By Walter Putnam Blount
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Extra info for Fractures in Children
Posilion is obtained by Dunlop traction without manipulation. It is particularly indicated in the unstable tmnscondylar fractures (18, 19). (Fig. 29). One may continue the traction for three weeks and then place the nrm in a sling There is usually no need to maintain the traction so long. tient ambulatory by acutely flexing the elbow. This Inay be done conveniently with rectal pentothal. A collar and cutl'maintain the position (Fig. 37). The ability to reduce but not to hold the position of a supracondylar fracture has influenccd some men to use intcl'l1ftl fixation.
89), closed reduction is rarely successful, and prompt open rcclur:tion is the treatment of choice. ;t fow days, the immrdiate ancllate results should be excellent (Fig. 90). f\ b:ld prognosi"i (:13) is not justified (Figs. 91,92). Great care should be Ilsed in h:ll1dling the cpiphysis. h small hooks. tiotL of the forearm wilt not displace thc fmgment. o;hould be maintained \\'hile t,he wound is closed und plaster upplied. Tnternal fixation is unclesimble and usually U1l1leeessal'y (34). If the opemtive reduclion is delayed for a woek or 1,\\"0 or if the fractmo is comminuted, there will be cOllsidernble new bone formed and motion will be greatly restricted.
This relieves vasospasm of the collateral ar~ terioles and the reflex involvement of the intimate vasculature of the muscles (23). Delay is disastrous. Within three or foul' hours, irreversible changes have taken place. The all-too-frequent claw hand usually means inadequate or delayed therapy. )HEN Rclcnf£on Tn the avcrnge C:lSC, lhe reduced supracondylar fracture should be immobilized in flexion fol' throe weeks. At 1,he end of that j;ime, the callus is strong enough to flllow the elbo\\" to be lo\\"cl'cd La a right angle in ,l sling.