Rang's children's fractures PDF
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4860_FM_ppi-xiv 3/25/05 7:22 AM Page i RANG’S CHILDREN’S FRACTURES Third Edition 4860_FM_ppi-xiv 3/25/05 7:22 AM Page ii Dennis R. Wenger, M.D., Mercer Rang, M.D., and Maya E. Pring, M.D. 4860_FM_ppi-xiv 3/25/05 7:22 AM Page iii RANG’S CHILDREN’S FRACTURES Third Edition Mercer Rang, M.D. Professor of Orthopedic Surgery University of Toronto Maya E. Pring, M.D. Associate Staff—Orthopedics Children’s Hospital—San Diego Assistant Clinical Professor of Orthopedics University of California—San Diego Dennis R. Wenger, M.D. Director, Pediatric Orthopedic Training Program Children’s Hospital—San Diego Clinical Professor of Orthopedic Surgery University of California—San Diego 4860_FM_ppi-xiv 3/25/05 7:22 AM Page iv Acquisitions Editor: Robert Hurley Managing Editor: Stacey Sebring Project Manager: Fran Gunning Senior Manufacturing Manager: Benjamin Rivera Marketing Director: Sharon Zinner Design Coordinator: Doug Smock Production Services: Nesbitt Graphics, Inc. Printer: Edwards Brothers © 2005 by LIPPINCOTT WILLIAMS & WILKINS 530 Walnut Street Philadelphia, PA 19106 USA www.LWW.com All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Printed in the USA Library of Congress Cataloging-in-Publication Data Rang, Mercer. Rang’s children’s fractures / Mercer Rang, Maya Pring, Dennis Wenger; foreword by Robert Salter. — 3rd ed. p. cm. Rev. ed. of: Children’s fractures. 2nd ed. ©1983. ISBN 0-7817-5286-8 1. Fractures in children. I. Pring, Maya. II. Wenger, Dennis R. (Dennis Ray) III. Title. IV. Title: Children’s fractures. [DNLM: 1. Fractures—Child. WE 180 R196r 2006] RD101.R33 2006 617.1'5'083—dc22 2005007039 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of the informa-tion in a particular situation re- mains the professional responsibility of the practitioner. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in the publication have Food and Drug Adminis- tration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice. The publishers have made every effort to trace the copyright holders for borrowed material. If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity. 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Visit Lippincott Williams &Wilkins on the Internet: http://www.lww.com. 10 9 8 7 6 5 4 3 2 1 4860_FM_ppi-xiv 3/25/05 7:22 AM Page v Contents Contributors vii Foreword ix Preface xi Acknowledgments xiii Chapter 1 Children are Not Just Small Adults 1 Chapter 2 The Physis and Skeletal Injury 11 Chapter 3 Orthopedic Literacy: Fracture Description and Resource Utilization 27 Chapter 4 Emergency Fracture Reduction 41 Chapter 5 Casts for Children’s Fractures 53 Chapter 6 Clavicle 75 Chapter 7 Shoulder and Humeral Shaft 85 Chapter 8 Elbow—Distal Humerus 95 Chapter 9 Elbow—Proximal Radius and Ulna 119 Chapter 10 Radius and Ulna 135 Chapter 11 Hand 151 Chapter 12 Pelvis and Hip 165 Chapter 13 Femoral Shaft 181 Chapter 14 Knee 201 Chapter 15 Tibia 215 Chapter 16 Ankle 227 Chapter 17 Foot 243 Chapter 18 Spine 253 Chapter 19 Fractures in Special Circumstances 271 Chapter 20 Accident Prevention, Risk, and the Evolving Epidemiology of Fractures 293 Coda 305 Index 307 v 4860_FM_ppi-xiv 3/25/05 7:22 AM Page vi 4860_FM_ppi-xiv 3/25/05 7:22 AM Page vii Contributors LCDR Jeffrey A. Cassidy Medical Corps, United States Navy Reserves Director of Pediatric Orthopaedic Services Naval Medical Center, San Diego Henry G. Chambers, M.D. Chief of Staff Children’s Hospital—San Diego Associate Clinical Professor of Orthopedics University of California—San Diego CAPT Bruce L. Gillingham Medical Corps, United States Navy Director for Surgical Services Pediatric Orthopaedic Surgeon Naval Medical Center, San Diego François D. Lalonde, M.D. Associate Staff—Orthopedics Children’s Hospital—San Diego Assistant Clinical Professor of Orthopedics University of California—San Diego Scott J. Mubarak, M.D. Director, Pediatric Orthopedic Clinical Program Children’s Hospital—San Diego Clinical Professor of Orthopedics University of California—San Diego Peter O. Newton, M.D. Director, Scoliosis Program Program Consultant, Surgical Research Children’s Hospital—San Diego Associate Clinical Professor of Orthopedics University of California—San Diego Philip Stearns, C.P.N.P. Director, Nurse Practitioner