Paediatric Fractures

Question 1

What is a buckle fracture?

Answer 1

Compression fracture, very common in children

Fracture ends don’t separate so very stable

Question 2

What is a greenstick fracture?

Answer 2

Break in only one side of the cortex (doesn’t cross the whole bone)

Question 3

Why do paediatric fractures heal more quickly?

Answer 3

Periosteum is thicker and tends to remain intact

Question 4

Why can a higher degree of angulation be tolerated in paediatric fractures?

Answer 4

Much greater remodelling potential

Question 5

In general terms, how does management of fractures differ in children (compared to adults)?

Answer 5

Surgical stabilisation less frequently required –>

Manipulation + casting often enough unless unstable

Question 6

At what age do fractures start being treated as ‘adult fractures’?

Answer 6

Age 12-14

Question 7

What are the complications of a fracture involving the growth plate in children?

Answer 7

May disturb growth –> short limb or angular deformity

Question 8

Which method is used to classify physeal fractures in children?

Answer 8

Salter-Harris classification

Question 9

What is Salter-Harris type 1?

Answer 9

Pure physeal separation (along the line of growth plate)

Best prognosis - least likely to result in growth arrest

Question 10

What is Salter-Harris type 2?

Answer 10

Most common
Similar to type 1 but has a small metaphyseal fragment attached to physis + epiphysis
Unlikely to cause growth arrest

Question 11

What are Salter-Harris types 3 and 4? How should they be managed?

Answer 11

Intra-articular fracture splitting the physis
Risk of growth arrest

Should be reduced and stabilised to ensure a congruent articular surface + minimise disturbance

Question 12

What is Salter-Harris type 5?

Answer 12

Compression injury to the physis with subsequent growth arrest
Cannot be diagnosed on initial X-rays - only detected once angular deformity has occured

Question 13

How are Monteggia + Galeazzi injuries managed in children?

Answer 13

ORIF (same as adult) - high rates of redislocation if only manipulation and casting

Question 14

If both forearm bones are fractured how should it be managed?

Answer 14

If angulated –> manipulation + cast

If displaced –> flexible IM nail (unstable)

Question 15

How do supracondylar fractures of the elbow most commonly occur?

Answer 15

Heavy fall onto outstretched hand

Question 16

How should a supracondylar elbow fracture be managed?

Answer 16

Undisplaced (stable) –> splint

Angulated, rotated or displaced –> closed reduction + pinning with wires

Question 17

Which structures are at risk of damage in a supracondylar elbow fracture and how are they assessed?

Answer 17

Brachial artery –> must check radial pulse

Median nerve –> cannot make OK sign

Question 18

If there is evidence of neurovascular compromised following a supracondylar elbow fracture, what should be done?

Answer 18

Emergency surgery

Question 19

What should be considered in a femoral shaft fracture in a child under 2?

Answer 19

It is non-accidental injury?

Question 20

How would a femoral shaft fracture be managed in a child < 2?

Answer 20

Gallows traction + early hip spica cast

Question 21

How would a femoral shaft fracture be damaged in a child age 2-6?

Answer 21

Thomas splint or hip spica cast

Question 22

How would a femoral shaft fracture be damaged in a child age 6-12?

Answer 22

Flexible IM nail

Question 23

How would a femoral shaft fracture be damaged in a child age > 12?

Answer 23

Adult type IM nail

Question 24

Why should pathological fractures be considered in a child with a femoral shaft fracture?

Answer 24

Femur common site for bony tumours

Question 25

Which xray sign may indicate a fracture even if the bone looks normal?

Answer 25

Fat pad sign (aka sail sign)

- may be only clue in non-displaced fractures

Question 26

What is a toddler’s fracture?

Answer 26

Undisplaced spiral fracture of the tibial shaft –> very common in toddlers

Question 27

How is a toddlers fracture managed?

Answer 27

Short time in cast

risk of compartment syndrome much less than in adult