Paediatric orthopaedic trauma Flashcards
what factors allow quick healing of fractures in children?
metabolically active periosteum
cellular bone
plastic (more elastic bone so bends more)
what characteristics of children bone are different compared to adult?
increased collagen
increased porosity
increased cellularity
increased plasticity
how are children fractures able to remodel well in plane of joint movement?
appositional periosteal growth/resorption
differential physeal growth
what is the salter-halter criteria for children fractures?
S - straight through epiphyseal plate A - above plate L - lower than the plate TE - through everything (below and above plate) R - crushed
what can be the consequence of a salter-halter fracture?
fracture through the growth plate can result in growth damage if it is bad enough SH 3, 4 & 5 can result in; deformity (elbow) arrest (knee, ankle) over growth (femur)
what is a Galeazzi fracture?
fracture to the proximal 1/3 of the radius with dislocation of the distal radioulnar joint
what is a monteggria fracture?
fracture of the distal 1/3 of the ulnar with dislocation of the proximal head of the radius
what are the complications from a forearm fracture?
compartment syndrome = volkmanns syndrome
posterior interosseous nerve injury (PIN)
superficial radial nerve injury
5% refracture
radioulnar synostosis
when would you do an internal fixation for a forearm fracture in a child instead of conservative?
intra articular fracture open fracture very unstable fracture reaching skeletal maturity fracture through the growth plate comminuted
why is physical injury more common in the femur compared to the tibia?
and why is this of importance in clinical practise?
the attachment of the ligament is below the level of the physics in the femur os the pulling force is on the epiphysis
if the physis is damaged then there is a high risk of neurovasuclar injury and can can have profound effects on long term height
what are the surgical treatment options for physeal injury?
immobilise with cast
percutaneous fix
open reduction internal fixation (ORIF) articular displacement
what are the complications from physical injury?
virus from damage to the common peroneal nerve
hyperextension from vascular injury
physeal arrest
what are harris lines?
growth arrest lines
used to monitor growth of long bones in children
what are the surgical treatment options for physeal arrest as a complication of a physeal injury/fracture?
complete epiphsiodesis
contralateral epiphysiodesis
corrective osteotomy
what is a tibial spine fracture?
intra articular avulsion fracture of the bony attachment of the ACL (also known as the tibial spine)
how is a tibial spine fracture graded?
meyer’s and mckeever
I - undisplaced
II - hinged
III - displaced
what is the treatment for grades I, II and III tibial spine fractures?
I and II = long leg cast
II and III = ORIF/AxIF
what are the risk factors for a patella dislocation?
laxity/hypermobility poor vests medalis oblique Q angle femoral anteversion tibial external rotation patella alta
what are osteochondral lesions?
injury or small fracture of the cartilage surface of the talus
how does osteochondral lesions occur.?
trauma
single traumatic injury from abnormal motion of the ankle which puts strain on the ankle. the tibia/fibia and talus will contact each other with a massive stress = fracture
what are the treatment options for osteochondral injuries?
type 1 (cartilage intact) = immobilise type 2 (flap) and type 3 (fragment) = drilling/fixation
what are the ottawa rules?
x-ray films are required when there is pain in malleolar zone + bony tenderness at tip of lateral malleolus
x-rays required if pain in mid-foot zone + bony pain at the navicular bone or base of 5th metatarsal
+ also inability to weight bear both immediately and in A&E
what is the management for an ankle dislocation?
displaced < 3 cm - pop
displaced > 3cm - MUA
persistant displacement - open reduction
SH 4 - ORIF
what is Osgood schlatters disease?
inflammation at the point where the patellar tendon attaches to the tibia spine
occurs with repetitive strain on the knee i.e. children who do athletics
what is severs disease?
inflammation of the growth plate of the heel in children
caused by repetitive strain on the heel therefore occurs in children who are very active
what are the warning signs of non accidental injury?
incongruent history
bruising
burns
multiple fractures with multiple stages of healing
metaphyseal fracture, humeral shaft fracture
rib fractures
