Children’s Fractures Flashcards
What is the epidemiology of fractures in children?
25% of children injured every year = 10-25% of injuries are fractures
More common in boys
What is the distribution of fractures in children?
80% in upper limbs, 20% in lower limbs, 0.7% are open, 15% are physeal
What are fractures only found in children?
Greenstick, tours and plastic deformation
What are greenstick fractures?
Occur in young soft bones, bone bends and breaks
What are torus fractures?
Also called buckle fractures, one side a f bone is compressed and buckles but doesn’t break all the way through
What is plastic deformation?
Bend in bone without obvious fracture
What is the history of a fracture?
Mechanism, how high/fast, forces involved, predict injuries and exclude or confirm
What are you looking and feeling for when examining a patient?
Look = deformity, swelling, bruising, asymmetry Feel = point tenderness to correlate with x-ray
What makes up the neurovascular examination of a patient?
Colour, cap refill, temperature, O2 sats, pulse, sweating, sensation, skin wrinkling in water
What are some signs and tests that can be done during an examination?
Distal neurovascular assessment, OK sign, hitchhikers thumb, star fish sign
What causes fractures to displace?
Muscle action and gravity
What must be excluded in a child with a fracture?
Non accidental injury
What are some features of the history that may indicate non accidental injury?
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
What are some situations that may indicate a non accidental injury?
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
What are the basic principles for treatment of fractures?
Reduce, retain and rehabilitate
Why do children have reduced need for accurate reduction of fractures?
They have greater remodelling potential
What is the most common modality used to stabilise fractures in children?
Plaster = above or below the knee/elbow
How are diaphyseal fractures immobilised?
Above and below the joint
How are metaphyseal fractures immobilised?
Only by immobilising adjacent joint
What are the exceptions to the normal treatment principles?
Displaced intra-articular or growth plate fractures, open fractures
What are some treatment methods used?
Palvik harness Gallows traction = 3 months - 3 year old Thomas and Kendrick splints Hip spica = allows early discharge Flexible nailing for femur
What is the Salter Harris classification for?
Physeal injuries
What are the different levels of Salter Harris injuries?
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
