Chapter 138 - Pediatric Polytrauma and Upper Extremity Fractures Flashcards
salter harris fractures occur thru which physeal zone?
hypertrophic
what injury mechanism leads to c spine injuries in you kids (<8) following MVC
decelleration leads to distraction injuries -> kids with big heads relative to their trunk
when does multiorgan failure occur following trauma in kids vs adults
kids: multiorgan failure IMMEDIATELY
adults: multiorgan failure 48-72 hours later
kids have a dampened systemic inflammatory response and a robust local inflammatory response
compartment syndrome resulting from tibial tubercle fractures result from injury to what artery?
anterior tibial recurrent artery
what fractures are pathognomonic for NAT?
metaphyseal corner fractures and posterior rib fractures
what is the most COMMON fracture in NAT
isolated, transverse long bone fractures
congenital pseudarthrosis of the clavicle is related to what condition?
none. isolated issue. thought to be related to external compression of the subclavian artery against the developing clavicle.
what is the last physis in the body to fuse?
medial clavicular physis - age 23-25
what percentage of humeral growth occurs at the proximal physis?
80%
indications for surgical fixation of proximal humerus fracures in kids
<10 yo: any angulation acceptable
10-12yo: >60-75 degrees of angulation
>12yo: up to 45 degrees of angulation or 2/3 cortical displacement
most common nerve injury in SCH
- AIN injury in extension type SCH
nerve injury associated with posterolateral fracture displacement in SCH
median n
second most common nerve injury in SCH
radial nerve
seen with posteromedial fracture displacement
nerve injury associated with flexion type SCH
ulnar nerve
can also be iatrogenic 2/2 blind medial pin
how long do you cast a non-op SCH?
3 weeks
indications for non-op mgment of SCH
- type I
- type II ONLY IF:
anterior humeral line intersects the capitellum
no anteromedial comminution
no varus alignment
what elbow position puts ulnar nerve at highest risk with medial pinning in SCH
elbow flexion or hyperflexion
what causes Volkmann Ischemic contracture most commonly
compression of the brachial artery post operatively by casting in >90 degrees of flexion
most common complication of non-op managed t II or III SCH
recurvatum deformity is the most common complication of non-op managed type II, III fractures and is poorly tolerated 2/2 limited growth potential of the distal humerus
ossification centers of the distal humerus
CRITOE
Capitellum - 1yr
Radial head - 4yo (girls)
Medial epicondyle - 6
Trochlea - 8
Olecranon - 10
LE - 10
what view to get for lateral condyle fractures
internal oblique view
key point to lateral condyle ORIF
DO NOT do a posterior approach
- the retrograde blood supply to the lateral condyle comes from posterior and you will cause osteonecrosis
most common non-union of lateral condyle fracture?
cubitus valgus
can be accompanied by tardy ulnar nerve palsy decades later
indications for treatment of medial epicondyle fractures
displacement >5mm
entrapped articular fragment
if there is an entrapped medial condyle fragment what is the reduction maneuver to try to dislodge it closed?
supination, valgus, and wrist/finger extension
distal humeral physeal separations displace in which direction?
posteromedially
distal humeral physeal separation is commonly misdiagnosed as what?
an elbow dislocation but elbow dislocations rarely happen in very young children
(distal humeral physeal separations most commonly occur in kids <3, up to 6)
when you see a distal humerus physeal separation what should you think of?
NAT!!!
surgical indications for pedi radial neck fractures
> 30degrees residual angulation
3-4mm translation
<45 degrees of pro/supination
common complications of radial neck fractures in kids (op or non-op)
stiffness!
radial head overgrowth
surgical treatment of a pedi olecranon fracture
tension band with absorbable suture as the tension band
nursemaid elbow
longitudinal traction with the annular ligament sliding over the radial head
kid holds the elbow extended an pronated
reduction: hyperpronation in extension, or flexion plus supination
greenstick fractures typically result from what force?
rotational injuries
how does the radial head dislocation with monteggia fractures?
the radial head follows the apex of the ulnar fracture
I: anterior apex ulna -> anterior dislocation
II: ulna apex posterior -> Posterior dislocation (most common)
III: lateral
IV: any ulna fracture + proximal radius FRACTURE DISLOCATION
common complication of monteggia fracture
PIN palsy after injury
