Pediatric Skeletal Trauma: A Practical Guide

625 Pages·2022·51.71 MB·English

by  Ingo Marzi, Johannes Frank, Stefan Rose

Pediatric
Skeletal
Trauma
A Practical Guide
Ingo Marzi
Johannes Frank
Stefan Rose
123
Pediatric Skeletal Trauma
Ingo Marzi • Johannes Frank
Stefan Rose
Pediatric Skeletal
Trauma
A Practical Guide
Ingo Marzi Johannes Frank
Department of Trauma Department of Trauma
Hand & Reconstructive Surgery Hand & Reconstructive Surgery
University Hospital Frankfurt University Hospital Frankfurt
Goethe University Goethe University
Frankfurt am Main, Germany Frankfurt am Main, Germany
Stefan Rose
University Hospital Frankfurt
Goethe University
Frankfurt am Main, Germany
ISBN 978-3-030-93683-9 ISBN 978-3-030-93685-3 (eBook)
https://doi.org/10.1007/978-3-030-93685-3
© Springer Nature Switzerland AG 2022
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Preface
Even with great care and every possible preventive measure, accidents in
childhood are unavoidable. The result is stress for each affected child, their
parents, friends, and not least, for all persons involved in treating the resulting
injuries. Parents are generally anxious and insecure in these circumstances,
and their expectations can be extraordinarily high. A thorough understanding
of pediatric traumatology is needed to master these situations safely and suc-
cessfully, providing each injured child with age-appropriate care and the best
possible outcome.
This book has been designed with this in mind to offer solid preparation
for the treatment of injured children. Its pragmatic structure should provide
rapid orientation when needed for immediate situations as well as an overall
treatment concept and approaches to therapy and follow-up. This manual is
composed of two parts: one focused on general topics and the other on
specifics.
The general sections offer a systematic presentation of the unique features
of pediatric fractures and injuries overall, as well as typical developmental
phenomena. These are essential for a fundamental understanding of clinical
and radiological diagnosis along with conservative and operative therapeutic
approaches.
The specialized sections first discuss the normal developmental regional
anatomy and radiographic presentation in childhood. This is followed by a
detailed introduction of the most foreseeable injuries to the extremities, with
many case studies and examples. Injuries to the soft tissues, the pelvis, and
the spine are also specifically addressed. These sections are carefully struc-
tured. A short, informative text is offered for each injury localization, fol-
lowed by a comprehensive tabular presentation listing specific features as
well as the indications for conservative and/or operative treatment.
Immediately following these tables, the most characteristic injuries are dem-
onstrated with radiographs, including treatment and follow-up images.
Emphasis has been placed on clear diagrams, treatment instructions, and
unambiguous recognition of injuries on imaging. The chapters are replete
with practical treatment tips.
The book also has three special chapters discussing the treatment of unrec-
ognized injuries and post-traumatic deformities resulting from growth distur-
bances and other complications.
This comprehensive presentation of pediatric traumatology is based on the
experience of the collaborating authors Ingo Marzi, Johannes Frank, and
v
vi Preface
Stefan Rose treating injured children in large academic medical centers for
over thirty years. Most cases presented were treated and documented by the
authors themselves, and the treatment algorithms used correspond to the cur-
rent guidelines and consensus discussions.
The work itself, in parts, introduces treatment developments to those ini-
tially presented in Ingo Marzi’s German-language textbook that was first
published in 2006: Kindertraumatologie. The original text included contribu-
tions from numerous well-known traumatology, pediatric surgery, and ortho-
pedic specialists of national and international renown, for which the current
authors are very grateful. The 2nd edition from 2010 and especially the 3rd
edition from 2016 have been extensively edited by the authors and supple-
mented with their own case studies and treatment experience; thus, the cur-
rent Pediatric Skeletal Trauma Manual also reflects the authors’ individual
long-term clinical experience.
The authors would like to thank their colleagues at the University Hospital
Department of Traumatology: Dr. Maren Janko, Dr. Katharina Mörs, and Dr.
