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  • Title: The conservative treatment of the fractures and dislocations of the extremities in children.
    Author: Tosovský V, Stryhal F.
    Journal: Acta Univ Carol Med Monogr; 1986; 111():1-145. PubMed ID: 2886016.
    Abstract:
    Both authors have dedicated most of their time since 1948 to the treatment of fractures in children. On the basis of their experience they are therefore submitting to the medical public those methods and results of the conservative treatment of fractures and dislocations in children which stood the test of time. The experiences of both authors as well as successful therapeutic methods of other surgeons are discussed in this book. Differences are stated between fractures in adults and in children which may be attributed to the growth factor of children's bones and their enormous biological drive. These factors will play their part in correcting certain displaced fractures by re-moulding, fractures which in an adult would have to be perfectly reduced unless a permanent deformity should ensue associated with subsequent impairment of function to the injured limb. The authors are stating which displaced angulations and side to side displacements in a fracture may be left and which must be repaired under all circumstances and why, if conservative treatment fails, surgery has to be performed. Sideways and longitudinally displaced fractures, especially metaphysial ones do not warrant a perfect reduction. Rotational displacements must be corrected every time even in very small infants e.g. in newborn babies. Age plays an important part in the healing of fractures. Moulding and union of a fracture will be most rapid in newborn babies and infants while in fractures of adolescents a similar procedure has to be adopted as in fractures of adults. Special problems of epiphysiolyses and epiphysial fractures are discussed emphasizing that conservative treatment may be unsuccessful in epiphysiolyses Salter-Harris type III and IV and surgical intervention may be indicated. Fractures of upper and lower limbs are dealt with in detail while paying special attention to obstetrical fractures. Fractures round the elbow are treated in a similar manner, they will frequently heal in angulation of the upper limb and may cause nerve injuries and ischaemic changes of the forearm. Special attention is being paid to the longitudinal overgrowth of fractures of the femoral diaphysis associated with the sequelae of the treatment of these very serious injuries to newborn babies and infants as well as to toddlers and older children.
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