{"id":303,"date":"2019-08-02T22:38:03","date_gmt":"2019-08-02T20:38:03","guid":{"rendered":"https:\/\/radler-ortho.com\/?page_id=303"},"modified":"2022-01-25T15:38:25","modified_gmt":"2022-01-25T14:38:25","slug":"fehlverheilte-frakturen","status":"publish","type":"page","link":"https:\/\/radler-ortho.com\/en\/kinder\/fehlverheilte-frakturen\/","title":{"rendered":"Malunited Fractures"},"content":{"rendered":"\n

Unlike some other\ntissues in the body, the human bone has the ability to fully regenerate after a\nfracture. Between the ends of the fracture segments, callus (fresh bone\nmaterial) is formed, which gradually becomes harder and more stable. The time\nit takes until the bone is completely healed depends on the affected bone, the\naffected area, and the age of the patient.<\/p>\n\n\n\n

Fractures in children\nalmost always heal well. Most often, a cast or splint is used to fix the bone. Sometimes\nsurgical stabilization with elastic nails or plates is necessary. In some\ncases, especially with casting, the position and alignment of the fracture\ncannot be completely corrected. Mild malalignment and\/or shortening or even\nover-length might persist. In young children and in cases of metaphysis (fractures\nthat are close to the end of the bone), those malalignments can correct\nspontaneously with growth. <\/p>\n\n\n\n

Malalignment in older\nchildren, malalignment occurring after fractures more in the middle of the bone,\nand torsional (rotational) malalignment correct less well and often persist. In\nthose cases, surgical correction can be warranted.<\/p>\n\n\n\n

\"Knochenbruch<\/figure><\/div>\n\n\n\n

If a fracture involves\nthe growth plate, deformity and malalignment can develop or increase during\nfurther growth. <\/p>\n\n\n\n

Premature closure of a\ngrowth plate after a fracture leads to limb-length discrepancy with more or\nless severe shortening of the bone, depending on the age of the patient at the\ntime of the trauma. If the physis (growth plate) is only partially closed, and\nespecially if the bone bridge closing the physis is on the side of the bone, a\ndeformity will occur in addition to the shortening. <\/p>\n\n\n\n

If the bone bridge\ncrossing the physis is small, surgical removal of the bridge can be attempted.<\/p>\n\n\n\n

Rarely, a limb can be\nlonger after fracture. This occurs more with fractures in the diaphysis (middle)\nof the bone. However, the resulting limb-length discrepancy is usually small\nand can reduce spontaneously during further growth. <\/p>\n\n\n\n

Osteotomies<\/strong><\/h2>\n\n\n\n

If a fracture is malunited (has healed in an incorrect position), it is possible to correct it surgically. The bone ends are usually osteotomized (cut), anatomically aligned, and fixed with plates, screws, or nails. Sometimes external fixation<\/a> is used to achieve the best result. <\/p>\n\n\n\n

Generally, we see\nthree different patterns: malalignment, shortening, or a combination of both.\nAnother important parameter is the status of the growth plate (whether it is\ninjured or healthy). If it is healthy, it can be used to guide or control\ngrowth. <\/p>\n\n\n\n

In the presence of\nmalalignment and\/or shortening with a healthy growth plate and enough growth\nremaining, guided growth is an option. Guided growth can be achieved by performing\nhemi-epiphysiodesis (blocking the growth plate on one side) using a small plate\nand two screws. Additionally, it can be achieved by performing epiphysiodesis (blocking\nthe growth plate completely) to stop growth of the longer limb and correct limb-length\ndiscrepancy. <\/p>\n\n\n\n

Although\nhemi-epiphysiodesis using a small pate and two screws is an exact procedure\nthat is commonly applied, stopping the growth to correct limb-length\ndiscrepancy is more difficult. The timing of surgery is essential, because the\ngrowth plate of the long bone must be stopped at exactly the right time so that\nboth bones end up the same length. Although various mathematical models and\nparameters for this calculation are available, the result in an individual\npatient can vary and fall out of the prediction. Nevertheless, stopping the\ngrowth is an elegant way to correct limb-length discrepancy in bones that end\nup longer after fracture. <\/p>\n\n\n\n

Malalignment without\nshortening can easily be corrected acutely using internal fixation (nail,\nscrews, plates) in most cases. If the deformity is severe or overly complex\n(more than one plane and additional rotation), gradual correction using\nexternal fixation might be preferable. <\/p>\n\n\n\n

For posttraumatic shortening with or without malalignment, six-axis external fixation<\/a> or implantable lengthening nails<\/a> are available. <\/p>\n","protected":false},"excerpt":{"rendered":"

Unlike some other tissues in the body, the human bone has the ability to fully regenerate after a fracture. Between the ends of the fracture segments, callus (fresh bone material) is formed, which gradually becomes harder and more stable. The time it takes until the bone is completely healed depends on the affected bone, the … Continue reading Malunited Fractures<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":19,"menu_order":9,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"translation":{"provider":"WPGlobus","version":"2.12.2","language":"en","enabled_languages":["de","en"],"languages":{"de":{"title":true,"content":true,"excerpt":false},"en":{"title":true,"content":true,"excerpt":false}}},"amp_enabled":true,"_links":{"self":[{"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/pages\/303"}],"collection":[{"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/comments?post=303"}],"version-history":[{"count":15,"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/pages\/303\/revisions"}],"predecessor-version":[{"id":4129,"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/pages\/303\/revisions\/4129"}],"up":[{"embeddable":true,"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/pages\/19"}],"wp:attachment":[{"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/media?parent=303"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}