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Fractures in Children and Adolescents

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Book cover Intramedullary Nailing

Abstract

Fractures of the growing bone require fixation techniques, which preclude any injury to the growth plate regions. This requirement is met by Elastic Stable Intramedullary Nails (ESIN) which are positioned between both metaphyseal regions. Pronounced malposition and/or shortening, open fractures and fractures with impending skin perforation are indications for clavicle nailing in adolescents. Retrograde nailing with two elastic nails, inserted from lateral, is the method of choice for stabilization of humerus fractures. In radial neck fractures with severe tilting of the radial head, a retrograde nail may reduce and fix the head. In Monteggia lesions, the ulna fracture is reduced and fixed with an antegrade nail. Forearm fractures with unacceptable axial deviation are reduced and fixed with one antegrade nail in the ulna and a retrograde nail in the radius. Ascending elastic nailing is done for femur shaft and proximal femur fractures. The medial and lateral entry sites are located above the distal physis. End caps are used to prevent shortening in spiral and multiple segment fractures. Fractures of the distal third of the femur are nailed in a descending technique. The entry sites of two nails are located on the lateral cortex below the greater trochanter. Combined tibia and fibula fractures, open fractures and unstable fracture types such as spiral and multifragmental tibia fractures are good indications for ESIN. Descending nailing is the method of choice. The nail entry points are medially and laterally distal to the apophysis of the proximal tibia. Thorough knowledge of each fracture type, fracture location and age specific healing pattern is necessary for safe and effective treatment of pediatric fractures.

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Authors and Affiliations

  1. Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang, Goethe-University Frankfurt, Theodor-Stern-Kai 7, Frankfurt, D- 60590, Germany

    Christoph Nau MD & Ingo Marzi MD, PhD

  2. Department of Pediatric Surgery, Children’s Hospital, Inselspital University of Berne, Berne, Switzerland

    Kai Ziebarth MD & Steffen Berger MD, PhD

Authors
  1. Christoph Nau MD
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  2. Ingo Marzi MD, PhD
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  3. Kai Ziebarth MD
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  4. Steffen Berger MD, PhD
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Corresponding authors

Correspondence to Ingo Marzi MD, PhD or Steffen Berger MD, PhD .

Editor information

Editors and Affiliations

  1. Center for Orthopedics &Traumatology, University Medical Center Johannes Gutenberg University, Mainz, Germany

    Pol M. Rommens

  2. Academic Teaching Hospital Fulda, Fulda, Germany

    Martin H. Hessmann

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© 2015 Springer-Verlag London

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Nau, C., Marzi, I., Ziebarth, K., Berger, S. (2015). Fractures in Children and Adolescents. In: Rommens, P., Hessmann, M. (eds) Intramedullary Nailing. Springer, London. https://doi.org/10.1007/978-1-4471-6612-2_24

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  • DOI: https://doi.org/10.1007/978-1-4471-6612-2_24

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-6611-5

  • Online ISBN: 978-1-4471-6612-2

  • eBook Packages: MedicineMedicine (R0)

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