Children's fractures Flashcards
What is the epidemiology of children’s fractures?
- 60 % boys
- 40 % girls
- 80 % Upper limb
- 20 % Lower limb
- 0.7% Open
- 15 % physeal
What are physeal injuries?
Physeal injuries are very common in children, making up 15-30% of all bony injuries. The growth plate, or physis, is the translucent, cartilaginous disc separating the epiphysis from the metaphysis and is responsible for longitudinal growth of long bones
What is a greenstick fracture?
A fracture of the bone, occurring typically in children, in which one side of the bone is broken and the other only bent.
What type of fracture is shown here?
Greenstick fracture
Define what a torus/buckle fracture is
They are extremely common injury seen in children. Because children have softer bones, one side of the bone may buckle upon itself without disrupting the other side; this is also known as an incomplete fracture.
What type of fracture is shown?
Buckle or torus fracture
Describe what plastic deformation of bone is
A bow-shaped deformity of bone from trauma strong enough to cause the bone to bend but not break. It is typically seen in children, esp. in the ulna or fibula.
What deformity is shown here ?
Plastic deformation of bone
Describe immature bone in general terms
Epiphysis, Physis (growth plate), metaphysis, diaphysis
When assessing child injuries what must you always exclude ?
NAI (non-accidental injury) i.e. child abuse
What are signs which point to NAI?
- History that does not match the nature or the severity of the injury
- Vague parental accounts or accounts that change during the interview - inconsistency
- Accusations that the child injured him/herself intentionally
- Delay in seeking help
- Child dressed inappropriately for the situation
What are some of the typical features of NAI in kids?
- Any obvious or unsuspected fractures in a child under <2yr particularly prewalking
- Injuries in various stages of healing, especially burns and bruises
- More injuries than usually seen in children of the same age
- Injuries scattered on many areas of the body
- Increased intracranial pressure in an infant
- Suspected intra-abdominal trauma in a young child
- Any injury that does not fit the description of the cause given
What is the main difference in management of fractures in kids compared to adults?
Kids have a greater remodelling potential which often reduces need for accurate reduction hence more amenable to conservative treatment - Plaster/Traction/less invasive fixation
Describe what a type I physeal injury is
A complete physeal fracture with or without displacement
Describe what a type II physeal injury is
A physeal fracture which extends through the metaphysis, producing a chip fracture of the metaphysis which may be very small
