Children's Fractures - 08/11/18 Flashcards
What % of children get injured every year?
25%
Which gender more commonly gets fractures?
Boys
Which limb is most common for childrens fractures?
Upper limb
What are 3 fractures that are specific to children?
Greenstick
Torus
Plastic deformation
Describe the bony anatomy of childrens bone?
Physis = Growth Plate
On the joint side - epiphysis
Shaft - Diaphysis
Metaphysis is extending to diaphysis
What is Wollfs law?
Bone in a healthy person will adapt to the load under which it is places
What is hueter volkman law?
Compression forces inhibit growth and tensile forces stimulate growth
Is fracture healing better in children or adults?
Children
What important aspects of the history are important?
Mechanism How high? How Fast? Forces involved Predict injuries and exclude or confirm
What are features of non accidental injury?
History that does not match the nature of the injury
Vague parental accounts, or account that change
Accusations that child injured themselves intentionally
Delay in seeking help
Child dressed inappropriately for the situation
Any obvious or unsuspected fractures in a child under 2
Injuries in various stages of healing
More injuries than usual
Scattered injuries
Increased intracranial pressure
Suspected intra-abdominal trauma
Any injury that does not fit the description
What is important in the LOOK part of the examination?
Deformity
Swelling
Bruising
Assymetry
What is important in the FEEL part of the examination?
For point tenderness that correlates with X-ray
What is important in the neurovascular exam?
Colour Capillary refill Skin temperature O2 saturations Pulse Sensation Sweating Skin wrinkling
What is the MOVE part of the examination?
Often too painful DNV OK sign - medial Hitchikers thumb - radial Star fish - ulnar Initial force on impact
What causes a fracture to displace?
Muscle action and gravity
Initial force on impact
What can cause a wrist drop/
Radial nerve impingement
Humeral fracture`
What are symptoms of ulnar nerve damage?
Loss of function of hands and fingers
What is used in the diagnosis of child fracture?
X-ray if ossified
Ultrasound
Arthrogram for joint injuries
CT or MRI for detail
What are the 3 Rs of fracture management?
Reduce
Retain
Rehabilitate
What important in the reduce part?
Remodelling potential reduced need for accurate reduction at a young age
What is gallows traction?
Suspending legs off of the bed
3 months to 3 years
<48 hours traction and then spica or inpatient traction 2/52
What is important in the Retain part?
Broad arm sling support
Collar
Cuff
Which fractures definitely need fixed?
Displaced Intraarticular fractures
Displaced growth plate injuries
Open Fractures
What is the classification for physeal injuries?
Salter Harris classification
SALTER acronym
S- Straight across A - Above L - Lower TH - Through everything R - cRush
What are the indications for external fixation?
Contaminated wounds
Acute vascular injury
Burns
Multiple injuries