Treatment of Fractures in Children and Adolescents (PDF)

There are many textbooks on fractures in adults, but few deal with those in children and young persons. Publications on fractures in children are usually written by orthope­ dic surgeons who are familiar with the problems presented by the growing skeleton. The principles taught in the best known works on fractures in children by BLOUNT (1954), RETTIG (1957), CHIGOT and ESTEVE (1957), EHALT (1960), POLLEN (1973), and RANG (1974), differ from each other only slightly. The controversy which has sur­ rounded the treatment of fractures in adults in recent years has never extended to chi1drens' fractures. Skillful nonoperative treatment of the latter leads to uneventful healing in the majority of cases, which cannot always be said of similar injuries in adults. "Considerable skill" is required to induce nonunion in a child, and its occur­ rence always results from a serious error of management. In the adult, prolonged immobilization frequently leads to muscle atrophy, joint stiffness, and disturbances of the peripheral innervation and circulation. Fracture treatment by internal fixation in the manner originally described by LANE (1894), LAMBOTTE (1892, 1907, 1913), KONIG (1905, 1931), and DANIS (1932, 1949) has gained wide acceptance only in the last 15 years. Since 1958, MULLER, ALLGOWER, WIL­ LENEGGER, and the other members of the Swiss Association for the Study of Internal Fixation (ASIF) have been developing techniques and instruments for the operative treatment of fractures.