Paediatric fracture Flashcards
Why do children fractures tend to stabilise faster and better than adults?
They have a much thicker periosteum
What fracture in children can occur due to compressive force?
Buckle fracture
What is shown in this X-ray?
Buckle fracture
What tend to happen to children in trauma instead of bone fracturing?
Bone bowing or bending
What is a greenstick fracture?
Bowing of the bone with breakage in only 1 cortex of the bone, which the other cortex bends
What is shown in this X-ray?
Bone bowing
What is a torus fracture?
A fracture in which there is creasing of the bone
What system is used to classify physeal injury in children?
Salter Harris classification
What are the 5 classes of physeal injury?
- S - Slip (Fracture passes transversely through the physis)
- A - Above (Fracture passes from above the physis and through it)
- L - Lower (Fracture passes from below the physis and up through the epiphysis and transversely out)
- T - Through (Longitudinal fracture straight through both the metaphysis and physis)
- cR - Crush (Crush injury to the growth plate)
What is the most common elbow fracture in children?
Supra-condylar fracture
What are the 7 structures of the elbow that ossify to form the elbow joint?
CRITOL:
C - Capitellum
R - Radial head
I - medial epIcondyle
T - Trochlear
O - Olecranon
L - Lateral epicondyle
At what ages do the 7 structures of the elbow joint ossify?
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
What X-ray sign will be seen on supra-condylar fracture?
Presentation of a fat pad (Sail sign)
What are the 3 main types of extension type supra-condylar fractures?
- 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
What is the management for type I (undisplaced) extension type, supra-condylar fracture?
Conservative management
What is the management for type IIa extension type, supra-condylar fracture?
Conservative management
What is the management for type IIb extension type, supra-condylar fracture?
Wires and MUA
What is the management for type III extension type, supra-condylar fracture?
Wires and MUA
What is shown in this X-ray?
Undisplaced, extension type supra-condylar fracture
What is shown in this X-ray?
Type IIb, extension type supra-condylar fracture (Displaced posterior, inact posterior periosteal hinge - Anterior humeral line does not transect capitellum)
What is shown in this X-ray?
Type III, extension type supra-condylar fracture (Displaced posteriorly - No posterior periosteal hinge)
What are some common sites of non-accidental injury?
- 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
How should suspicion of non-accidental injury be managed?
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
What are some features suggestive of non-accidental injury?
- 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
What management is used in diaphysial and metaphyseal fracture?
Plaster of paris casting
