bone xrays Flashcards
describe the 5 grades of salter (SALTR) harris classification of #
Slip grade 1 - # thru growth place alone (not M/E)
Above grade 2 - # thru the grwth place + above into M
beLow grade 3- # thru growth plate and below into E
Through grd 4 - # thru growth plate and M and E
Rammed Grd5 Compression of growth plate
Complication of salter Harris fractures
Premature closure of growth plate 27% angle deformity
38% grade 3/4 SH fractures
Order of bone fusion of elbow
CRITOE Capitellium Radial head Internal epicondyle Trochlea Olecraneom Ext epicondyle 1,3,5,7,9,11years I,T order important in elbow Fractures
Fat pads in elbow fractures
Posterior fat pad should not be seen if see = #
Anterior fat pad. Sail like projection =#
Slipped femoral epiphysis
Presentation hip pain 50% knee pain 25% limp groin pain Boys 12-15 Girls before first period Obesity Bilateral 10% at presentation 20-80% other times Need 2 views AP and FROG view Slip anterior or post
Signs of slipped femoral epiphysis on X-ray
Decreased ht of the epiphysis
No epiphysis lateral to Kliens line
Metaphysics increased radiolucency
Klein’s line not thru the femoral head
What is kliens line
Line drawn from the superior femoral neck and it should bisect the femoral head epiphysis (if the head below it’s slipped)
Child abuse signs on X-ray. High specificity
Classical metaphysial fracture CML Rib fractures post med Scapular Sternum Spinous processes
What fractures are moderate specificity of child abuse (6 things)
Multiple fractures esp bilaterally
Fractures of different ages
Vertebral fractures
Digital fractures (babies don’t #digits stomped on)
Complex skull fractures
Epiphyseal separation (birth trauma >4kg or child abuse)
What signs on X-ray are low specificity for child abuse
Sub periosteal fractures
Clavicle fractures
Fractures of long bones shaft
Linear skull fractures
When are Classical metaphysesl fractures seen
Where is it seen. What bones
In child abuse
<18 months of age usually <2years (small enough to be shaken twisted)
Seen in the long bones of the legs and in the humerus
Bucket handle tear / Conner fracture
What is the DD of CML classic metaphyseal lesion (3)
1 physiological see sub periosteial changes related to rapid growth 1-5 months of age (6/12) usually bilateral <2mm
2 Ricketts frayed splayed metaphysis / R Rosary/ osteopenia -pathological fractures
3 osteogenesis imperfecta. Rare ( CML and post rib #rare in OI)
Physiological differences children’s fractures to adults
Remodeling Overgrowth Progressive deformity Non union Speed of healing. Quicker
Remodeling in childhood fractures
1 tolerate treated degrees of deformity esp close to the growth plate there is better remodeling
2 you need >2years of remodeling to go eg <12 yrs female >14year males
3 if the fracture is in the plane of the bone
Remodeling WONT happen if
1 intra articular fracture
2 fracture 90 degrees to the plane of the bone
What is overgrowth in relation to childhood fractures
Overgrowth can happen in fractures that get a bit blood flow eg femur and can get a difference in the leg length
What is non union in fracture
Rare in children
1Happens if there is a displaced intra articular fracture eg lateral humural fracture
2 Fracture has soft tissue interposition
Age of child is important in fractures
Remodeling need 2 years more of growth for it to work 12 girls 14 boys
<3 years 25 % of Fractures non accidental injury
Pulled elbow in toddlers mechanism and what is it
Pulled elbow
Subluxation of the radial head
Will resolve on its own
X-rays what things should you get in a ? Fracture
2 views and need to involve both joints above and below
Elbow fractures
Radio calielium line should be straight on lat view
Fat pads should not be seen ? Arthrosis effusion fracture
Comparison with the other side if uncertain
If a child has a fracture what things do you look for on examination
1 swelling deformity
2 neurovascular
3 point tenderness = characteristic of #
4 move ?tendon injury
If fracture has neurovascular involvement what should you do
Requires URGENT. Treatment with reduction don’t need analgesia
EMERGENCY
Toddler fracture = spiral fracture common happen when they trip
True not NAI
Open fractures are orthopedic emergency
True Photo Clean big bits out Sterile dressing don’t disturb till child in OT Antibiotics X-ray Surgery within 6 hours
Neonatal Fractures humerus clavicle femur common sites in birth trauma
> 4-4.5kg normal
Osteogenesis imperfect
Supracondylar fractures are common in childhood
True 3-10 year of age Fall on an outstretched hand 15% have nerve palsy ant intraossus nerve Brachial artery entrapment /injury
Fracture pattern
Spiral fracture (twisting force ) bowing fracture
Oblique
Transverse direct blow
Butterfly >2 elements to the # lots of energy involved in #
Growth plate injury
Progressive angular deformity
Limb length discrepancy
Joint incongruity
