Paed Trauma Flashcards
Whats the most common paediatric fracture?
Forearm, by a lot
First we’re gonna go over a few “principles” of childhood fracturs:
- Children heal well
- remodel well
- Incomplete fractures
- Physis fractures
Children heal very well due to metabolically active periosteum and high plasticity of bone (means they don’t break completely). What does this mean for our management?
They rarely require fixation
Often don’t need long immobilisation or casts
Childhood bones remodel very well
This means that kids with an intact growing physis will tend to realign the fracture themselves as they grow
Kids have high plasticity bones meaning they tend to have incomplete fractures, whats the benefit of this?
You get a thick periosteal hinge at the fracture which enables you to easily align the fraction and it will heal very fast
Still gotta make sure you do align the bone or it will heal overlapped
In general kid’s fractures heal faster, what if the physis is damaged?
You must use surgery to prevent it aligning abnormally and then growing deformed
What are the major types of forearm fracture?
15% break shaft
80% break distal radius
What are the special types of forearm shaft fracture?
Galeazzi fracture - Force from wrist breaks radial shaft
Monteggia fracture - Forace at lateral elbow breaks ulna shaft
How do we go about assessing a fracture in a child?
- Mechanism of injury
- Deformity
- Soft tissue (wound, vascular status, sensation/motor function)
- X-ray
How do we manage forearm fractures?
Realign and use a cast:
Buckle fractures only need a cast for 3-4ks, greenstick up to 6 wks and a complete fractures for longer
What are the major types of knee injury?
- Physeal (mostly femoral)
- Tibial spine
- Tibial tubercle
- Patellar fracture
- Patellar dislocation
- Osteochondral lesions
How do we treat a tibial spine fracture?
Must be careful as it overlaps with the ACL
Small ones get cast but most get fixed, either:
- Internal fixation
- Arthroscopic internal fixation
How do we recognise a patellar fracture?
They can’t straight leg raise
How would we treat a patellar fracture?
If its displaced - Cylinder cast
If its in place - ORIF (open reduction & internal fixation)
What risk factors could make you think “oh, maybe its a patellar dislocation”?
- Laxity
- Poor Vastus medialis obliques (VMO)
- Large Q Angle
- High femoral anteversion
- Tibial ext rotation
- Patella alta
What is the Q angle?
angle between long axis of femur and tibia
A larger angle –> More valgus tibia –> greater risk of patellar dislocation
What is patella alta?
A high patella, sits above its groove
How do we treat a patellar dislocation?
Don’t cast it for more than 2wks
Repair medial ligament
Mobilise
VMO exercises
What is an osteochondral lesion?
Damage to the cartilage covering the joints
It can occur at the knee as result of developmental problems coupled with a traumatic injury
How do we look for an osteochondral lesion?
Plain X-ray & MRI
How do we treat an osteochondral lesion?
Depends on the type:
1) Intact cartilage so just immobilise
2) Flap & 3) Fragment use drilling & fixation
How do we assess an ankle injury in kids?
Mechanism of injury
Deformity
Soft tissue
AP & Lateral X-ray
How do we treat an ankle injury?
Casts & Plates
What are the two major types of overuse injury in kids?
- Osgood-Schlatter’s
- Sever’s
What is Osgood-Schlatter’s?
Inflammation of the patellar tendon at insertion
What is Sever’s disease?
Inflammation of the calcaneus growth plate
Non-accidental injury in kids is very important, what should you look out for to spot it?
- Incongruent history
- Bruising patterns
- Burns
- Multiple fractures at different healing stages
- Metaphyseal or humeral shaft fractures
- Rib fractures
- Non-ambulant fractures
