15.11.5 Paediatric Trauma Flashcards
Two paediatric injuries with the highest mortality
- CNS injuries (head injuries)
- Spine fracture (highest mortality in MSK)
Mechanism vs common patterns
Pedestrian struck by motor vehicle
Slide 4
Difference between adult and paediatric pt with injuries
- Smaller body mass leads to greater force applied
- Large surface area to body volume therefore prone to hypothermia
- Blunt trauma involving the brain is most serious
- Apnoea, hypoventilation and hypoxia 5 x more common
- Aggressive management of AW and breathing
- Psychological ramifications
- Affect on the family unit
- Incomplete calcification of skeleton
- Internal organ damage without obvious overlying external fractures
- Rib and skull fractures = MASSIVE ENERGY TRANSFER
- Growth disturbances
- Increased physiological reserve (paediatric goes from being stable to crashing in a very small time) -> therefor need to identify very early
- Hypotension is a LATE sign of shock
- Kids crash quickly and LATE
Skeletal differences
- growth plates are still open
- in neonates very large part of skeleton is not ossified
- bone is more elastic
- peri-ostial bone relation is a lot bigger
Non accidental injuries red lights
History
- Discrepancy between history and degree of injury
- Delay in presentation
- Repeated trauma, hospital shopping
- History keeps changing
- Inappropriate response by parents
- Mechanism of injury implausible based on developmental stage
- When the story doesn’t make sense
Findings
- Bruises different ages
- Old scars or healed fractures on x ray
- Perioral injuries
- Genital/ perianal injuries
- Fractures of long bones younger than 3 years of age
- Ruptured internal viscera without major blunt trauma
- Multiple subdural haematomas
- Retinal haemorrhages
- Bites/ cigarette burns/ rope marks
- Sharply demarcated burns
- Skull or rib fractures under 24 months (child will only have rib fracture when the child was in a very big accident) -> therefor will point towards non-accidental
Non orthopaedic injury
- Head trauma
- Blunt chest trauma
➡️Tension pneumothorax
➡️Pulmonary contusion (often without rib fractures)
➡️Pneumothorax (commonly without rib fractures) - Blunt abdominal trauma
➡️Spleen rupture
➡️Duodenal injuries
➡️Mesenteric injuries - Orogastric tube decompression and catheterisation helps to evaluate the abdomen appropriately
Radiation exposure in children
Cumulative dose >10mSv linked to an increased cancer risk.
Orthopaedic injuries
- Can be difficult because lack of mineralization around the epiphysis and growth plate
- Less blood loss from long bone and pelvic fractures
- Physeal injuries can lead to growth disturbance
- Greenstick fractures
- Torus fractures
Salter-Harris Classification of physeal fractures
Slide 20
Types
1 -
2 -
3 -
4 - Combination of 2 and 3
5 - crushing injury to growth plate that presents few years after injuries with deformed bone
Complication of growth plate injuries
Growth arrests
- Complete arrest leads to shortening
- Partial arrest leads to angulation
- unilateral growth arrest (only part of growth plate stop) -> angular deformity
Type of injuries
Elasticity
- Buckle fractures
- Greenstick fractures(Failure of the tensile side)
- Bowing or plastic deformities (eg ulna’s curve grew in the wrong way) -> overcorrection
Torus fracture
- Derived from Latin (tori) meaning a swelling or protuberance
- Failure of cortex on compression side
- Torus (buckle) fractures of distal metaphysis of radius & ulna is the most common in lower forearm in young children
Remodelling potential
- remodelling of bone after injury went wrong
- the younger the pt is, the more extent the remodelling will happen (therefor increased risk for something to go wrong)
- only injury that will never remodel = rotational injuries (therefor not really a fracture)
Complication with pt in cast
- Recurrent deformity in the cast is the most common problem
- Occurs once the swelling subsides and cast becomes loose
