Paed Trauma Flashcards
Whats the most common paediatric fracture?
Forearm
What are 2 principles of pediatric fractures that are important to remember?
What are 2 types of fractures common in pediatrics
- 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? [2]
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? [2]
What can you do to make sure it doesn’t heal overlapped?
You get a thick periosteal hinge at the fracture which enables you to easily align the fraction and it will heal very fast
Still have to make sure you do align the bone or it will heal overlapped
In general, pediatric fractures heal faster but what if the physis is damaged?
What is a complication of physeal injury
You must use surgery to prevent it aligning abnormally and then growing deformed
Physeal injuries can cause twice as much growth at femur resulting in leg length discrepancy
What are the major types of forearm fracture? [2]
shaft (15%)
# distal radius (80%)
What are the special types of forearm shaft fracture? [2]
Galeazzi fracture - Force from wrist breaks radial shaft + dislocation of distal radioulnar
Monteggia fracture - Force at lateral elbow breaks ulnar shaft + dislocation of proximal radial
How do we go about assessing a fracture in a child? [4]
How do we manage forearm fractures?
- Mechanism of injury
- Deformity
- Soft tissue damage (wound, vascular status, sensation/motor function)
- X-ray
Management: realign and use a cast
Treatment of forearm fractures
Cast timelines for buckle, greenstick and complete #?
What additional treatment modality for complete #?
What increases risk for remanipulation due to instability of joint? [3]
Buckle fractures only need a cast for 3-4 weeks, greenstick up to 6 wks and a complete fractures for longer and k wire through bone for 6 weeks
Risk for remanipulation due to instability:
Complete fractures
Failed anatomic reduction
Below elbow POP
What are the major types of knee injury? [6]
- Physeal (mostly femoral)
- Tibial spine
- Tibial tubercle
- Patellar fracture
- Patellar dislocation
- Osteochondral lesions
How do we treat a tibial spine fracture? [3]
NB Must be careful as it overlaps with the ACL
Small # get cast but most get fixed by:
- Internal fixation
- Arthroscopic internal fixation
How do we recognise a patellar fracture of sleeve type (where distal pole of patella pulls off normal patella distally)?
RF of patellar fractures [6]
How would we treat a patellar fracture?
They can't straight leg raise. Classical sign: flops downwards Risk factors: - Laxity eg Ehlers Danos - Poor Vastus medialis obliques (VMO) - Large Q Angle - High femoral anteversion - Tibial ext rotation - Patella alta Treatment of patellar # - Undisplaced: Cylinder cast - Displaced ORIF
What is the Q angle?
What does a larger Q angle indicate?
What is patella alta?
angle between long axis of femur and tibia
A larger angle –> More valgus tibia –> greater risk of patellar dislocation
A high patella, sits above its groove
What is an osteochondral lesion? [2]
Ix [2]
Treatment [2]
Damage to the cartilage covering the joints
It can occur at the knee as result of developmental problems coupled with a traumatic injury
X-ray and MRI
Depends on the type:
1) Intact cartilage so just immobilise
2) Flap or fragment use drilling and fixation