Maika Voth, for their support in compiling case studies. Special thanks to Dr.
Sarah Hamilton for her English-language assistance in the drafting of the
text. We would like to thank Springer Nature Publishers London for the
attractive implementation of the book.
We also sincerely thank our wifes Petra Marzi, Dorothea Frank, and Birgit
Rose for their continued support throughout the time-consuming preparation
of this book.
• Marzi I (ed) (2006) Kindertraumatologie, 1st ed. Springer, Heidelberg,
p 468
• Marzi I (ed) (2010) Kindertraumatologie, 2nd ed. Springer, Heidelberg,
p 423
• Marzi I (ed) (2016) Kindertraumatologie, 3rd ed. Springer, Heidelberg,
p 572
Frankfurt am Main, Germany Ingo Marzi
Frankfurt am Main, Germany Johannes Frank
Frankfurt am Main, Germany Stefan Rose
August 2022
Contents
Part I General Considerations
1 Bone Growth and Healing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.1 B ony Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Diametric Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Longitudinal Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Epiphyseal Plate Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Suspension of Growth: Physiological Plate Fusion . . . . . . . . 4
1.2 B one Healing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Callus Formation and Consolidation Times . . . . . . . . . . . . . . 5
Consolidation Times. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.3 H ealing and Growth Abnormalities . . . . . . . . . . . . . . . . . . . . . 6
Diametric Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Longitudinal Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.4 S pontaneous Correction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Recommended Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2 Injury Patterns and Diagnostics . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2.1 F ractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Articular Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.2 D islocations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Shoulder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Elbow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Hips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
2.3 R adiological Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Radiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Computed Tomography (CT) . . . . . . . . . . . . . . . . . . . . . . . . . 21
Magnetic Resonance Imaging (MRI) . . . . . . . . . . . . . . . . . . . 21
Other Approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2.4 R adiological Development of the Pediatric Skeleton . . . . . . . 21
Coned Epiphysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Pseudoepiphysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
vii
viii Contents
2.5 Radiological Diagnostic Clues . . . . . . . . . . . . . . . . . . . . . . . . . 25
Harris Lines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Fat Pad Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Battered Child Syndrome (Child Abuse) . . . . . . . . . . . . . . . . 26
2.6 Pediatric Fracture Classifications . . . . . . . . . . . . . . . . . . . . . . . 30
AO Pediatric Comprehensive Classification of Long Bone
Fractures (PCCF) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Li-La Classification for Pediatric Long Bone Fractures . . . . 35
Recommended Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
3 Treatment Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
3.1 Conservative Treatment Options . . . . . . . . . . . . . . . . . . . . . . . 37
Basic Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
3.2 Technical Features of Conservative Treatment . . . . . . . . . . . . 42
Basic Casting Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Cast Wedging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Special Casting Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . 44
3.3 Conservative Fracture Treatment . . . . . . . . . . . . . . . . . . . . . . . 47
Radiographic Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Follow-Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Consolidation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
3.4 Operative Treatment Options . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Reduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Fixation Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Further Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Recommended Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
4 Soft Tissue Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
4.1 Vascular Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Causes, Mechanism of Injury . . . . . . . . . . . . . . . . . . . . . . . . . 67
Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Diagnostic Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Primary Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Complications, Growth Disturbances . . . . . . . . . . . . . . . . . . 69
Follow-Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
4.2 Nerve Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Causes, Mechanisms of Injury . . . . . . . . . . . . . . . . . . . . . . . . 70
Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Diagnostic Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Primary Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Complications, Growth Disturbances . . . . . . . . . . . . . . . . . . 73
Follow Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
4.3 Tendon Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Causes, Mechanism of Injury . . . . . . . . . . . . . . . . . . . . . . . . . 74
Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Diagnostic Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Contents ix
Primary Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Complications, Growth Disturbances . . . . . . . . . . . . . . . . . . 82
Follow Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Recommended Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Part II Specific Injuries
5 Shoulder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
5.1 S houlder Girdle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Physiological Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Clavicle Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Injuries of the Acromioclavicular Joint . . . . . . . . . . . . . . . . . 98
Injuries of the Sternoclavicular Joint . . . . . . . . . . . . . . . . . . . 99
Scapular Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
5.2 S houlder Joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Glenohumeral Shoulder Dislocation and Rotator Cuff Injuries . . .