and Physician Assistant Program Department of Orthopedics Children’s Hospital—San Diego C. Douglas Wallace, M.D. Medical Director of Orthopedic Trauma Children’s Hospital—San Diego Assistant Clinical Professor of Orthopedics University of California—San Diego vii 4860_FM_ppi-xiv 3/25/05 7:22 AM Page viii 4860_FM_ppi-xiv 3/25/05 7:22 AM Page ix Foreword It was in 1955 that Dr. Walter Blount wrote his splendid CLASSIC entitled Fractures in Children in which he emphasized that fractures in children were definitely different from fractures in adults. During the ensuing 50 years, numerous books on this important subject have been written by eminent pediatric orthopedic surgeons. Of these books, the most widely read as well as the most enjoyed have been the first and second editions (1974 and 1983) of Children’s Fractures written solely by the late Dr. Mercer Rang. Tragically and poignantly, Dr. Rang passed away in October 2003 after a courageous battle against a prolonged illness. I deem it a special privilege to have recruited Mercer to the Orthopaedic Staff of the Hospital for Sick Children in Toronto in 1967 where he became a warm friend and an admirable colleague for the rest of his life. His most endur- ing and endearing as well as appreciated quality was his remarkable skill as a teacher through both the spoken and written word. Prior to Dr. Rang’s illness, he and his good friend Dr. Dennis Wenger had already co-authored a superb book entitled The Art and Practice of Children’s Orthopedics.Also before Mercer’s illness, this pair of gifted teachers had already begun the onerous task of co-authoring the third edition of Children’s Fractures. Surely there can be no finer tribute to Mercer Rang than Dennis Wenger’s per- petuation of this book with an additional author, Maya Pring. Although neither the first nor the second editions contained a Foreword, the Preface that Mercer wrote for the second edition was so delightfully typical of his whimsical humor that I felt the first paragraphs should be included in his memory in this Foreword: A parable: The child in the back of the car has a broken arm. The driver stops to ask directions, “Excuse me, can you tell me the way to the Children’s Hospital, please?” A well-meaning pedestrian steps forward to offer advice: “It’s really very easy.” He begins to describe the usual way, rattling through the roads and land- marks to be noted. Before this information has had time to sink in he begins again with another route, “This is the best way; I read it in last week’s paper.” He moves his hands to indicate turns and so on, before realizing that his instructions have not been comprehended. “Well, perhaps you should take the easiest route. It’s about 4 miles straight down the road.” Directions about fracture care are a little like this. Together, the late Dr. Mercer Rang and the current authors, Dr. Dennis Wenger and Dr. Maya Pring, have created an outstanding book that is an en- tirely appropriate successor to Mercer’s first two editions. Woven throughout the tissue of this exemplary book is the thread of that un- common sense, namely, common sense. As in the previous two editions, the illustrations are impressive. Indeed, most of the line drawings were rendered by Mercer Rang’s artistic hand. Recent advances in the management of children’s fractures since the second edition of Mercer’s book (1984) have been described in detail. Examples of such advances include the initial cast treatment of femoral shaft fractures in infants and very young children as well as the open reduction and internal fraction of femoral shaft fractures in older children, the closed reduction and percutaneous ix 4860_FM_ppi-xiv 3/25/05 7:22 AM Page x pinning of supracondylar fractures of the humerus, and the flexible intra- medullary flexible nails for diaphyseal fractures. Every person who treats children’s fractures will be enormously grateful to the late Mercer Rang as well as to Dennis Wenger and Maya Pring for writing this most admirable book. It should become an essential reference book in the emergency department of every hospital in which children’s fractures are treated. This exemplary book is certainly a fitting memorial to the late Dr. Mercer Rang. ROBERT B. SALTER Toronto x
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