پاورپوینت کامل صدمات فیزیکی ۶۴ اسلاید در PowerPoint

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پاورپوینت کامل صدمات فیزیکی ۶۴ اسلاید در PowerPoint

اسلاید ۴: Physeal injuries represent 15% to 30% of all fractures in children.The incidence varies with age and has been reported to peak in adolescents.Physeal injuries involving the phalanges account for over 30% of all physeal fractures (wrist jt more common)

اسلاید ۵: Growth hormone increases the number of cells in the physeal columns;Thyroid hormone potentiates cytoplasmic proliferation;Oestrogens play an important role in triggering physeal closure.Hormonal effects upon skeletal growth

اسلاید ۶: zones/resting zone

اسلاید ۷:

اسلاید ۸:

اسلاید ۹: Epiphyaseal vessels—supply germinal layerMetaphyseal vessels—supply central ¾ of physisPeriosteal physis—supply peripheralTypes of epiphysisPressure epiphysisTractionAtavisticaberrantBlood supply of physis

اسلاید ۱۰: The first two zones have an abundant extracellular matrix and, consequently, a great deal of mechanical integrity, particularly in response to shear forces. The third layer, the hypertrophic zone, contains scant extracellular matrix and is weaker. On the metaphyseal side of the hypertrophic zone there is an area of provisional calcification leading to the zone of enchondral ossification. The calcification in these areas provides additional resistance to shear. Thus, the area of the hypertrophic zone just above the area of provisional calcification is the weakest area of the physis, and it is here that most injuries to the physis occur

اسلاید ۱۱: It is a wedge-shaped group of germinal cells that is continuous with the physis The zone of Ranvier consists of three cell types—Osteoblasts form the bony portion of the perichondral ring at the metaphysis; chondrocytes contribute to latitudinal growth;fibroblasts circumscribe the zone and anchor it to perichondrium above and below the growth plate.Zone of Ranvier

اسلاید ۱۲: It is a fibrous structure that is continuous with the fibroblasts of the zone of Ranvier and the periosteum of the metaphysis. It provides strong mechanical support for the bone–cartilage junction of the growth platePerichondrial Ring (LaCroix)

اسلاید ۱۳:

اسلاید ۱۴: Epiphyseal blood supply by Dale and Harris Type A, The epiphysis is nearly entirely covered by articular cartilage. Consequently, the blood supply traverses the metaphysis and may be damaged on separation of the metaphysis and epiphysis. Type B, The epiphysis is only partially covered by articular cartilage. Because the blood supply enters through the epiphysis, separation of the metaphysis and epiphysis will not compromise the blood supply to the germinal layerProximal femur Proximal humerusDistal femurProximal & distal tibiaDistal radius

اسلاید ۱۵: The most frequent mechanism of injury is fractureM C, fracture injury is direct, with the fracture pattern involving the physis itself. Occasionally, physeal injury from trauma is indirect and associated with a fracture elsewhere in the limb segment, either as a result of ischemia or perhaps compressioninfection, disruption by tumour, cysts, tumour-like disorders, vascular insult, repetitive stress, irradiation, and other rare etiologiesEtiology

اسلاید ۱۶: Long bone osteomyelitis or septic arthritis (particularly of theshoulder, hip, and knee) can cause physeal damage resulting in either physeal growth disturbance or frank growth arrest

اسلاید ۱۷: Partial or complete growth arrests can occur from a pure vascular injury to an extremity.Salter–Harris type V injuries; the most common location for this is the tibial tubercle after femoral shaft or distal femoral physeal fracturesVascular Insult

اسلاید ۱۸: EPIDEMIOLOGYSH2 MCPHALNGES 44%, DISTAL RADIUS 18%,DISTAL TIBIA11%MALE:FEMALE -2:1- 14YEARS:12YEARSoccurred twice as often in the upper extremities as in the lower extremities.

اسلاید ۱۹: Salter and harrisBased on the Radiographic appearance of fracture.The first three types were adopted from Poland (types I, II, and III) and Aitken (Aitken type III became Salter-Harris type IV)The higher the classification the more likely Is physeal arrest or joint incongurity to occur

اسلاید ۲۰: Is a separation of the epiphysis from the metaphysis occurring entirely through the physis. It usually occurs in the zone of hypertrophy (weakest)It is rare and seen most frequently in infants or in pathologic fractures, such as those secondary to rickets or scurvy. Because the germinal layer remains with the epiphysis, growth is not disturbed unless the blood supply is interrupted, as frequently occurs with traumatic separation of the proximal femoral epiphysis.PhalengesMetacarpals

اسلاید ۲۱: Radiograp