106
Recommended Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
6 Humerus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
6.1 P hysiological Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Ossification Centers and Growth Plate Fusion . . . . . . . . . . . . 115
6.2 P roximal Humerus Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Incidence, Mechanism of Injury and Clinical Picture . . . . . . 117
Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
6.3 D iaphyseal Humeral Fractures . . . . . . . . . . . . . . . . . . . . . . . . . 123
Incidence, Mechanism of Injury and Clinical Picture . . . . . . 123
Recommended Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
7 Elbow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
7.1 P hysiological Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Age-Dependent X-ray Findings . . . . . . . . . . . . . . . . . . . . . . . 131
7.2 S upracondylar Humerus Fractures . . . . . . . . . . . . . . . . . . . . . . 134
Incidence, Mechanism of Injury, and Clinical Presentation . 134
Classification and Treatment Concept . . . . . . . . . . . . . . . . . . 134
7.3 D istal Humerus Transcondylar Fractures . . . . . . . . . . . . . . . . . 150
Incidence, Mechanism of Injury, and Clinical Presentation . 150
7.4 E lbow Dislocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Incidence, Mechanism of Injury, and Clinical Presentation . 160
7.5 D istal Humerus Epicondylar Fractures . . . . . . . . . . . . . . . . . . 167
Incidence, Mechanism of Injury, and Clinical Presentation . 167
Recommended Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
8 Proximal Radius and Olecranon . . . . . . . . . . . . . . . . . . . . . . . . . . 175
8.1 P hysiological and Radiological Findings . . . . . . . . . . . . . . . . . 175
8.2 F ractures and Dislocations of the Proximal Radius . . . . . . . . . 177
8.3 F ractures of the Proximal Ulna . . . . . . . . . . . . . . . . . . . . . . . . 186
Recommended Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
x Contents
9 Forearm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
9.1 Physiological Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
9.2 Fracture Types and Localisation of the Forearm . . . . . . . . . . . 197
9.3 Forearm Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
9.4 Monteggia Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226
9.5 Galeazzi Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
9.6 Technical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Recommended Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
10 Hand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
10.1 Carpal Fractures and Dislocations . . . . . . . . . . . . . . . . . . . . . 245
Incidence, Mechanism of Injury and Clinical Picture . . . . . 246
10.2 Metacarpal Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
Incidence, Mechanism of Injury and Clinical Picture . . . . . 258
10.3 Finger Fractures and Dislocations . . . . . . . . . . . . . . . . . . . . . 270
Incidence, Mechanism of Injury and Clinical Picture . . . . . 270
Recommended Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
11 Hip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
11.1 Physiological Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
11.2 Proximal Femur Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Incidence, Mechanism of Injury, and Clinical
Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Type I Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
Type II Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
Type III Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286
Type IV Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Treatment Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290
11.3 Apophyseal Avulsions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
11.4 Traumatic Hip Dislocations . . . . . . . . . . . . . . . . . . . . . . . . . . 298
11.5 Transient Synovitis, Legg–Calvé–Perthes Disease
(LCPD), and Slipped Capital Femoral Epiphysis (SCFE) . . . 300
Recommended Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
12 Femur . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
12.1 Physiological Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
12.2 Femoral Shaft Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314
Incidence, Mechanism of Injury and Clinical Picture . . . . . 314
Subtrochanteric Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
Transverse Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326
Oblique and Spiral Fractures . . . . . . . . . . . . . . . . . . . . . . . . 330
Compound Femur Fractures . . . . . . . . . . . . . . . . . . . . . . . . 334
Distal Femur Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
Technical Tipps Femur Fractures . . . . . . . . . . . . . . . . . . . . . 344
Recommended Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348
13 Knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
13.1 Physiological Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349