15. Paediatric Trauma Flashcards
How many bones are in the:
- Adult Skeleton?
- Child Skeleton (at Birth)?
- 206
2. 270
What are the 3 broad categories of causes for Paediatric Fractures?
- Accidental (Sports)
- Non-Accidental
- Pathological
Where are the majority of Paediatric Fractures located?
Upper Limb
When do the different Elbow Ossifications occur?
CRITOE:
C - Capitellum - 1 Year Old
R - Radial Head - 3 Years Old
I - Internal (Medial) Epicondyle - 5 Years Old
T - Trochlea - 7 Years Old
O - Olecranon - 9 Years Old
E - External (Lateral) Eptcondyle - 11 Years Old
What is the definition of a Fracture?
A Breakage or Breaking in the continuity of Bone / Cartillage
What are the Key Components of describing a Fracture?
- What Type? (Transverse, Spiral, Buckle etc.)
- Of Which Part? (Proximal, Distal, Metaphyseal etc.)
- Of Which Bone?
- With How Much? (Angulation, Displacement, Shortening etc.)
What are the Different Types of Fracture?
- Transverse
- Oblique
- Spiral
- Backle
- Impacted
- Comminuted
- Greenstick
- Intra / Extra - Articular
- Butterfly
- Burst
- Crush
What is the most common type of fracture in 3-9 year olds?
Supracondylar Fracture of the Humerus
What is the most common cause of death in Children?
Trauma - 43%
Who more commonly gets Fractures in Paediatrics?
- Boys (3:2)
- Increased Physeal Injury with Age
- Those with a Previous Fracture / Metabolic Bone Disease
What are the Principles of Children’s Fractures?
- They are often simple, incomplete and heal quickly
- They remodel well in plane of Joint Movement
- They form a Thick Periosteal Hinge
- Fractures involving Physes can result in progresive Deformity
What are the common Forearm Fractures in Children?
- Shaft Fractures
- Special Cases:
- a) Galeazzi Fracture (Radial Shaft)
- b) Monteggia Fracture (Ulna Shaft)
- Distal Radial Fractures
Note - 80% are Proximal Shaft Fractures
What is important in the Assessment of a Forearm Fracture in Paediatrics?
- History - Mechanism (Low Energy (Buckle / Greenstick vs High Energy (Open / Displaced / Soft Tissue Injury)
- Deformity
- Soft Tissue - Whole Limb, Wounds, Sensation / Motor Function, Vascular Status
What are the Surgical Indications for a Forearm Fracture in Paediatrics?
< 9 years old:
- > 15 Angulation
- > 45 Malrotation
> 9 years old:
- a) > 10 Angulation (Proximal)
- b) > 15 Angulation (Distal)
- > 30 Malrotation
Both: Open, Segmental, Neurovascular Compromise etc.
What are the Surgical Options for a Forearm Fracture in Paediatrics?
- External Fixation
2. Open Reduction Internal Fixation (ORIF)
What are complications of Surgery?
- Compartment Syndrome
- Non-Union / Re-fracture
- Radioulnar Synostosis
- Superficial Radial Nerve Injury
- Distal Radio-Ulnar Joint / Radiocapitellar Problems
What is the management of a:
- Buckle Forearm Fracture?
- Greenstick Forearm Fracture?
- Complete Forearm Fracture?
- Cast - 3-4 weeks
- Cast - 4-6 weeks
- Cast +/- KW - 4-6 weeks
What is the Differential for Knee Trauma?
- Infection
- Inflammatory Arthropathy
- Neoplasm
Apophysitis - Hip / Foot Problems
- Sickle Cell Anaemia, Haemophilia
Where can Bony Injuries occur, in relation to the Knee Joint?
- Physeal (2 Femoral : 1 Tibial)
- Metaphyseal
- Tibial Spine / Tubercle
- Patellar Fracture (Rare)
- Sleeve Fracture
- Patellar Dislocation
What can cause Injuries at the knee Joint?
- Hyperextension - Vascular Injury
2. Varus - Common Peroneal Nerve Injury
What are the treatment options for a Knee Joint Injury?
- Cast immobilization
- Percutaneous Fix
- Open Reduction, Internal Fixation Articular Displacement
What is the Treatment for a Patellar Fracture?
Open Reduction, Internal Fixation
What are the Risk Factors for a Patellar Dislocation?
- Laxity
- Poor Vastus Medialis Oblique (VMO)
- Q Angle
- Femoral Anteversion
- Tibial External Rotation
- Patella Alta
What is the Management of a Patellar Dislocation?
- Cast (2 weeks) - Repair Medial Ligament
- Mobilise - Lateral Release
- Vastus Medialis Oblique (VMO) Exercises - Medialise Tibial Tubercle, Semi Tenodesis
What information do you need to know about Osteochondral Lesions?
- They are caused by a single traumatic indicent / developmental
- They are seen in plain films +/- MRI
- Type 1 (Cartilage intact) - Immobilize it
- Type 2 (Flap) and 3 (Fragment) - Drill / Fixation to fix it
How is Anterior Knee Pain diagnosed?
Diagnosis of Exclusion - Rule out Inflammatory, Neoplasm etc.
What is the most common plane of an Ankle Fracture?
Physis as it is weaker than Ligaments
What are the different classifications of Ankle Fractures?
- Mechanistic
2. Anatomical (Salter-Harris)
What are the Different Slater-Harris Classifications of Fractures?
Type 1 - Fracture Line is within the Physis
Type 2 - Extends from the Physis into the Metaphysis
Type 3 - Fracture enters the Epiphysis from the Physis
Type 4 - Fracture extends across the Physis, from the Articular Surface to the Epiphysis
Type 5 - Fractures are Crush Injuries of the Physis
Note - Type 2 is the most common
How is an Ankle Injury assessed?
- History - Mechanism
- Deformity
- Soft Tissue
- Antero-Posterior + Lateral Radiographs
What are the different Pitfalls, with regards to Ankle Injury?
- The Missed Fracture
- The Normal Variant
- Persistent Displacement - Sesamoid Healing
What is the worries with Transitional Fractures of the Ankle?
Growth Plate Closing
What are the 2 Overuse Injuries you may see in a child?
- Osgood-Schlatter’s Disease
2. Sever’s Disease
