Fractures Flashcards
What is the significance of the metaphysis in pediatric bones?
The metaphysis connects to the physis (growth plate), which is an area of weakness in children’s bones
How do ligaments and tendons compare to bones in children?
In children, ligaments and tendons are stronger than bones.
List the key properties of pediatric bones
(1) Less dense
(2) More porous
(3) Lower mineral content
(4) Less stiff
(5) Lower bending strength
How does the periosteum in children’s bones affect fracture types?
The thick periosteum leads to incomplete fractures like greenstick or torus fractures, and bones tend to bend or bow rather than fully break
What are the types of fractures specific to pediatric bones?
- Greenstick fracture
- Torus fracture
- Plastic deformation
What is a greenstick fracture?
Incomplete fracture where one side breaks, and the other side bends.
What is a Torus fracture
Buckling or creasing of the bone
What is Plastic deformation?
A bone bends and stays bent without an obvious fracture
Why is the growth plate prone to injury in children?
The growth plate (physis) is the weakest part of developing bones and is vulnerable to fractures, which can cause growth deformities
What classification is used for growth plate fractures?
Salter-Harris classification - graded from I to V
What is class 1 of the Salter-Harris classification?
Fracture straight across the physis
What is class 2 of the Salter-Harris classification?
Fracture through physis and metaphysis, forming a triangular fragment
What is class 3 of the Salter-Harris classification?
Fracture crosses the physis and exits through the epiphysis
What is class 4 of the Salter-Harris classification?
Fracture goes through both the physis and metaphysis
What is class 5 of the Salter-Harris classification?
A crush injury to the growth plate
What fractures are suspicious for NAI?
Femoral fractures in non-walking children and rib fractures
What is the common classification for supracondylar fractures?
Gartland classification
Type I of Gartland classification
Non-displaced
Type 2 of Gartland classification
Displaced with an intact posterior cortex
Type 3 of Gartland classification
Displaced with posterior cortex disrupted
Type 4 of Gartland classification
Fully displaced
What signs indicate possible vascular compromise in supracondylar fractures?
- Check radial pulse
- Capillary refill
- Nerve function
Why are children more suitable for conservative fracture treatment?
Children’s bones have greater remodeling potential and heal rapidly, so less invasive methods like plaster casts and traction are often sufficient
Diaphyseal fractures
Flexible nails
Metaphyseal fractures
K wires
Epiphyseal fracture
K wires and screws
External fixation
Reserved for contaminated wounds or severe injuries
What is the ‘Fat Pad Sign’ in elbow fractures?
Also called the “Sail sign,” it indicates a supracondylar fracture on X-ray due to displaced fat pads around the joint
What are the most common types of elbow fractures in children?
Supracondylar fractures
What is a toddler’s fracture, and how does it present?
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
What are common symptoms of a fracture?
(1) Localised tenderness
(2) Swelling
(3) Deformity
(4) Crepitus.
What should be assessed in a distal neurovascular exam?
Pulses
Capillary refill
Temperature
Colour
Sensation
Motor power
Name the nerves assessed in an upper limb neurovascular exam
Radial, median, ulnar, axillary
Why is non-accidental injury (NAI) important in pediatric fractures?
It indicates potential child abuse
What is the initial management for a fracture?
Clinical assessment
Analgesia (usually IV morphine)
Splinting/traction
Imaging.
What imaging methods are commonly used for fractures?
X-ray, CT, MRI
What is the preferred treatment for unstable extra-articular fractures with soft tissue swelling?
Closed reduction with intramedullary nail fixation
What is an open fracture?
A fracture where the bone breaches the skin and contacts the outside environment
What are the two types of open fractures?
Inside-out
(bone punctures skin)
Outside-in
(skin is lacerated from external injury)
What is the Gustilo classification used for in open fractures?
To describe contamination, wound size, ability to close, and presence of vascular injury
What is the most common type of infection in open fractures?
Polymicrobial
What imaging is used to assess open fractures?
X-ray with AP and lateral views
What is the immediate management of an open fracture?
(1) Direct pressure for bleeding
(2) Reduction of dislocation
(3) Removal of debris
(4) Sterile dressing
(5) Stabilization
(6) Neurovascular assessment
What antibiotics are given as prophylaxis for open fractures?
IV flucloxacillin (gram-positive)
IV gentamicin (gram-negative)
IV metronidazole (anaerobes for soil contamination)
When is tetanus vaccine or immunoglobulin given in open fractures?
If history is unknown or contaminated injury; give both vaccine and Ig if necessary
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?
Reduction of the right lower leg fractures
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?
Greenstick fracture
What is the correct order of fracture healing?
Inflammation - soft callus - hard callus - remodelling
At which stage of fracture healing is woven bone converted into lamellar bone?
Bone remodelling
A [Blank] clot forms at the site of a fracture?
Fibrin
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?
Woven, trabecular
