Paediatric Fractures

Question 1

What is a complete fracture?
Toddlers fracture?
Plastic deformity
Greenstick fracture
Buckle fracture?

Answer 1

Complete - both sides of cortex are breached
Toddlers - Oblique tibial fracture in infants
Plastic deformity - stress on bone resulting in deformity without cortical disruption
Greenstick fracture - unilateral cortical breach only
Buckle fracture - incomplete cortical disruption resulting in periosteal haematoma only

Question 2

What is the classification system for paediatric fractures?

Answer 2

Salter Harris (SALT Crush)
I - Fracture through the physeal growth plate only
II - Fracture through the physeal growth plate and the metaphysis, most common
III - Fracture through the physis and the epiphysis
IV - Fracture through the physis, metaphysis and epiphysis
V - Crush injury involving the physis

Question 3

How are various salter harris fracture treated?

Answer 3

Assume growth plate tenderness is indicative of fracture even if XR is normal
III,IV,V will usually require surgery
V associated with disruption to growth

Question 4

When should you consider non-accidental injury in children?

Answer 4

Delayed presentation
Delay in attaining milestones
Lack of concordance between proposed and actual mechanism of injury
Multiple injuries
Uncommon trauma site
Risk register

Question 5

What is osteogenesis imperfect?

Answer 5

Defective osteoid formation due to congenital inability to produce adequate intercellular substances like osteoid, collagen and dentine (teeth)
Failure of maturation of collagen in all the connective tissues.
Radiology may show translucent bones, multiple fractures, particularly of long bones, workman bones (irregular patches of ossification) and trefoil pelvis

Question 6

What are the subtypes of osteogenesis imperfect?

Answer 6

I - collagen is normal quality but insufficient quantity
II - Poor collagen quantity and quality
III - collagen poorly formed, normal quantity
IV - sufficient collagen quantity but poor quality

Question 7

What is osteoporosis?

Answer 7

Bones become harder and more dense
Autosomal recessive
Commonest in young adults
RAdiolgoy - lack of differentiation between cortex and medulla - marble bone

Question 8

What is Perthes disease?

Answer 8

Degenerative condition affecting hip joints of children between 4-8 years
Avascular necrosis of the femoral head.
5x more common in boys
10% bilateral
Features:
Hip pain - develops progressively over a few weeks
Limp
Stiffness and reduced range of hip movement
X-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening

Question 9

What is slipped upper femoral epiphysis?

Answer 9

10-15 years old
Obese children and boys
Displacement of the femoral head epiphysis postern-inferiorly
Bilateral slip in 20%
May present acutely following trauma or more commonly chronic persistent symptoms
Features:
Knee or distal thigh pain
Loss of internal rotation of the leg in flexion

Question 10

Describe Juvenile idiopathic arthiritis

Answer 10

Arthritis occurring in <16 years old lasting for more than 3 months
Pauciarticular JIA – 4 or less joints affected
JOint pain and swelling - knees, ankles, elbows
imp
ANA may be positive - associated with anterior uveitis