Salter-harris type ii fracture treatment india,m even autoonderdelen almelo,type 2 diabetes and kidney problems uk - Good Point


In this article we will focus on detection of fractures, that may not be so obvious at first sight. Before you read this article, you need to understand the classification of ankle fractures and exorotation injuries that were highlighted in Ankle - Fractures 1 and 2. Almost all fractures of the malleolus tertius are part of a rotational injury resulting in a Weber B or Weber C fracture.
In some cases the tertius fractures are easily seen on the x-rays, but frequently they can be difficult to detect.
It is important to find these fractures, since a tertius fracture can be the only clue to an unstable ankle injury. When we study the radiographs of a patient with an ankle injury, we have to study the region of the malleolus tertius very carefully. In many cases there is only a small gap between the fracture parts and detection depends on optimal radiography and a high level of suspicion. This tertius fracture can also be seen on the lateral view, but in many cases we need all the information of both the lateral and AP-view to diagnose a tertius fracture. In some cases a fracture of the malleolus tertius is barely or not visible on the radiographs and can only be seen on CT. The CT shows an avulsion of the tertius at the insertion of the posterior syndesmosis (red arrows). Maybe the fracture is seen on the AP-view as indicated by the red arrows, but this is questionable.
Notice that there is also an avulsion at the tibial insertion of the anterior syndesmosis, i.e.
The technician made the standard AP-, Mortise- and lateral view and showed them to the radiologist, who was a little bit puzzled.
The radiologist decided first to order a CT to find out if there really was a tertius fracture. It is amazing, that such a large tertius fragment is so difficult to see on the radiographs.
Also notice the soft tissue swelling on the medial side indicating rupture of the medial collateral ligaments (arrow).
Medial soft tissue swelling and a tertius fracture are both indications of a Weber C or Pronation Exorotation injury. Since there is no fibula fracture seen on the x-rays of the ankle, there must be a high fibular fracture. At physical exam there was some swelling on the medial side and although the patient did not complain of any pain higher in the lower leg, there was some tenderness when the fibula was palpated.
This case illustrates the importance of medial soft tissue swelling aswell as the finding of a tertius fracture. According to Lauge Hansen we can conclude that this patient first had a rupture of the medial collateral ligaments (stage 1), followed by a rupture of the anterior syndesmosis (stage 2) and a high fibula fracture (stage 3) and finally an avulsion of the malleolus tertius, i.e. There was an indication for fixing the posterior malleolar fracture, since the fragment involved more than 25% of the articular surface of the distal tibia. Knowing that this can be the only clue to a high Weber C, additional radiographs were taken. Final diagnosis is a Weber C fracture or according to Lauge Hansen: Pronation Exorotation injury stage 4.
It is seen when someone's foot hits the ground and a fragment of the malleolus tertius is pushed off by the talus. The Salter-Harris classification describes fractures that involve the epiphyseal plate or growth plate.


