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58. Describe the level and pattern of this child's fracture.

59. This is the radiograph of the tibia of a young man who was kicked whilst playing rugby. What is the pattern of fracture? What observations would you make regarding the detection of such a fracture?

60. This is a radiograph of the elbow of an adult injured in a fall. There is obvious clinical deformity. What is the injury?

61. This is a radiograph of (he arm of a child severely crushed in a run- 62. What is the pallern of this injury? over road traffic accident. Describe the injury.

63. Describe this fracture. What problems might you anticipate with it?

64. Describe the level and any angulation or displacement that you see in this fracture.

65. Can you detect any abnormality in this Al' radiograph of the wrist and forearm of a child?

66. This is the radiograph of a palicnl who complained of pain in the side of the fool following a sudden inversion injury. Where is the fracture, and what is the pattern of injury.'

67. The history in this case is of pain in the back following a fall. What is the pattern of fracture?

68. This radiograph is of the hip of an elderly lady who complaincd of pain alter a fall. What deformity is present? Have you any observations to make regarding any factors contributing to the fracture?

69. What is this pattern of fracture? What is the importance of accurate reduction in this case?

70. What pattern of injury is illustrated in this thumb radiograph? What is its significance?

71. This injury was sustained in a road traffic accident. Describe the pattern of injury and the deformity.

72. Types of epiphyses: There are two types of epiphyses: ( I ) pressure epiphyses, which form part of the articulating surfaces of a joint, and (2) traction epiphyses, which lie at muscle insertions, are non-articular and do not contribute to the longitudinal growth of the bone.

75. Pressure epiphyses (b): Within the epiphyseal plate (I) is a layer of active cartilage cells (2). The newly formed cells undergo hypertrophy. Calcification and transformation to bone occur near the metaphysis (3). When there is an epiphyseal separation, it occurs at the weakest point, the layer of ccll hypertrophy (4). The active region (2) remains with the epiphysis.

73. Traction epiphyses cntd: Injuries to the traction epiphyses are nearly always avulsion injuries. The sites commonly affected include (I > the base of the fifth metatarsal. (2) the tibial tuberosity. (3) the calcaneal epiphysis. Traction injuries are probably the basic cause of Osgood Schlatter's and Sever's disease (2 & 3). Other sites include the lesser trochanter, ischium and the anterior iliac spines.

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