Fractures

Question 1

Why are children’s bones more flexible than adult’s bones?

Answer 1

Children have more cancellous bone, which is the spongy

Question 2

What does children’s bones being more flexible make them more prone to?

Answer 2

Children’s bones are more prone to breaking

Question 3

How is the healing process in children compared to adults?

Answer 3

Bones in children have very good blood supply and are able to heal much more quickly with less long term deformity compared with adults.

Question 4

How do children’s bones break differently to adults?

Answer 4

Bones in children are more likely to break cleanly in two compared with adults.

Question 5

Which fracture are children more prone to?

Answer 5

Greenstick fractures

Buckle fracture

Question 6

What is a greenstick fracture?

Answer 6

Where only one side of the bone breaks whilst the other side of the bone stays intact.

Question 7

How is greenstick fracture described?

Answer 7

Unicortical break in the cortex

Question 8

How long can a greenstick fracture take to heal?

Answer 8

8 weeks

Question 9

What is the mechanism of injury of a buckle fracture?

Answer 9

Axial loading causing one cortex to buckle without affecting the other cortex.

Question 10

What does the incomplete cortical disruption with a buckle fracture lead to?

Answer 10

Periosteal haematoma

Question 11

How long does a buckle fracture take to heal?

Answer 11

4 weeks

Question 12

What can fractures in the growth plate cause?

Answer 12

Issues with growth in that bone

Question 13

What are growth plate fractures classified using?

Answer 13

Salter-Harris classification

Question 14

What does the higher the salter-harris grade indicate?

Answer 14

The higher the grade, the more likely the fracture is to disturb growth

Question 15

What is the SALTER pneumonic?

Answer 15

• Type 1: Straight across
• Type 2: Above
• Type 3: BeLow
• Type 4: Through
• Type 5: CRush (erasure of the growth plate)

Question 16

What is type 1 on Salter-Harris classification?

Answer 16

Fracture through the physis only

straight across

Question 17

What is type 2 on Salter-Harris classification?

Answer 17

Fracture through the physis and metaphysis

Above

Question 18

What is type 3 on Salter-Harris classification?

Answer 18

Fracture through the physis and epiphyisis to include the joint
(below)

Question 19

What is type 4 on Salter-Harris classification?

Answer 19

Fracture involving the physis, metaphysis and epiphysis

Through

Question 20

What is type 5 on Salter-Harris classification?

Answer 20

Crush injury involving the physis
ERasure of the growth plate

Question 21

What is the first principle in the management of paediatric fractures?

Answer 21

To achieve mechanical alignment of the fracture

Question 22

What can be used to achieve mechanical alignment of the fracture?

Answer 22

• Closed reduction via manipulation of the joint

* Open reduction via surgery

Question 23

What is the second principle in the management of paediatric fractures?

Answer 23

Provide relative stability for a period of time, to allow healing

Question 24

What are possible ways that the bone can be fixed in place?

Answer 24

• External casts
• K wires
• Intramedullary wires
• Intramedullary nails
• Screws
• Plate and screws

Question 25

What is the ladder of pain management in children?

Answer 25

• Step 1: Paracetamol or ibuprofen

* Step 2: Morphine

Question 26

Buckle fracture

Answer 26

Compression fracture
Break caused by sudden pressure on bone (fall)
Pressure buckles bone without snapping it

Question 27

Greenstick fracture

Answer 27

Bone bends and cracks rather than complete break