anterolateral.

Question 24

Juvenile tillaux Fracture

Answer 24

Biplanar fracture lateral aspect of the distal tibia is pulled off by the intact distal tib fib ligament.

The mechanism of injury will give a Salter Haris Grade three type of injury (through the metaphysis)