Childrens fractures

Question 1

In close wounds, how does bevelling indicate order? (for applied ballistics)

Answer 1

1st injury has more bevelling then 2nd injury

Question 2

What is a common mechanism of injury in kids?

Answer 2

falling

Question 3

Why are “healthy” kids less injured from falls then adults or older kids?

Answer 3

They are lighter, shorter, slower and more flexible. Thicker periosteum

Question 4

Why do kids have more bone flexibility?

Answer 4

higher proportion of water, larger haversian canals, more porous bones, slightly lower mineral cotent

Question 5

What beneficial role does the periosteum play in children fractures?

Answer 5

more rapid healing and initial stability. remain a hinge in most breaks

Question 6

What is the weakest place on a childs bone?

Answer 6

the epiphyseal plates (growth plates) because they are uncalcified. Ligaments are stronger than growth plates.

Question 7

Growth plate rates?

Answer 7

may differ at opposite ends in quickness of growth

Question 8

Injury to growth plate?

Answer 8

May cause complete cessation of bone growth at that plate! or one side may stop and the other continue causing irregular growth

Question 9

Why is the quick healing sneaky?

Answer 9

child abuse can be easily covered

Question 10

children’s and adults bone difference?

Answer 10

adults are static, children’s are dynamic (structural and functional) and are susceptible to different fracture patterns
Presence of unfused epiphyses and growth centres

Question 11

Time related variation in childrens fractures?

Answer 11

temporal variations closely with progressive anatomic changes.

Question 12

What is the 2nd most common cause of child morbidity?

Answer 12

severe trauma. After infection

Question 13

What is the leading cause of polytrauma?

Answer 13

MVA

Question 14

Toddlers:

Schoolchildren:

Answer 14

distal forearm, ankle, foot.

fractures of skull, tibial shaft.

Question 15

Compositional differences

Answer 15

1. have higher proportion of water
2. have larger Haversian systems
3. are more porous
4. have slightly lower mineral content – allows greater elasticity and plasticity of bone

Question 16

Epiphysis and physis are responsible for what?

Answer 16

bone growth: shaft length, contour of bone ends, axial relationships at joints

Question 17

Epiphyseal Injury

Answer 17

Epiphyseal separation in children is analogous to ligament injury or dislocation in adult.

Question 18

Bone strength vs. ligament strength

Answer 18

Joint capsule and ligaments are 2-5 X stronger in children than physis.
Hence, trauma that causes ligament injury or dislocation in adult will more likely cause epiphyseal separation or fracture in child.

Question 19

most common type fracture?

Answer 19

Greenstick fracture:– about 50% of children’s fractures.

Question 20

Chondroepiphysis:

Answer 20

each epiphysis is a complete cartilaginous structure at end of each long bone at birth (except distal femur);

Question 21

What is the corresponding ossifying structure to chondroepipysis?

Answer 21

is the chondro-osseous epiphysis.

Question 22

What is important to remember about chondroepiphysis?

Answer 22

exhibit variations in the appearance of the ossification centers, a factor that must be considered to appropriately diagnose fractures of these regions
In particular this applies to the multiple epiphyses of the distal humerus

Question 23

What is a physis?

Answer 23

physis = growth plate = epiphyseal plate

Primary agent of endochondral ossification pre- and postnatally

Question 24

Contour of most physes _______ during development. except in the______.

Answer 24

does not change a great deal

exceptions are physes in proximal humerus and proximal femur

Question 25

Because the contours [of the epiphyses] are undergoing constant change,

Answer 25

fracture pattern susceptibilities also change

Question 26

what accelerates longitudinal bone growth?

Answer 26

resection (cutting) of periosteum

Question 27

what are the common incomplete fractures found in children?

Answer 27

1. classic greenstick
2. torus
3. bowing

Question 28

Greenstick fracture:

Answer 28

due to angulation (bending) forces; convex side is in tension, concave side is in compression – incomplete transverse fracture occurs on tension side; fracture line then becomes longitudinal (in proximal or distal shaft or both); mainly radius, ulna, clavicle.

Question 29

Torus fracture:

Answer 29

buckling of cortex due to compression; may be subtle; usually near ends of long bones (metaphyseal regions); microfractures allow buckling to occur without an overt fracture line.

Question 30

Lead pipe fracture:

Answer 30

combination – incomplete transverse fracture affecting one cortex (bending or angulation force), torus fracture of opposite side (compression force); uncommon; in metaphysis.

Question 31

Bow, or plastic bowing, fracture:

Answer 31

bending of bone due to angulation force without any macroscopically visible evidence of fracture; especially in radius and ulna, less in fibula.

Question 32

Bow fracture conforms to______ of stress-strain curve

Answer 32

plastic deformation region,

(elastic limit has been exceeded, hence bone can not return to pre-load state).

Question 33

Bowing in forearm may interfere with what motions?

Answer 33

pronation and supination

Question 34

what energy source can also cause long bone to bow?

Answer 34

heat