Childhood fractures Flashcards
What would you consider in the history?
- Mechanism of injury
- Any other injuries/sites of pain?
- Previous injuries
- Family hx of fractures, blue sclera, deafness (osteogenesis imperfecta)
What are signs of Non-accidental injury?
- Hx of trauma inconsistent with injuries, Changing or inconsistent Hx, Unexplained co-existent injuries or Previous Hx injury
- Injuries which do not fit with the development age of the child
- Children known to social services
- Poor parent-child bonding
- Parental attempts at excusing or justifying the injury inappropriately or blaming a younger sibling or pet
What are common childhood fractures?
- Wrist
- Buckle
- Clavicle
- Distal humerus
- Supracondylar fractures
What is a greenstick fracture?
One side of the bone breaks whilst the other stays intact
What is a buckle fracture?
Incomplete fractures of the shaft of long bone that is characterised by bulging of the cortex
How can you identify a supracondylar fracture?
The anterior humeral line should transect through the middle 1/3 of the capitellum
• Fractures will cause the capitellum to be displaces posteriorly
What are the possible complications of a supracondylar fracture?
- Damage to brachial artery
* Damage to ulnar nerve
What are the complications of a growth plate fracture?
- Growth may cease
- Limb is shortened
One-side deformity and asymmetrical growth
What is the Salter-Harris system for supracondylar fractures?
SALTR mnemonic: • Type I: Straight across • Type II: Above • Type III: BeLow • Type IV: Through • Type V: CRush
In relation to the growth plate
What is osteogenesis imperfecta?
Genetic mutation that affects the formation of collagen
What is the clinical presentation of osteogenesis imperfecta?
- Hypermobility
- Blue/grey sclera
- Triangular face
- Short stature
- Deafness
- Dental problems (formation of teeth)
- Bone deformities (bowed legs and scoliosis)
- Joint and bone pain
What is the radiological presentation of osteogenesis imperfecta?
- Translucent bones
- Multiple fractures
- Long bones mainly affected
- Wormian bones (irregular patches of ossification)
- Trefoil pelvis
How do you manage osteogenesis imperfecta?
- Bisphosphonates
* Vitamin D supplements
What is the pain ladder for children vs adults?
Children:
- Paracetamol or ibuprofen
- Morphine
Adults:
- Non-opioid
- Non-opioid + Opioid (co-codamol)
- opioid (morphine) + non-opiod
What analgesic medications cannot be used in children?
- Codeine
- Tramadol
- Aspirin
