Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK- Surgery and Trauma (CORTEXT 5 and 6) > Children's Fractures > Flashcards

Children's Fractures Flashcards

1
Q

Fractures in children are more likely to affect which limb?

A

Upper limb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some important questions to ask about a fracture in a child?

A

Mechanism

How high

How fast

Forces involved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

A child who is not yet walking with what type of fracture would make you suspicious of NAI?

A

Long bone fractures

Also metaphyseal injuries in infants are rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

A child presenting with a fracture and with what other things wrong would make you more suspicious of NAI?

A

Raised intra-cranial pressure

Intra-abdominal trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

If you have any suspicion of NAI, how should these patients be managed?

A

Admit for safety

Full examination of the child and skeletal survey

History from the parents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where in the bone of children is the primary ossification centre?

Where in the bone of children is the secondary ossification centre?

What is the area of the bone which forms the growth plate known as?

What part of children’s bones are mostly cartilage before being differentiated into bone as they get older?

A

Diaphysis (shaft)

Epiphysis

Physis

Epiphysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

At what age does the proximal femoral epiphyseal secondary ossification centre appear?

By what age (roughly) will this be completely replaced by bone?

A

4 months

16 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What part of children’s bones are responsible for longitudinal growth?

What part of children’s bones are responsible fo circumferential growth?

A

Physis

Periosteum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Children’s bones are more elastic and pliable, which means what in terms of fractures?

A

They tend to buckle, or partially fracture/splinter with some fibres still attached

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the periosteum in children like compared to adults?

What does this mean in terms of fractures?

A

Thicker

It tends to remain intact which helps stability and can assist reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some reasons that childrens fractures tend to heal better than adults?

A

The thick periosteum is a rich source of osteoblasts

They have greater potential to remodel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the 3 main principles of treatment of children’s fractures?

A

Reduce

Retain

Rehabillitate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Children’s fractures tend to be surgically stabilised much less frequently due to their greater healing potential.

If the position is really unacceptable, what may still be all that is required?

A

Manipulation and casting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where do you put a cast for a diaphyseal fracture?

Where do you put a cast for a metaphyseal fracture?

A

Over the break, and the joint above and below

Only over the adjacent joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If surgical stabilisation is really required in a child, what materials tend to be used?

When are plates and screws utilised?

A

Pins, wires and rods (less invasive)

Very unstable injuries where a fracture is associated with a dislocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some consequences of a physeal fracture?

A

Disturb growth which can result in a shortened limb

Angular deformity if only one side of the physis is affected by grwoth arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Overall, what are the exceptions to the rules of conservative management in childrens fractures?

A

Displaced intra-articular fractures

Displaced physeal fractures

Some open fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

At what age do childrens fractures start to be treated the same as adults?

Why?

A

12-14 (once the child has reached puberty)

Remodelling potential is less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the relationship between the Salter Harris classification of a physeal fracture and its prognosis?

A

Higher up the classification, the worse the prognosis

20
Q

What Salter-Harris classification is this fracture?

What does this mean?

What is its prognosis?

A

Type 1

Complete physeal separation +/- displacement

The best prognosis- very unlikely to result in growth arrest

21
Q

What Salter-Harris classification is this fracture?

What is this?

Is it likely to cause growth arrest?

A

Type II

A physeal fracture which produces a chip fracture of the metaphysis

Unlikely, it has a good prognosis

22
Q

What Salter Harris classification is this fracture?

What is this?

A

Type III

A physeal fracture whcih extends into the epiphysis

23
Q

What Salter-Harris classification is this fracture?

What is this?

A

Type IV

A phseal fracture with epiphyseal and metaphyseal fractures also

24
Q

What Salter-Harris classification is this fracture?

What is this?

When can these be detected on x-rays?

A

Type V

A compression of the growth plate with susequent growth arrest

Only once they have caused deformity, not on initial x-rays

25
Q

Which Salter-Harris fractures are intra-articular?

Can these cause growth arrest?

How should they be treated?

A

III and IV

Yes

Reduced and stabilised to ensure a congruent articular surface and minimise growth disturbance

26
Q

What type of fracture is this?

What is this?

Who do these tend to occur in?

A

Greenstick fracture

The bone bends or cracks instead of breaking completely. There is still continuity of some fibres.

Children < 10

27
Q

How are Greenstick fractures treated?

What is usually the mechanism of injury for a Greenstick fracture?

