Fractures

Question 1

What is the significance of the metaphysis in pediatric bones?

Answer 1

The metaphysis connects to the physis (growth plate), which is an area of weakness in children’s bones

Question 2

How do ligaments and tendons compare to bones in children?

Answer 2

In children, ligaments and tendons are stronger than bones.

Question 3

How does the periosteum in children’s bones affect fracture types?

Answer 3

The thick periosteum leads to incomplete fractures like greenstick or torus fractures, and bones tend to bend or bow rather than fully break

Question 4

What are the types of fractures specific to pediatric bones?

Answer 4

1. Greenstick fracture
2. Torus fracture
3. Plastic deformation

Question 5

What is a greenstick fracture?

Answer 5

Incomplete fracture where one side breaks, and the other side bends.

Question 6

What is a Torus fracture

Answer 6

Buckling or creasing of the bone

Question 7

What is Plastic deformation?

Answer 7

A bone bends and stays bent without an obvious fracture

Question 8

Why is the growth plate prone to injury in children?

Answer 8

The growth plate (physis) is the weakest part of developing bones and is vulnerable to fractures, which can cause growth deformities

Question 9

What classification is used for growth plate fractures?

Answer 9

Salter-Harris classification - graded from I to V

Question 10

What fractures are suspicious for NAI?

Answer 10

Femoral fractures in non-walking children and rib fractures

Question 11

What is the common classification for supracondylar fractures?

Answer 11

Gartland classification

Question 12

Type I of Gartland classification

Answer 12

Non-displaced

Question 13

Type 2 of Gartland classification

Answer 13

Displaced with an intact posterior cortex

Question 14

Type 3 of Gartland classification

Answer 14

Displaced with posterior cortex disrupted

Question 15

Type 4 of Gartland classification

Answer 15

Fully displaced

Question 16

What signs indicate possible vascular compromise in supracondylar fractures?

Answer 16

1. Check radial pulse
2. Capillary refill
3. Nerve function

Question 17

Why are children more suitable for conservative fracture treatment?

Answer 17

Children’s bones have greater remodeling potential and heal rapidly, so less invasive methods like plaster casts and traction are often sufficient

Question 18

Diaphyseal fractures

Answer 18

Flexible nails

Question 19

Metaphyseal fractures

Answer 19

K wires

Question 20

Epiphyseal fracture

Answer 20

K wires and screws

Question 21

What is the ‘Fat Pad Sign’ in elbow fractures?

Answer 21

Also called the “Sail sign,” it indicates a supracondylar fracture on X-ray due to displaced fat pads around the joint

Question 22

What are the most common types of elbow fractures in children?

Answer 22

Supracondylar fractures

Question 23

What is a toddler’s fracture, and how does it present?

Answer 23

It is a spiral fracture of the tibia, typically presenting with a child refusing to bear weight.

Initial X-rays may appear normal, but further imaging is required to confirm the diagnosis

Question 24

Name the nerves assessed in an upper limb neurovascular exam

Answer 24

Radial, median, ulnar, axillary

Question 25

Why is non-accidental injury (NAI) important in pediatric fractures?

Answer 25

It indicates potential child abuse

Question 26

What is the preferred treatment for unstable extra-articular fractures with soft tissue swelling?

Answer 26

Closed reduction with intramedullary nail fixation

Question 27

What is an open fracture?

Answer 27

A fracture where the bone breaches the skin and contacts the outside environment

Question 28

What are the two types of open fractures?

Answer 28

Inside-out (bone punctures skin) Outside-in (skin is lacerated from external injury)

Question 29

What is the Gustilo classification used for in open fractures?

Answer 29

To describe contamination, wound size, ability to close, and presence of vascular injury

Question 30

What is the most common type of infection in open fractures?

Answer 30

Polymicrobial

Question 31

What is the immediate management of an open fracture?

Answer 31

(1) Direct pressure for bleeding (2) Reduction of dislocation (3) Removal of debris (4) Sterile dressing (5) Stabilization (6) Neurovascular assessment

Question 31

What antibiotics are given as prophylaxis for open fractures?

Answer 31

IV flucloxacillin (gram-positive) IV gentamicin (gram-negative) IV metronidazole (anaerobes for soil contamination)

Question 32

When is tetanus vaccine or immunoglobulin given in open fractures?

Answer 32

If history is unknown or contaminated injury; give both vaccine and Ig if necessary

Question 33

A 54 year old woman is brought into the emergency department having fallen from a horse. The patient appears to have an isolated injury to her right leg, with no history of head injury or loss of consciousness. On initial assessment, the patient is alert and orientated with a c-spine collar and blocks in place, cardiovascular and respiratory examination is unremarkable. The abdomen is soft and non-tender, a pelvic binder is in place. On full exposure, there is a displaced open fracture of the right tibia and fibula, which is contaminated with soil, there is minimal bleeding. The right dorsalis pedis and posterior pulses are absent and the right foot is pale with reduced sensation. No other injuries are found. Observations show a heart rate of 108, blood pressure of 122/63, respiratory rate of 16, oxygen saturations of 98% on room air, and temperature of 36.4 celsius. IV access is available. What is the single most important initial management consideration?

Answer 33

Reduction of the right lower leg fractures

Question 34

A 7-year-old boy is brought to the emergency department by his mother after falling down, whilst playing at the playground. He fell on an outstretched hand and is now crying of pain in his right forearm. He stopped playing immediately after the fall and refused to use his right hand. On examination, his right forearm is swollen and bruised. There is some tenderness on palpation of the middle of the forearm. An x-ray is requested and it shows an angulated fracture in the mid-diaphysis of the right radius. The fracture is incomplete as it goes through the cortex on the convex side of a bone that has been bent while the opposite cortex (concave surface) remains intact. What type of fracture does this describe?

Answer 34

Greenstick fracture

Question 35

What is the correct order of fracture healing?

Answer 35

Inflammation - soft callus - hard callus - remodelling

Question 36

At which stage of fracture healing is woven bone converted into lamellar bone?

Answer 36

Bone remodelling

Question 37

A [Blank] clot forms at the site of a fracture?

Answer 37

Fibrin

Question 38

After injury, bone tissue will first replicate and grow, later remodelling according to the forces acting on it. A teenager fell off his bike 2 weeks ago, fracturing his distal radius, and wants to know when his wrist will have healed and be strong enough for him to risk doing some sports again. What type of bone will most likely first form at the site of the fracture?

Answer 38

Woven, trabecular

Question 39

What are the Salter-Harris fracture types?

Answer 39

I - Physis only II – Physis + metaphysis III – Physis + epiphysis (joint) IV – Metaphysis + physis + epiphysis V – Crush injury to physis (may look normal on X-ray)