Paediatric fractures (injury basics)

Question 1

What fractures are children more likely to suffer than adults and why?

Answer 1

• Greenstick and buckle fractures
• Greenstick: children have cancellous bone (as opposed to cortical in adults) which is more flexible but less strong, meaning one side can break while the other stays intact
• Buckle: cancellous bone has less resistance against compression than cortical

Question 2

What are Salter-Harris fractures, and what is the grading system?

Answer 2

• Fractures at the growth plate
  1) Straight across
  2) Above growth plate
  3) BeLow GP
  4) Through GP
  5 CRush
• The higher the grade the more likely that growth will be disturbed

Question 3

Pain management in kids?

Answer 3

• WHO ladder has only 2 steps: paracetamol or ibuprofen, then add morphine
• If require morphine then require admission
• Tramadol, codeine, and aspirin contraindicated in kids/u16s

Question 4

Why are tramadol, codeine and aspirin not used in kids?

Answer 4

• Tramadol and codeine: unpredictable metabolism therefore effects vary too much
• Aspirin (under 16s): risk of Reyes disease (exception is when treating Kawasaki disease)

Question 5

What 6 things should make you consider none accidental injury?

Answer 5

• Delayed presentation
• Delays in reaching milestones
• Lack of concordance between proposed and actual mechanism of injury
• Multiple injuries
• Injury sites not commonly expose to trauma
• At risk children

Question 6

What 2 main pathologies are responsible for pathological fractures in children?

Answer 6

Osteogenesis imperfecta and osteopetrosis

Question 7

Osteogenesis imperfecta?

Answer 7

• ‘Brittle bone disease’
• Defective osteoid formation from congenital inability to produce intracellular components such as collagen and denine
• Autosomal dominant
• Often failure of collagen maturation in all tissues

Question 8

What might be seen on radiology in osteogenesis imperfecta?

Answer 8

• Translucent bones
• Multiple fractures (particularly in lone bones)
• Wormian bones (irregular ossification patches)
• Trefoil pelvis (abnormal shape of pelvic inlet)

Question 9

What are the 3 types of osteogenesis imperfecta?

Answer 9

1) Normal collagen but not enough produced
2) Poor collagen quality and quantity
3) Enough collagen produced but poor quality

Question 10

What are the associations and complications of osteogenesis imperfecta?

Answer 10

• Associations: blue sclera, short height, loose joints, hearing loss, breathing problems, teeth problems
• Complications: cervical or aortic artery dissection

Question 11

What is osteopetrosis?

Answer 11

• Hard dense bones
• Autosomal recessive
• Most common in young adults
• Radiology shows marble bone (lack of differentiation between medulla and cortex)

Question 12

What aspects of a history may suggest a fracture?

Answer 12

• History of injury
• Tenderness of bone
• Deformity of bone
• Pain with remote force
• Abnormal mobility
• Patient will protect and support limb/part of body