The fracture through the growth plate is usually obscure and difficult to differentiate from normal variations of the growth plate. A type II growth plate fracture starts across the growth plate, but the fracture then continues up through the metaphysis. This is the most common type of growth plate fracture, and tends to occur in older children.
A type III fracture also starts through the growth plate, but turns and exits through the end of the bone, and into the adjacent joint.These injuries can be concerning because the joint cartilage is disrupted by the fracture. These injuries also tend to affect older children in whom the growth plate is partially closed. Type IV is a fracture through all three elements of the bone, the growth plate, metaphysis and epiphysis. Notice that the epiphyseal fracture is in the sagittal plane, the fracture through the growth plate is in the axial plane and the metaphyseal fracture is in the coronal plane.
Proper positioning is also essential with type IV growth plate fractures, and surgery may be needed to hold the bone fragments in proper position. Type V growth plate fractures carry the most concerning prognosis as bone alignment and length can be affected. These types of fractures may permanently injure the growth plate, requiring later treatment to restore alignment of the limb. This fracture is named triplane because it occurs in the coronal, sagittal and axial plane. It is seen exclusively in young adolescents in the period, when the medial tibial epiphysis is closed, while the lateral portion is still open leaving it vulnerable to injury. As the force cannot continue into the medial part of the growth plate since this is already closed, the epiphysis will fracture. At first this looks like a Weber B fracture with an oblique fracture in the fibula as seen on the lateral view (black arrows). On the AP-view there is a lucency within the epiphysis, which is the epiphyseal fracture in the sagittal plane.
Notice also that the medial epiphysis is already closed, while the lateral portion is still open(blue arrows). In 1840 Maisonneuve described a frature of the proximal shaft of the fibula, which was caused by exorotation force applied to the ankle. These fractures are easily overlooked because the patients rarely complain of pain in the region of the proximal fibula, since the ankle is most painful. According to Lauge-Hansen this is the first stage of a pronation exorotation injury, which results in a Weber C fracture. In all these subsequent stages, purely ligamentous injury will not be visible on the radiographs of the ankle. So even in a Weber C stage 4 sometimes only a fracture of the medial malleolus will be visible.
In the illustration we see the fractures and ligamentous injury on the left and the resulting x-rays on the right.
Most fractures of the malleolus tertius are part of a complex ankle injury, either Weber B or Weber C. So if there is a tertiu sfracture and no sign of a Weber B fracture, then we have to start looking for a high Weber C fracture. An isolated tertius fracture on the ankle radiographs indicates the presence of an unstable ankle injury. Additional radiographs of the lower leg were taken and demonstrated a high fibular fracture, also known as Maisonneuve fracture.


This case demonstrates that there can be an unstable ankle injury that needs surgery even when the radiographs of the ankle do not show a fracture.
An isolated fracture of the malleolus tertius is uncommon, but as part of a supination exorotation (Weber B) or pronation exorotation injury (Weber C) it is quite common. No sign of an oblique fracture of the lateral malleolus, so we can exclude a Weber B fracture.
Additional radiographs of the lower extremity demonstrate a high fibular fracture (blue arrow). In such a case, you have to rule out a Maisonneuve fracture, which is a high Weber C fracture.
External rotation injury of the ankle is the most common ankle injury and can lead to a Weber B or Weber C fracture.
One of the first stages in this injury is rupture of the anterior tibiofibular ligament (or anterior syndesmosis). Whenever you see such a fracture, you have to look for higher stages of this exorotation injury.
There is a Tilleaux fracture due to avulsion of the anterolateral part of the distal tibia by the anterior syndesmosis. Stage 1 is rupture of the medial collateral ligaments and stage 3 is a fibula fracture above the level of the syndesmosis. So now we start looking for stage 4, which is rupture or avulsion of the posterior syndesmosis. The fracture occurs when the medial epiphysis has fused and the lateral part becomes avulsed at the attachment of the anterior tibiofibular ligament (or syndesmosis). Fractures of the ankle, combined experimental-surgical and experimental-roentgenologic investigationsby N. The AO Surgery Reference is a huge online repository of surgical knowledge, consisting of more than 7000 pages. Greenstick fractures may need to be turned to a complete fracture (under anesthesia!) to allow a good alignment before immobilization. 3.- Under the category “other fractures” we include some fractures with special features that worth a specific explanation. A line drawn along the anterior surface of the humerus on the lateral radiography (called "anterior humeral line") should intersect the middle third of the capitellum. 2 clicks for more privacy: On the first click the button will be activated and you can then share the poster with a second click. Rapid bedside assessment of the renal function of patients undergoing contrast-enhanced CT. Especially the medial swelling should make you consider a pronation exorotation injury (Weber C).
Often type II growth plate fractures must be repositioned under anesthesia, but healing is usually quick and complications are uncommon. At that age it is a fracture through the growth plate and is then called a juvenile Tilleaux. 18): Toddler’s fractures are oblique non-displaced fractures caused by low-energy torsional forces applied to the very porous bone of infants and young children. The slipped femoral epiphysis wasn't noticed the first time, and one week later the patient returned like this.



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