Paediatric fracture

Question 1

Why do children fractures tend to stabilise faster and better than adults?

Answer 1

They have a much thicker periosteum

Question 2

What fracture in children can occur due to compressive force?

Answer 2

Buckle fracture

Question 3

What is shown in this X-ray?

Answer 3

Buckle fracture

Question 4

What tend to happen to children in trauma instead of bone fracturing?

Answer 4

Bone bowing or bending

Question 5

What is a greenstick fracture?

Answer 5

Bowing of the bone with breakage in only 1 cortex of the bone, which the other cortex bends

Question 6

What is shown in this X-ray?

Answer 6

Bone bowing

Question 7

What is a torus fracture?

Answer 7

A fracture in which there is creasing of the bone

Question 8

What system is used to classify physeal injury in children?

Answer 8

Salter Harris classification

Question 9

What are the 5 classes of physeal injury?

Answer 9

1. S - Slip (Fracture passes transversely through the physis)
2. A - Above (Fracture passes from above the physis and through it)
3. L - Lower (Fracture passes from below the physis and up through the epiphysis and transversely out)
4. T - Through (Longitudinal fracture straight through both the metaphysis and physis)
5. cR - Crush (Crush injury to the growth plate)

Question 10

What is the most common elbow fracture in children?

Answer 10

Supra-condylar fracture

Question 11

What are the 7 structures of the elbow that ossify to form the elbow joint?

Answer 11

CRITOL:
C - Capitellum
R - Radial head
I - medial epIcondyle
T - Trochlear
O - Olecranon
L - Lateral epicondyle

Question 12

At what ages do the 7 structures of the elbow joint ossify?

Answer 12

CRITOL with ascending odd numbers
C - Capitellum - 1
R - Radial head - 3
I - medial epIcondyle - 5
T - Trochlear - 7
O - Olecranon - 9
L - Lateral epicondyle - 11

Question 13

What X-ray sign will be seen on supra-condylar fracture?

Answer 13

Presentation of a fat pad (Sail sign)

Question 14

What are the 3 main types of extension type supra-condylar fractures?

Answer 14

• I - Undisplaced
• IIa - Displaced posteriorly, intact posterior periosteal hinge - Anterior humeral line transects capitellum
• IIb - Displaced posterior, inact posterior periosteal hinge - Anterior humeral line does not transect capitellum
• III - Displaced posteriorly - No posterior periosteal hinge

Question 15

What is the management for type I (undisplaced) extension type, supra-condylar fracture?

Answer 15

Conservative management

Question 16

What is the management for type IIa extension type, supra-condylar fracture?

Answer 16

Conservative management

Question 17

What is the management for type IIb extension type, supra-condylar fracture?

Answer 17

Wires and MUA

Question 18

What is the management for type III extension type, supra-condylar fracture?

Answer 18

Wires and MUA

Question 19

What is shown in this X-ray?

Answer 19

Undisplaced, extension type supra-condylar fracture

Question 20

What is shown in this X-ray?

Answer 20

Type IIb, extension type supra-condylar fracture (Displaced posterior, inact posterior periosteal hinge - Anterior humeral line does not transect capitellum)

Question 21

What is shown in this X-ray?

Answer 21

Type III, extension type supra-condylar fracture (Displaced posteriorly - No posterior periosteal hinge)

Question 22

What are some common sites of non-accidental injury?

Answer 22

• Rib fractures
• Femoral shaft fractures in non-ambulatory children
• Unexplained fractures in a different stage of healing (X-ray shows healing but adult says it happened that day)
• Femoral fracture in child <1 year (Falling over wouldn’t cause that fracture)
• Epiphyseal and metaphyseal fractures of the long bone

Question 23

How should suspicion of non-accidental injury be managed?

Answer 23

If non-accidental injury is suspected, a skeletal survey such as a bone scan may be useful

Involvement of a paediatric team and wider MDT is mandatory and accurate documentation is essential

Question 24

What are some features suggestive of non-accidental injury?

Answer 24

• Obvious/supected fractures in a child under 2yrs
• Injuries in various stages of healing, especially burns and bruises
• More injuries than usually seen in children of the same age
• Injuries scattered on many areas of the body
• Increased intracranial pressure in an infant
• Suspected intra-cranial trauma in a young child
• Any injury that does not fit the description of the cause given

Question 25

What management is used in diaphysial and metaphyseal fracture?

Answer 25

Plaster of paris casting