Children’s Fractures

Question 1

What is the epidemiology of fractures in children?

Answer 1

25% of children injured every year = 10-25% of injuries are fractures
More common in boys

Question 2

What is the distribution of fractures in children?

Answer 2

80% in upper limbs, 20% in lower limbs, 0.7% are open, 15% are physeal

Question 3

What are fractures only found in children?

Answer 3

Greenstick, tours and plastic deformation

Question 4

What are greenstick fractures?

Answer 4

Occur in young soft bones, bone bends and breaks

Question 5

What are torus fractures?

Answer 5

Also called buckle fractures, one side a f bone is compressed and buckles but doesn’t break all the way through

Question 6

What is plastic deformation?

Answer 6

Bend in bone without obvious fracture

Question 7

What is the history of a fracture?

Answer 7

Mechanism, how high/fast, forces involved, predict injuries and exclude or confirm

Question 8

What are you looking and feeling for when examining a patient?

Answer 8

Look = deformity, swelling, bruising, asymmetry 
Feel = point tenderness to correlate with x-ray

Question 9

What makes up the neurovascular examination of a patient?

Answer 9

Colour, cap refill, temperature, O2 sats, pulse, sweating, sensation, skin wrinkling in water

Question 10

What are some signs and tests that can be done during an examination?

Answer 10

Distal neurovascular assessment, OK sign, hitchhikers thumb, star fish sign

Question 11

What causes fractures to displace?

Answer 11

Muscle action and gravity

Question 12

What must be excluded in a child with a fracture?

Answer 12

Non accidental injury

Question 13

What are some features of the history that may indicate non accidental injury?

Answer 13

History doesn’t match injury
Vague parental accounts or inconsistencies
Accusations that child did it deliberately
Delay in seeking help
Child dressed inappropriately for situation

Question 14

What are some situations that may indicate a non accidental injury?

Answer 14

Fracture in child < 2 especially pre walking
Injuries in various stages of healing (especially burns and bruises)
More injuries than normal in a child of that age
Increased intracranial pressure in an infant
Suspected intra-abdominal trauma in young child

Question 15

What are the basic principles for treatment of fractures?

Answer 15

Reduce, retain and rehabilitate

Question 16

Why do children have reduced need for accurate reduction of fractures?

Answer 16

They have greater remodelling potential

Question 17

What is the most common modality used to stabilise fractures in children?

Answer 17

Plaster = above or below the knee/elbow

Question 18

How are diaphyseal fractures immobilised?

Answer 18

Above and below the joint

Question 19

How are metaphyseal fractures immobilised?

Answer 19

Only by immobilising adjacent joint

Question 20

What are the exceptions to the normal treatment principles?

Answer 20

Displaced intra-articular or growth plate fractures, open fractures

Question 21

What are some treatment methods used?

Answer 21

Palvik harness 
Gallows traction = 3 months - 3 year old
Thomas and Kendrick splints
Hip spica = allows early discharge
Flexible nailing for femur

Question 22

What is the Salter Harris classification for?

Answer 22

Physeal injuries

Question 23

What are the different levels of Salter Harris injuries?

Answer 23

Type 1 = complete physeal fracture with or without fracture
Type 2 = physeal fracture that extends through the metaphysis, producing a chip fracture of the metaphysis
Type 3 = physeal fracture that extends through epiphysis
Type 4 = physeal fracture plus epiphyseal and metaphyseal fractures
Type 5 = compression fracture of growth plate