Musculoskeletal case studies for medical students
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A 6 year old child after a bicycle accident. Neurovascular intact, no other injuries
Initial X ray
AP x ray
Lateral X ray
The six year old who suffered an ankle injury. How this was treated, and why?
X ray after treatment
After reduction and k-wires
Post management further view
Lateral x ray after ORIF
n children the growth plate is the weakest point. Ankle injuries here present as growth plate injuries. Here a separation of the growth plate has taken place. The fracture goes through the distal tibial growth plate and also includes a triangular piece of the metaphysis. The fracture does not extend into the ankle joint. It can be classified as Salter Harris II growth plate injury.
Discussion of management
A closed reduction was attempted. As the growth plate stayed wider medially it was necessary to cut the skin and fish out the periosteal fold that had blocked reduction ( this is a common cause of failure of closed reductions). The epiphysis was stabilised by two smooth k-wires. It is safe to bridge the joint by small wires. If screws are used, do not cross the joint with them. Use screws only if they can be placed parallel to the growth plate either above it (Salter 2 fracture) or within the epiphysis (Salter 3 fracture).
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