Paediatric orthopaedic trauma

Question 1

what factors allow quick healing of fractures in children?

Answer 1

metabolically active periosteum
cellular bone
plastic (more elastic bone so bends more)

Question 2

what characteristics of children bone are different compared to adult?

Answer 2

increased collagen
increased porosity
increased cellularity
increased plasticity

Question 3

how are children fractures able to remodel well in plane of joint movement?

Answer 3

appositional periosteal growth/resorption

differential physeal growth

Question 4

what is the salter-halter criteria for children fractures?

Answer 4

S - straight through epiphyseal plate 
A - above plate
L - lower than the plate 
TE - through everything (below and above plate)
R - crushed

Question 5

what can be the consequence of a salter-halter fracture?

Answer 5

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)

Question 6

what is a Galeazzi fracture?

Answer 6

fracture to the proximal 1/3 of the radius with dislocation of the distal radioulnar joint

Question 7

what is a monteggria fracture?

Answer 7

fracture of the distal 1/3 of the ulnar with dislocation of the proximal head of the radius

Question 8

what are the complications from a forearm fracture?

Answer 8

compartment syndrome = volkmanns syndrome
posterior interosseous nerve injury (PIN)
superficial radial nerve injury
5% refracture
radioulnar synostosis

Question 9

when would you do an internal fixation for a forearm fracture in a child instead of conservative?

Answer 9

intra articular fracture 
open fracture
very unstable fracture
reaching skeletal maturity 
fracture through the growth plate 
comminuted

Question 10

why is physical injury more common in the femur compared to the tibia?
and why is this of importance in clinical practise?

Answer 10

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

Question 11

what are the surgical treatment options for physeal injury?

Answer 11

immobilise with cast
percutaneous fix
open reduction internal fixation (ORIF) articular displacement

Question 12

what are the complications from physical injury?

Answer 12

virus from damage to the common peroneal nerve
hyperextension from vascular injury
physeal arrest

Question 13

what are harris lines?

Answer 13

growth arrest lines

used to monitor growth of long bones in children

Question 14

what are the surgical treatment options for physeal arrest as a complication of a physeal injury/fracture?

Answer 14

complete epiphsiodesis
contralateral epiphysiodesis
corrective osteotomy

Question 15

what is a tibial spine fracture?

Answer 15

intra articular avulsion fracture of the bony attachment of the ACL (also known as the tibial spine)

Question 16

how is a tibial spine fracture graded?

Answer 16

meyer’s and mckeever
I - undisplaced
II - hinged
III - displaced

Question 17

what is the treatment for grades I, II and III tibial spine fractures?

Answer 17

I and II = long leg cast

II and III = ORIF/AxIF

Question 18

what are the risk factors for a patella dislocation?

Answer 18

laxity/hypermobility
poor vests medalis oblique
Q angle 
femoral anteversion
tibial external rotation
patella alta

Question 19

what are osteochondral lesions?

Answer 19

injury or small fracture of the cartilage surface of the talus

Question 20

how does osteochondral lesions occur.?

Answer 20

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

Question 21

what are the treatment options for osteochondral injuries?

Answer 21

type 1 (cartilage intact) = immobilise 
type 2 (flap) and type 3 (fragment) = drilling/fixation

Question 22

what are the ottawa rules?

Answer 22

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

Question 23

what is the management for an ankle dislocation?

Answer 23

displaced < 3 cm - pop
displaced > 3cm - MUA
persistant displacement - open reduction

SH 4 - ORIF

Question 24

what is Osgood schlatters disease?

Answer 24

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

Question 25

what is severs disease?

Answer 25

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

Question 26

what are the warning signs of non accidental injury?

Answer 26

incongruent history
bruising
burns
multiple fractures with multiple stages of healing
metaphyseal fracture, humeral shaft fracture
rib fractures