Children's Fractures Flashcards
which gender is more affected by fractures in children?
boys
when does fracture incidence peak in childhood?
around 6-7 and again around 13
how does immature skeleton differ?
in terms of periosteum
name 3 fractures specific to children
greenstick
torus
plastic deformation
physis vs epiphysis vs metaphysis vs diaphysis?
physis = growth plate epiphysis = at the end of the bone, grows seperately metaphysis = thin part between epiphysis and diaphysis, contains the growth plate
what is the physis made of?
cartilage
what is wollfs law?
bone in a healthy person will adapt to the load under which it is placed
what is hueter volkman law?
compression forces inhibit growth and tensile forces stimulate growth
fracture healing in child vs adult?
better in child
in adult will basically just heal in the same site - i.e displaced
in child there’s continuous remodelling so will heal in better alignment?
important history for fractures in children and why is this important?
mechanism how high if a fall how fast forces involved predict injuries and exclude/confirm diagnosis
features of a non-accidental injury?
history doesnt match injury
vague/inconsistent parental accounts of what happened
any previous or unsuspected fractures in child <2 or pre-walking
injuries in various stages of healing - bruising, burns etc
more injuries than usually seen in children that age
injuries in scattered pattern over body
increased intracranial pressure in infant
suspected intra-abdominal trauma in young child
common clinical features of NAI?
metaphyseal corner fractures
scattered sites around body
look assessment of fracture?
deformity
swelling
bruising
asymmetry
feel examination of a fracture?
point tenderness to correlate with X ray
neurovascular examination
features of neurovascular examination?
colour
cap refill
skin temp
O2 saturation
pulse
sensation (can be difficult in young children/babies so sweat can be used)
sweating (loss of sweating in nerve injury - possibly due to fracture)
skin wrinkling on immersion in water (doesn’t happen in nerve damage)
move part of fracture examination?
often too painful but can do distal neurovascular assessment
how do you document nerve damage?
radial - sensory, motor (whether present)
ulnar - sensory, motor (whether present)
median - sensory, motor (whether present)
what can damage to the radial nerve cause?
wrist drop
innervates extensors of wrist, thumb etc
symptoms of ulnar nerve damage?
loss of function of hand and fingers
innervates intrinsic hand muscles
classic sign of median nerve damage?
cant flex thumb or index finger when making a fist
diagnosis of child fracture?
X ray if old enough where bone is ossified
US or arthrogram (joint injury) can also be used if bones not ossified
CT or MRI for more detail
how do you assess each forearm nerve quickly?
OK sign = median
hitchhikers thumb = radial
starfish = ulnar
what can displace a fracture?
initial force on impact
muscle action and gravity deform fractures once they’ve lost their integrity
general principles of fracture management?
reduce
retain
rehabilitate
how does age affect need for reduction of a fracture?
remodelling potential reduced need for accurate reduction at a young age
higher remodelling potential when very young/child so reduction less important
what is gallows traction?
used for femoral shaft fracture in 3 months - 3 yr olds
suspends legs vertically off the bed
<48 hrs traction then Spica or inpatient traction for 2 week
what is flexible nailing?
insertion of a flexible nail into a fractured bone
what is flexible nailing used for>
long bones - femur, tibia, humerus, radius and ulna
advantages and disadvantaged?
ADVANTAGES
predictable position and rapid healing
early joint mobilisation and weight bearing
DISADVANTAGES
infection risk
risk of anaesthesia as must be done surgically
how do you retain a reduced joint?
sling, collar and cuff etc
cast - plaster of paris
what is the most common method of fracture retaining?
plaster of paris
how do you generally manage metaphyseal fracture?
immobilise adjacent joint (joint below)
general management of diaphyseal fracture?
immobilise joint above and below
- prevents rotation
what are the exceptions to conservative management of fractures and need to be fixed?
displaced intra-articular fractures
displaced growth plate injuries
open fractures
good imaging for intra-articular fracture?
arthrogram - assists visualisation
classification of physeal fractures?
salter harris
type 1 = complete physeal fracture
type 2 = physeal fracture that extends into metaphysis
type 3 = physeal fracture that extends through epiphysis
type 4 = physeal fracture plus epiphyseal and metaphyseal fractures
type 5 = compression fracture of the growth plate
problems with physeal injury?
mal union
non union
when is external fixation used?
contaminated wounds
acute vascular injury
burns
multiple injuries
less invasive techniques of fixation?
diaphyseal
metaphyseal
epiphyseal