A

Even mild ones are immobilised in a cast (this holds the bones together and prevents it breaking completely if the child were to fall again)

Usually with a fall, most commonly in the arms

28
Q

What type of fracture is this?

What is this?

A

Torus (Buckle) Fracture

Incomplete fractures of the shaft of a long bone which is characterised by the bulging of the cortext

29
Q

Where do buckle fractures tend to affect?

Why do they most commonly occur?

How are they treated?

A

Distal radial metaphysis

Following a FOOSH

Self limiting, usually splint for 3-4 weeks

30
Q

What type of fracture is this?

What is it?

Which bones does this most commonly occur in?

A

Plastic deformation (bowing) fracture

An incomplete fracture of tubular long bones

Ulna and radius

31
Q

How are plastic deformation (bowing) fractures treated?

How do children present with these?

A

No intervention, heal with remodelling

Pain and swelling following a fall (often from climbing)

32
Q

What types of fractures commonly occur at the distal radius?

A

Buckle, greenstick and Salter Harris type II

(can also get complete fractures)

33
Q

Complete fractures of the distal radius may displace/angulate. In which direction is it more common for this to happen?

If complete fractures of the distal radius are stable, what is the treatment?

If complete fractures of the distal radius are very unstable, what is the treatement?

A

Dorsally

Casting

Wire or plate fixation

34
Q

How are fracture dislocations treated in children?

If both bones of the forearm are fractured but the periosteum is intact and they are fairly stable, how are they treated?

If both bones of the forearm are fractured and unstable, how are they treated?

A

Rigid fixation with plates and screw to avoid re-dislocation

Manipulation and casting

Flexible IM nail

35
Q

Which type of supracondylar fracture is more common in children, extension or flexion?

How does the extension type occur?

How does the flexion type occur?

A

Extension

Heavy FOOSH

Fall onto the point of the elbow

36
Q

What is the treatment for an undisplaced supracondylar fracture?

What is the treatment for an angulated/rotated/displaced supracondylar fracture?

What is the treatment for a severely displaced supracondylar fracture with damage to the brachialis muscle?

A

Splint

Closed reduction and pinning with wires

Open reduction

37
Q

In the extension type of supracondylar fracture, the distal fragment often displaces posteriorly which can press on which:

a) artery?
b) nerve?

How can you check if there has been damage to the nerve?

A

Brachial artery

Median nerve (predominantly anterior interosseous branch)

Ask patient to make ‘okay’ sign- this tests the FPL and FDP to see if the nerve is damaged

38
Q

If there is a displaced supracondylar fracture with an absent radial pulse, what is the treatment?

If the hand is still pulseless after this, what is the next step?

A

Emergency reduction

Open surgical exploration

39
Q

What is the mechanism of action for a femoral shaft fracture in children?

Why is some limb shortening accepted in these fractures?

A

Fall onto a flexed knee, or by indirect bending/rotational forces

There is usually overgrowth following healing

40
Q

What is the treatment for a femoral shaft fracture in a child < 2?

What is the treatment for a femoral shaft fracture in a child aged 2-6?

What is the treatment for a femoral shaft fracture in a child aged 6-12?

What is the treatment for a femoral shaft fracture in a child aged 12+?

A

Assess for NAI, Gallow’s traction and early casting

Thomas splint/hip cast

Flexible IM nail

Adult IM nail

41
Q

Why should you consider pathological fracture in a child with a femoral shaft fracture?

A

It is a common site for benign and malignant bone tumours

42
Q

What type of tibial shaft fracture is common in toddlers?

How are these treated?

How much angulation is generally tolerated before manipulation is required?

What is used for follow up?

Is any shortening/malrotation accepted?

A

Spiral (undisplaced)

Casting (compartment syndrome is much less common)

10 degrees

Serial x-rays (AP and lateral)

No

43
Q

What investigation is used for children’s fractures if:

a) The bones are ossified?
b) The bones are not ossified?
c) There is joint injury?
d) More detail is needed?

A

a) X-ray
b) Ultrasound
c) Arthrogram
d) CT/MRI

44
Q

In what direction does the epiphysis grow?

A

Distally

45
Q

What effect do each of the following forces have on growth?

a) Compression?
b) Tension?

A

a) Stimulate growth
b) Inhibit growth

MSK- Surgery and Trauma (CORTEXT 5 and 6) (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions