Brainscape's Knowledge GenomeTM

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


See full index

MSK > Cortex - Paediatric Trauma > Flashcards

Cortex - Paediatric Trauma Flashcards

1
Q

how is the periosteum different in children

A

is much thicker and tends to remain intact which can help stability and can assist reduction if required.

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

what is the role of the periosteum in children

A

serves to increase the width/circumference of growing long bones

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

do children fractures heal quicker or slower- why

A

quicker due to thick periosteum which is a rich source of osteoblasts

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

what wolffs law

A

childrens bones change shape with bone laid down along areas of stress- means they have greater potential to remodel

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

what does growth with bone being formed along the line of stress mean

A

fractures heal quicker and bones can correct up to 10 degrees of angulation per year of growth remaining in that bone

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

what happens when a fracture causes a degrees of angulation that is unacceptable (these angles much bigger in children)

A

less likely than adults to be surgically stabilised-

manipulation and casting (accepting a degree of residual angulation)

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

what is the difference in surgical stabilisation in childrens fractures

A

less invasive, temporary pins, wires and flexible rods used

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

when are plates and screws used in childrens fractures

A

for very unstable fractures, if associated with a dislocation and loss of position

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

when is a childs fracture treated like an adults

A

when they reach puberty- remodelling potential is less

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

what do fractures around the growth plate risk

A

disturb growth- shortened limb, angular deformity due to growth arrest on one side

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

what do salter harris classifications categorise

A

types of physeal fractures

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

describe a salter harris I fracture

A

pure physeal separation
best prognosis
least likely to result in growth arrest

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

describe a salter harris II fracture

A

most common
small metaphyseal fragment attached to the physis and epiphysis
likelihood of growth disturbance is low

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

describe salter harris III and IV fractures

A

intra‐articular and with the fracture splitting the physis and epiphysis

there is greater potential for growth arrest.

These fractures should be reduced and stabilized to ensure a congruent articular surface and minimize growth disturbance

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

describe a salter harris V fracture

A

compression injury to the physis with subsequent growth arrest

cannot be diagnosed on initial x ray- only detected once angular deformity gas occured

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

where does child abuse occur more commonly

A

in poverty, in children with special needs/ disability, children whos parents are substance abusers

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

what should raised the suspicion of NAI

A

multiple fracture of carying ages (varying amounts of callous formation)
multiple trips to A and E with different injuries
Inconsistent / changing history of events
Discrepancy of history between parents / carers
History not consistent with injury
Injuries not consistent with age of child eg non walking child
Multiple bruises of varying ages
Atypical injuries eg cigarette burns, genital injuries, torn frenulum, dental injuries, lower limb
and trunk burns
Rib fractures
Metaphyseal fractures in infants

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

what are common types of distal radius fractures in children

A

buckle fractures, greenstick fractures, salter harris II

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

how are distal radius buckle fractures treated

A

stable, only require 3-4 weeks of splintage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how are distal radius greenstick fractures treated

A

may be angulated and require manipulation and casting if there is significant deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

where do salter harris II fractures usually occur in older children

A

around the distal radial physis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

how are angulated salter harris II fractures treated

A

may need manipulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what displacement and angulation is more common in complete distal radius fractures

A

dorsal

24
Q

what prevents overcorrection of the deformity and aids stability in complete distal radius fractures

A

the dorsal periosteum usually remains intact

25
Q

what is the treatment for a complete distal radius fracture

A

If the fracture is fairly stable, casting may suffice.

If a complete fracture is very unstable after reduction, wire stabilization or plate fixation may be employed.

