Paediatric Fractures Flashcards
What is a buckle fracture?
Compression fracture, very common in children
Fracture ends don’t separate so very stable
What is a greenstick fracture?
Break in only one side of the cortex (doesn’t cross the whole bone)
Why do paediatric fractures heal more quickly?
Periosteum is thicker and tends to remain intact
Why can a higher degree of angulation be tolerated in paediatric fractures?
Much greater remodelling potential
In general terms, how does management of fractures differ in children (compared to adults)?
Surgical stabilisation less frequently required –>
Manipulation + casting often enough unless unstable
At what age do fractures start being treated as ‘adult fractures’?
Age 12-14
What are the complications of a fracture involving the growth plate in children?
May disturb growth –> short limb or angular deformity
Which method is used to classify physeal fractures in children?
Salter-Harris classification
What is Salter-Harris type 1?
Pure physeal separation (along the line of growth plate)
Best prognosis - least likely to result in growth arrest
What is Salter-Harris type 2?
Most common
Similar to type 1 but has a small metaphyseal fragment attached to physis + epiphysis
Unlikely to cause growth arrest
What are Salter-Harris types 3 and 4? How should they be managed?
Intra-articular fracture splitting the physis
Risk of growth arrest
Should be reduced and stabilised to ensure a congruent articular surface + minimise disturbance
What is Salter-Harris type 5?
Compression injury to the physis with subsequent growth arrest
Cannot be diagnosed on initial X-rays - only detected once angular deformity has occured
How are Monteggia + Galeazzi injuries managed in children?
ORIF (same as adult) - high rates of redislocation if only manipulation and casting
If both forearm bones are fractured how should it be managed?
If angulated –> manipulation + cast
If displaced –> flexible IM nail (unstable)
How do supracondylar fractures of the elbow most commonly occur?
Heavy fall onto outstretched hand
How should a supracondylar elbow fracture be managed?
Undisplaced (stable) –> splint
Angulated, rotated or displaced –> closed reduction + pinning with wires
Which structures are at risk of damage in a supracondylar elbow fracture and how are they assessed?
Brachial artery –> must check radial pulse
Median nerve –> cannot make OK sign
If there is evidence of neurovascular compromised following a supracondylar elbow fracture, what should be done?
Emergency surgery
What should be considered in a femoral shaft fracture in a child under 2?
It is non-accidental injury?
How would a femoral shaft fracture be managed in a child < 2?
Gallows traction + early hip spica cast
How would a femoral shaft fracture be damaged in a child age 2-6?
Thomas splint or hip spica cast
How would a femoral shaft fracture be damaged in a child age 6-12?
Flexible IM nail
How would a femoral shaft fracture be damaged in a child age > 12?
Adult type IM nail
Why should pathological fractures be considered in a child with a femoral shaft fracture?
Femur common site for bony tumours
Which xray sign may indicate a fracture even if the bone looks normal?
Fat pad sign (aka sail sign)
- may be only clue in non-displaced fractures
What is a toddler’s fracture?
Undisplaced spiral fracture of the tibial shaft –> very common in toddlers
How is a toddlers fracture managed?
Short time in cast
risk of compartment syndrome much less than in adult
