30: Paediatric Orthopaedic Emergencies: Fractures, NAI, Osteomyelitis

Question 1

why do children’s fractures heal so quickly?

Answer 1

• metabolically active periosteum
• cellular bone
• good blood supply
• often low velocity trauma

therefore, fixation is not usually required, do not over immobilise or over treat

Question 2

what are the four types of paediatric fracture?

Answer 2

1. cortical/buckle or torus fractures
2. greenstick fractures
3. plastic bending or bowing fractures
4. epiphyseal–metaphyseal (Salter–Harris) fractures

1-4 correspond to a-d on diagram

Question 3

childrens fractures remodel well in plane of…

Answer 3

joint movement

Question 4

outline the simple treatment of a childs fracture

Answer 4

• reduce the fracture (if needed)
• immobilise
• remove cast/splint when healed
• joint stiffness rare
• open fractures debride

Question 5

what are the warning signs of non-accidental injury?

Answer 5

• inconsistent history
• delay in presentation
• fracture pattern does not fit mechanism
• bruising - pattern and different ages
• burns
• multiple fractures, multiple stages of healing
• metaphyseal, humeral shaft
• ribs
• non-ambulant with no. long bones