Physeal injuries in children can disrupt growth and cause deformities if not properly treated. The physis is the growth plate between the epiphysis and metaphysis that allows for bone growth. Injuries are common in the extremities of young children and teenagers. Salter and Harris classification categorizes physeal injuries into 5 types based on the fracture pattern, with types III and IV having the highest risk of growth disturbances. Treatment involves gentle closed or open reduction and stabilization to restore anatomy without further damaging the physis. Prolonged immobilization and follow-up x-rays are needed to monitor healing and growth. Complications can include growth abnormalities, malunion, infection, and avascular necrosis if not adequately
Fracture of shaft and distal part of Femoral bone by Dr. Ammar AlsabaeAmmar Alsbae
This ppt show the fracture of shaft and distal part ( condylar and supracondylar ) of femuarl bone which include anatomy , classification , clinical picture , diagnosis , treatment and complications .
This PPT prepared by Ammar Alsabae , A medical student , faculity of medicine , Taiz university . Yemen .
This topic is under the General Principles of Surgery for MBBS Students. It also deals with Scars & Contractures. The student should know to differentiate between Hypertrophic Scar & Keloid..
management priorities in high energy trauma
Define the terms of fracture, dislocation and Subluxation
Identify the clinical and radiological pictures of fractures
Classify the different types of fractures
general principles of fracture management
Principles of open fracture management
Fracture of shaft and distal part of Femoral bone by Dr. Ammar AlsabaeAmmar Alsbae
This ppt show the fracture of shaft and distal part ( condylar and supracondylar ) of femuarl bone which include anatomy , classification , clinical picture , diagnosis , treatment and complications .
This PPT prepared by Ammar Alsabae , A medical student , faculity of medicine , Taiz university . Yemen .
This topic is under the General Principles of Surgery for MBBS Students. It also deals with Scars & Contractures. The student should know to differentiate between Hypertrophic Scar & Keloid..
management priorities in high energy trauma
Define the terms of fracture, dislocation and Subluxation
Identify the clinical and radiological pictures of fractures
Classify the different types of fractures
general principles of fracture management
Principles of open fracture management
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
2. Introduction:-
The physis or the growth cartilage is a
specialized layer of tissue unique to children
which provides for both longitudinal and
latitudinal growth of bone located between
the epiphysis and metaphysis.
Appears radiolucent on X-ray.
Injuries to the physis can cause cessation
of growth and resultant angular deformities.
3. Prevalence – 10 – 30 % of all childhood fractures
• AGE :- INFANCY & 10-12 yrs of age.
• Males > Females
• Common sites :- Upper extremity > Lower Extremity
-Phalanges are the most common site 37%,
distal radius 18% and
distal tibia 10%, other sites including distal femur ,proximal
tibia/fibula.
4. Epiphyseal blood supply according to Dale &
Harris
• TYPE A: Type A epiphyses are nearly completely covered by
articular cartilage. Therefore, most of the blood supply to the
epiphysis must enter from the perichondrium in a distal to proximal
direction . This blood supply is susceptible to disruption by
epiphyseal separation. The proximal femur and proximal humerus
are examples of type A epiphyses.
• TYPE B: Type B epiphyses are only partially covered by articular
cartilage. Such epiphyses are more resistant to blood supply
impairment by epiphyseal separation. The distal femur, proximal
and distal tibia, and distal radius are clinical examples of type B
epiphyses.
5. Etiology:-
• The most frequent mechanism of injury is fracture.
• Other mechanisms of injuries to the physis include :-
infection [Septic arthritis or metaphyseal osteomyelitis]
tumor
cysts
vascular insult
Repetitive stress injury [Gymnasts]
Irradiation
Neural involvement [in polio & Cerebral palsy]
iatrogenic causes [surgical insults]
Metabolic abnormalities [vit C def]
6. Clinical Presentation:-
• HISTORY :-
- Pain / Swelling around the affected joint.
- UPPER LIMB Function limited by pain.
- LOWER LIMB Inability to bear weight.
