Rockwood Children CH8

278

SECTION TWO • Upper Extremity

H

I Figure 8-43.  ( Continued ) H: Plate fixation of fracture anatomically. I: Radiographs of ORIF with volar plating system. (Courtesy of Children’s Orthopaedic Surgery Foundation.)

the radiocarpal joint or physis. Furthermore, K-wires may be used to joystick-displaced fracture fragments or in an intrafocal fashion 194 to further assist in fracture reduction. Intraoperative fluoroscopy is invaluable in these cases. Wrist arthroscopy may be a helpful adjunct for articular visualization. 35,53 With approximately 10 to 12 lb of distraction placed via finger traps to the index and long fingers, a small joint arthroscope (2.4 to 2.9 mm in diameter) may be inserted into the standard 3 to 4 wrist arthroscopy portal; this portal lies

between the third and fourth extensor compartments and is typ- ically 1 to 2 cm distal to Lister’s tubercle. Care should be taken to avoid excessive extravasation of arthroscopy fluid into the zone of injury during arthroscopy; expeditious arthroscopy and use of low pressure and flow rates are helpful in these situations. Finally, a wide spectrum of internal fixation options is avail- able. Percutaneous K-wires are effective when properly posi- tioned, particularly in younger patients with open physes in whom efforts are made to minimize the risk of iatrogenic growth

A

Figure 8-44.  A: CT scan of displaced Salter–Harris type IV fracture. B: Surgical correction included external fixation distraction, arthroscopi- cally assisted reduction, and smooth pin fixation. (Courtesy of Children’s Orthopaedic Surgery Foundation.)

B