26
Q

how do montegiia and galeazzi fractures go against the usual principles of childrens fractures

A

anatomic reduction and rigid fixation with plates and screws is typically used to treat these injuries

high rate of re‐dislocation of the radial head or distal radio-ulnar joint (DRUJ) if only manipulation and casting is used

27
Q

what is the usual treatment for angulated fracture of both bones of the forearm in children

A

usually have an intact periosteum and instability may only be in one plane- controlled with a cast after manipultation

28
Q

what is the usual treatment for displaced fracture of both bones of the forearm in children

A

tend to be unstable- flexible intramedullary nail usually used

29
Q

why are supracondylar injuries common in children

A

as supracondylar region of the distal humerus is a relatively weak point in the growing upper limb

30
Q

what is the usual mechanism of injury for a supracondylar fracture of the elbow

A

extension type fractures most common- heavy fall onto the outstretched hand

flexion injury- occurs with a fall onto the point of a flexed elbow

31
Q

how are undisplaced supracondylar fractures of the elbow treated

A

are stable, treated with a splint

32
Q

how are angulated, rotated or displaced supracondylar fractures of the elbow treated

A

require closed reduction and pinning with wires to prevent deformity

33
Q

what can happen to muscles in severely displaced / off‐ended fractures of the supracondylar elbow

A

brachialis muscle may be tethered in the fracture site- requires open reduction

34
Q

why is the patient unable to make an OK sign in off ended extension type fractures of the supracondylar humerus

A 
loss of action of FPL and FDP to the index- 
distal fragment (elbow) displaces posteriorly with stretch and pressure on the brachial artery and median nerve -predominantly its anterior interosseous branch
35
Q

why should displaced supracondylar fractures be reduced quickly

A

to avoid swelling which makes reduction more difficult

36
Q

what happens if the radial pulse is absent or reduced in volume in supracondylar fractures

A

emergency surgery

Closed reduction may be performed with wiring and the pulse may return if the artery is no longer under stretch. However occasionally the brachial artery will be trapped in the fracture site and if the hand remains pulseless after reduction, open surgical exploration is required

37
Q

what happens if there is a nerve injury in supracondylar fractures

A

urgent theatre management

38
Q

what are the majority of nerve injuries in supracondylar fractures

A

neurapraxias - improve with time

or occasionally axonotmesis which also improves with time

39
Q

what might indication entrapment of a nerve

A

Ongoing neuralgic pain (unpleasant shooting or burning pain radiating to the sensory districution of the nerve) or no improvement in diagnosed neurapraxia or axonotmesis

40
Q

what can cause a femoral shaft fracture in children

A

a fall onto a flexed knee or by indirect bending or rotational forces

41
Q

why can shortening in femoral shaft fractures in younger children be accepted

A

at overgrowth tends to occur after fracture healing

42
Q

what is the treatment for a femoral shaft fracture in children under 2

A

gallows traction and early hip spica cast is appropriate

43
Q

what is the worry in femoral shaft fractures in children under 2 years old

A

more than half cause by NAI

44
Q

what is the treatment for a femoral shaft fracture in children between ages 2 and 6

A

thomas splint or hip spica cast

45
Q

what is the treatment for a femoral shaft fracture in children between ages 6 and 12

A

femur is large enough to accommodate flexible intramedullary nails which obviate the need for traction or cast

46
Q

what is the treatment for a femoral shaft fracture in children over the age of 12

A

adult type intramedullary nail

47
Q

what is the worry in femoral shaft fractures of any age

A

femur common site for benign and malignant bone tumours- fractures may be pathological with osteolysis and cortical thinning

48
Q

what is known as the ‘toddlers fracture’

A

undisplaced spiral fractures of the tibial shaft

49
Q

what is the treatment for a ‘toddlers fracture’

A

short time in cast

50
Q

what is the management for the majority of childrens tibial fractures

A

cast

51
Q

is the risk of compartment syndrome in children tibial fractures higher or lower than in adults

A

lower

52
Q

how much angulation can be accepted in childrens tibial fractures

A

10 degrees

greater degrees treated with manipulation and casting

53
Q

why are serial x rays needed in tibial fractures in the cast

A

to ensure that the fracture does not drift into excessive angulation in the AP or lateral planes

54
Q

what is not excepted in tibial fractures

A

shortening or malrotation

55
Q

what are the opens for stabilising a very unstable or open tibial fracture in children

A

flexible intramedullary nails, plates and screws or external fixation

56
Q

what treatment can adolescents with a closed proximal tibial physis have

A

adult type intramedullary nail

MSK (71 decks)

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