PMU-Autor/inn/envon Rüden Christian
Juxta-articular fractures by definition involve the metaphyseal bone. Depending on the age of the child and the direction of displacement, there is a good potential for spontaneous correction due to the proximity to the growth plate; therefore, many of these fractures do not need an implant and can be conservatively treated. On the other hand, there may be damage to the growth plate with subsequent growth arrest. These aspects have to be considered when choosing the optimal fixation method. On the one hand stable fracture fixation is required but on the other hand the growth plate should not be significantly damaged. The most commonly used method is Kirschner wire osteosynthesis. Compression screw fixation can be an alternative in Salter and Harris type II fractures with an adequately large metaphyseal fragment. Screw fixation is also used in displaced metaphyseal avulsions or apophyseal fractures. With respect to the method of stabilization, the transition between the diaphyseal and metaphyseal regions poses a special challenge. Usually pin fixation does not lead to sufficient stability. Also elastic stable intramedullary nailing is not considered to be well suited for fractures in this region. Alternatives can be external fixator or plate osteosynthesis.
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