Reachout Orthopedics - Issue 1

by closed methods, type III and IV fractures mostly need open reduction and internal fixation. Generally, anatomic reduction of physeal plate with fracture and stable fixation maintain normal physeal growth and good articular surface. Particularly at the distal femoral region, even type II fractures can cause physeal growth arrest and angular deformity, so that reduction maneuvers must be applied gently and avoid further physeal damage. At this region, type III–IV fractures have higher incidence of physeal arrest and must be treated with open reduction and internal fixation because closed reduction can cause physeal bar due to loss of reduction [39–42]. At the surgery for type IV fractures, two parallel Kirschner wires or screws must be chosen for fixation instead of Kirschner wires or screws passing physis in order to avoid causing physeal bar. In order to protect physis from any kind of extra injury while maintaining stabile fixation at the surgery, taking care for forced compression of the fracture can be important and valuable. In our experimental model, we tried to investigate this issue. Since SH classification and displacement of the fracture are absolute predictors of the final outcome, Arkader et al . reported in their study that the treatment method can affect the final outcome [9]. Pennock et al . used the lag screw technique for type III and IV distal femur fractures with a high long-term success rate [43]. Regarding materials, the bone is accepted as a linear isotropic and homogeneous as cortical bone. But in fact it is anisotropic and heterogeneous; some of this area is cortical, and other is cancellous bone. We believe that this situation is a limitation of our study, and also application of this situation to this area Fig. 6: Tresca stresses. Fig. 7: Minimum principal stresses. At the surgery for type IV fracture, two parallel Kirschner wires or screws must be chosen for fixation instead of Kirschner wires or screws passing physis in order to avoid causing physeal bar. 6 reachOut Orthopedics