- History of trauma
• ON EXAMINATION :-
- swelling +
- Deformity +/- (minimal if present)
- Focal tenderness over physis +
- Limited ROM
8. Type 1
• Salter–Harris type I injuries are characterized by a transphyseal
plane of injury, with no bony fracture line through either the
metaphysis or the epiphysis.
• type I fractures occurred most frequently in the phalanges,
metacarpals, distal tibia, and distal ulna.
9.
10. Type 2
• Type II injuries have physeal and metaphyseal components;
the fracture line exits the physis to enter the metaphysis (i.e., away
from the germinal and proliferative layers) at one margin. Similar to
type I injuries, these fractures should have a limited propensity to
growth disturbances.
11.
12. Type 3
There are two fracture fragments:
a small fragment consisting of a portion of the epiphysis and physis, and
a large fragment consisting the remaining epiphysis and long bone.
. higher risk of subsequent growth disturbance.
• Anatomic reduction (usually open reduction) and stabilization are
required
13.
14. Type 4
• Type IV fractures are effectively vertical shear fractures,
extending from the articular surface to the metaphysis.
• These fractures are important because
• they disrupt the articular surface,
• violate all the physeal layers in crossing from the epiphysis to
the metaphysis
• may result in metaphyseal–epiphyseal cross union which
almost invariably results in subsequent growth disturbance.
frequent around the medial malleolus ,lateral condyle of
humerus.
15.
16. • In type 4, treatment principles
include obtaining
• anatomic reduction
• adequate stabilization
17. Type 5
.
• Mechanism of this injury is by
longitudinal compression, which
damages the germinal layer of
physeal cells.
• The prognosis for growth is poor, and
there is a likelihood of premature
growth cessation
18.
19. General Principle of Treatment in Acute Physeal Injuries :-
• All reductions must be done with utmost gentleness to prevent further
damage to the physis. Direct pressure on the physis by instruments
must be avoided during open reduction.
• Microvascular disruption also plays a significant role to produce growth
arrest.so,rather than trying multiple reductions ,more deformity after
the # can be accepted, if the potential to remodel is high.
• Because of the intra-articular component, displaced type III and IV
injuries must be reduced regardless of the time that has elapsed since
the injury.
• Percutaneous pinning is often sufficient to stabilize the fragment.
Cancellous cannulated screws of appropriate size may be used. Joystick
method may be used to reduce the type III and IV fractures, to avoid
open reduction (if possible).
20. • Reduction:-
• The reduction maneuver must be performed as early as possible to
prevent damage to the physis in the process of reduction.
• Each day of delay makes the reduction more difficult, especially in
infants and younger child.
21. Methods of Reduction:-
• Type I and II:
• Injuries can be managed by closed reduction, as these cause less damage
to the physis.
• Type III and IV:
• Might need open reduction to obtain anatomical reduction.
22. • Caution must always be exercised during open
reductions to prevent injury to the circulation
entering the epiphysis.
• In Infants and newborns—any swelling near a
joint, growth plate injury should be inspected
unless otherwise proved by CT scans and MRI.
• The most desirable internal fixation is epiphysis
to epiphysis and metaphysis to metaphysis if
possible, especially in young children.
23.
24.
25. • Period of immobilization and follow-up:
• Fracture is immobilized for at least 3–4 weeks.
• No activities or play is allowed for at least 4–6 weeks after removal
of cast.
• Follow-up will be needed for at least 1 yr to 2 yrs after the treatment,
and comparative radiographs of the contralateral limb should be
taken
27. •Osteomyelitis
•Neurological Complications
Median nerve compression in unreduced type II injury of distal radial
epiphysis is known.
•Vascular Complications
The popliteal artery is at risk in the physeal injuries around the knee
following hyperextension injuries. Unrecognize damage or disruptions of
the artery might lead to gangrene.
•Avascular Necrosis of Epiphysis
Completely displaced type I physeal injuries of the femoral and radial
head carry a high-risk of this complication. It results in cessation of growth.