Skip to main content
SpringerLink
Log in

Epiphysennahe Frakturen bei Kindern

Teil I: Obere Extremität

Fractures close to the epiphysis in children

Part I: Upper extremities

  • CME Weiterbildung • Zertifizierte Fortbildung
  • Published:
Der Unfallchirurg Aims and scope Submit manuscript

Zusammenfassung

Aufgrund biomechanisch relevanter Veränderungen am wachsenden Skelett sind zur Diagnose und Therapie kindlicher Frakturen einige grundsätzliche Kenntnisse erforderlich. Kinder erleiden sehr viel häufiger Frakturen an der oberen als der unteren Extremität. Im Gegensatz zu diaphysären Frakturen mit hoher Potenz zur Regeneration und Proliferation durch die Epiphysen sind bei epiphysennahen Frakturen Störungen des Wachstums zu erwarten. Zur Diagnostik muss der individuelle Reifezustand des Skeletts bekannt sein, eine native Röntgendiagnostik der betroffenen Region in 2 Ebenen ist ausreichend. Zur Aufklärung und Therapiewahl müssen die Grenzen der Korrekturfähigkeit – sowohl bezüglich des topographisch als auch des altersabhängig determinierten noch zu erwartenden Wachstums des betroffenen Bereichs – bekannt sein. Die klinische Untersuchung nach Frakturheilung ist bedeutsam, um Längendifferenzen, Achsfehlstellungen oder Funktionsdefizite erkennen und die weitere Betreuung oder Therapie veranlassen zu können.

Abstract

Fractures in children require special knowledge and skills due to the differences in biological and biomechanical properties of growing skeletons. Children suffer from fractures of the upper extremities much more than fractures of the lower extremities. While fractures of the diaphysis have a high regenerative and proliferation potential, impairment of the growth plate with consecutive disturbance of growth can be found more often in fractures close to the epiphysis. Most epiphysis fractures in children can be identified by a set of 2-plane X-ray images but precise knowledge about the skeletal maturation is required. In order to correctly decide about treatment regimes (conservative versus operative treatment) the limitations and limits of the ability of bone to correct misalignment must be anticipated. Clinical examination following fracture healing is mandatory to recognize differences in length, misalignment and deficits in function, which should receive further treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9
Abb. 10
Abb. 11
Abb. 12
Abb. 12
Abb. 13
Abb. 14

Literatur

  1. Bishop JY, Flatow EL (2005) Pediatric shoulder trauma. Clin Orthop Relat Res 432: 41–48

    Article  PubMed  Google Scholar 

  2. Cannata G, De MF, Mancini F et al. (2003) Physeal fractures of the distal radius and ulna: long-term prognosis. J Orthop Trauma 17: 172–179

    Article  PubMed  Google Scholar 

  3. Cornwall R (2006) Finger metacarpal fractures and dislocations in children. Hand Clin 22: 1–10

    Article  PubMed  Google Scholar 

  4. Cornwall R, Ricchetti ET (2006) Pediatric phalanx fractures: unique challenges and pitfalls. Clin Orthop Relat Res 445: 146–156

    PubMed  Google Scholar 

  5. Kawamoto K, Kim WC, Tsuchida Y et al. (2006) Incidence of physeal injuries in Japanese children. J Pediatr Orthop B 15: 126–130

    PubMed  Google Scholar 

  6. Kocher MS, Kasser JR, Waters PM et al. (2007) Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children. A randomized clinical trial. J Bone Joint Surg Am 89: 706–712

    Article  PubMed  Google Scholar 

  7. Laer LR von (1998) Wachstumsprognose nach Epiphysenfugenverletzungen. Acta Chir Austriaca [Suppl] 143: 1–4

    Google Scholar 

  8. Laer LR von (2001) Frakturen und Luxationen im Wachstumsalter. Thieme, Stuttgart New York

  9. Laer L von, Gunter SM, Knopf S et al. (2002) [Supracondylar humerus fracture in childhood – an efficacy study. Results of a multicenter study by the Pediatric Traumatology Section of the German Society of Trauma Surgery. II: Costs and effectiveness of the treatment]. Unfallchirurg 105: 217–223

    Article  Google Scholar 

  10. Lee SH, Lee DH, Baek JR (2007) Proximal humerus Salter type III physeal injury with posterior dislocation. Arch Orthop Trauma Surg 127: 143–146

    Article  PubMed  Google Scholar 

  11. Naranja RJ jr, Gregg JR, Dormans JP et al. (1997) Pediatric fracture without radiographic abnormality. Description and significance. Clin Orthop Relat Res 342: 141–146

    Article  PubMed  Google Scholar 

  12. Rennie L, Court-Brown CM, Mok JY et al. (2007) The epidemiology of fractures in children. Injury 38: 913–922

    Article  PubMed  Google Scholar 

  13. Slongo T, Audige L, Lutz N et al. (2007) Documentation of fracture severity with the AO classification of pediatric long-bone fractures. Acta Orthop 78: 247–253

    Article  PubMed  Google Scholar 

  14. Taeger G, Nast-Kolb D (2001) [Fractures of the distal humerus in the child]. Unfallchirurg 104: 435–443

    Article  PubMed  CAS  Google Scholar 

  15. Weinberg AM, Reilmann H, Lampert C et al. (1994) [Experience with external fixation in treatment of shaft fractures in childhood]. Unfallchirurg 97: 107–113

    PubMed  CAS  Google Scholar 

  16. Weinberg AM, Marzi I, Gunter SM et al. (2002) [Supracondylar humerus fracture in childhood – an efficacy study. Results of a multicenter study by the Pediatric Traumatology Section of the German Society of Trauma Surgery. I: Epidemiology, effectiveness evaluation and classification]. Unfallchirurg 105: 208–216

    Article  PubMed  CAS  Google Scholar 

  17. Zenios M, Ramachandran M, Milne B et al. (2007) Intraoperative stability testing of lateral-entry pin fixation of pediatric supracondylar humeral fractures. J Pediatr Orthop 27: 695–702

    PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Unfallchirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45122 , Essen, Deutschland

    G. Täger, L.E. Podleska, S. Ruchholtz & D. Nast-Kolb

  2. Abteilung für Kinder- und Jugendtraumatologie, Altonaer Kinderkrankenhaus Hamburg, Hamburg, Deutschland

    D. Sommerfeldt

Authors
  1. G. Täger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L.E. Podleska
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Ruchholtz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Sommerfeldt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Nast-Kolb
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Täger.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Täger, G., Podleska, L., Ruchholtz, S. et al. Epiphysennahe Frakturen bei Kindern. Unfallchirurg 110, 867–883 (2007). https://doi.org/10.1007/s00113-007-1336-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-007-1336-1

Schlüsselwörter

Keywords

Search

Navigation