1- childrens fractures

Question 1

what are a couple important aspects of history for childrens fractures?

Answer 1

• often collateral with parents
• mechanism of injury
• time of injury
• past medical
• last meal
• should think about non accidental injury

Question 2

what are some key differences about kids bones compared to adults?

Answer 2

they’re much more bendy and able to remodel
- they are less dense, more porous, less minerals, and less stiff (means more likely to bend & bow)

• they also have strong thick periosteum which helps with stability when realigning fracture

Question 3

what are some fracture patterns common in kids? (4)

Answer 3

1. buckle fracture (from compressive force)
2. green stick fracture (force causes crack on one side of bone while other side bends)
3. plastic deformation (it’s just a slight bend in bone, often don’t do anything about it)
4. physis fracture (SALTR)

Question 4

what is salter classification?

Answer 4

• for physis injury in kids, higher number = more severe
• s = straight, a = above, l= lower, t = through, r = crush/rammed

Question 5

why is it good to be young when fracture?

Answer 5

• children’s fractures heal faster (younger = faster)
• get stability much quicker so can remove cast quicker
• can have remodelling if child has more than 2 years left growing

Question 6

what is bone remodelling in kids?

Answer 6

when fracture in kids can heal itself. angulation & translation of bones (even pretty extreme ones) can be left and fix themselves

*doesn’t fix rotation

Question 7

what is common location for elbow fracture? which nerve can this damage?

Answer 7

supracondylar fracture = weakest part of elbow joint where humerus flattens & flares. this can damage anterior interosseus nerve (branch of medial)

Question 8

what is very important to check in exam if suspect or know supracondylar fracture?

Answer 8

potential for vascular compromise so check radial pulse & capillary refill!
(also check nerve function in hand)

Question 9

what classification is used to know severity of supracondylar fracture?

Answer 9

gartland

Question 10

what are titanium elastic nails used for?

Answer 10

bendy nails that hold fracture, nice & stable and take out after

• done in forearm if too big degree for remodelling and also in femurs

Question 11

why are big rods used to treat femur fracture in adult not used in kids?

Answer 11

kids heal quicker and more stable so don’t need and also couldn’t put rod as would destroy physis

Question 12

what are red flag fractures for non accidental injury?

Answer 12

• rib fractures
• femur fractures (especially kid not walking)
• multiple breaks of different ages (on xray can see healing at different stages)
• significant number fractures in child under 1

Question 13

what would you do if suspect non accidental injury?

Answer 13

skeletal survey done (xray whole skeleton)