Paediactrics - Fractures and NAI Flashcards
Why do childrens fractures heal quickly?
Metabolically active periosteum
Cellular bone
Good blood supply
Often low velocity trauma
What are the 3 important things you have to remember for treating childrens fractures since the fractures heal quickly?
Fixation is not usually required
Do not over immobilise
Do not over treat
What are the 4 types of fracture in children?
Complete fracture
Greenstick fracture
Buckle (torus)
Plastic deformity
Name 4 conservative treatments for childrens fractures
Cast
Braces
Splints
Traction
Describe the options for operative treament in children fractures
External fixation
- Monolateral
- Circular
Internal fixation
- IM nail (rigid or elastic)
- Biological
- Plate fixation
Children’s fracture re-modeling is more evident in what plane?
Plane of joint movement
What factors give better remodelling?
Translation > angulation > rotation
More remodelling in metaphyseal region
Greater potential in younger patient
Degree of deformity
Remodelling occurs well in what plane?
Plane of joint movement
Most children’s fractures need simple treatment.
Give 5 examples
Reduce the fracture (if needed)
Immobilise
Remove cast/ splint when healed
Joint stiffness rare
Open fractures debride
What are the children’s fracture principles?
Reduce fracture, cast
Increase deformity to reduce fracture
Bendy bones need bent cast to give straight limb
What is a periosteal hinge?
In certain fractures of long bones, the periosteum remains intact and acts as a hinge — it holds two pieces of the broken bone together
When would you supplement a cast with fixation?
6 points
Severe swelling likely
Need to re-inject wound (e.g. open fractures)
Multiple injuries
Segmental limb injuries
Fracture very unstable
Approaching Skeletal maturity
Is a physis stronger or weaker than ligaments?
Weaker
What is the risk to a child with physeal fractures?
Growth arrest risk
What classification helps to predict injuries that may affect growth
Salter-Harris Classification
What Salter-Harris classifications are low risk and which are high risk?
Low risk
-I and II
High risk
-III-V
What is the commonest Salter-Harris fracture seen?
II
What will you need to do with a Salter-Harris III if displaced?
Anatomical reduction and fixation
How do you manage a Salter-Harris IV fracture?
ORIF if displaced
Monitor for growth arrest
What is a Tillaux Fracture?
Tillaux fractures are Salter-Harris III fractures through the anterolateral aspect of the distal tibial epiphysis, with variable amounts of displacement
List the warning signs of NAI
Inconsistant history
Delay in presentation
Fracture pattern does not fit mechanism described
Bruising (pattern and ages)
Burns
Multiple fractures, multiple stages of healing
Metaphyseal #, humeral shaft #
Rib #
Non-ambulant # of long bones
Osteomyelitis is mainly seen where?
Around knee
Osteomyelitis is usually what organism?
Staphylococcus
How do you manage osteomyelitis?
Aim to prevent acute becoming chronic
Most require prolonged high dose antibiotics
Rarely require surgery
