Paediatric orthopaedic trauma Flashcards
What children are most likely to get traumatic injuries
boys more likely
Increased hyseal injury with age
Previous fracture
Metabolic bone disease
What are the principles of children’s fractures
Often simple, incomplete and heal quickly
Metabolically active periosteum
Cellular bone
Plastic
Fixation is not typically required
Do not over immobilise
Do not over treat
What occurs at the growth plates
Remodelling
Physeal arrest- fusion of the epiphyseal plates
Displacement
Lenght discrepancies
What is involved at the growth plates
Collagen
Porosity
Cellularity
Plasticity
What occurs at the periosteum?
Metbolically active
thick and strong
How should remodelling take place in a childs fracture
Remodel well in plane of joint movement
Appostional periosteal growth/resorption
Differential physeal growth
Application younger child, polar fractures, intact growing physis, saggital> frontal, X transverse
What can occur during a physeal fracture
Progressive deformity
Deformity- elbow
Arrest- knee,ankle
Overgrowth-femur
What bone is most commonly fractured in children?
What kind of fractures can occur
Forearm
Low energy- buckle, greenstick
High energy- open, displaced, soft tissue injury
Explain the different types of forearm fractures
Shaft fractures-
Galeazzi- fractures of the dital third of radius including RU joint
Monteggia- fracture of the proximal head of the ulna with dislocation of the proximal radius head
Distal radius fractures
What deforming forces can affect a forearm fracture
Biceps supinator- displace fracture superiorly
Supinator- supiante/pronate fracture
Pronator teres- pronate fracture
Pronator quadratus- pronate fracture
How do you assess a fracture?
History
Deformity
Soft tissues- whole limb, wounds, sensation, motor, vascular status.
Document findings, repeat post intervention
What are the different treatment outcomes?
Closed (non surgical)- good 90-95% functional results
Open/flex nail- resotred anatomy, early mobilisaiton, nerve injury, delayed union
What are indications for surgery
Open fracture
segmental fracture
nerurovascularly compromised
Failed close treatment
What are the principles of closed management
Analgesia, anaesthesia Theatre set up Reudce (disempact, bend force over apex) Verift Check radiographs week 1,2 &4 Change loose casrs Remoce when callus evident Restrict activity
What surgical options are available?
External fixator, rare, soft tissue injuries ORIF(internal fixation) Adolesccents communciated fracture Limietd immboilisation singe bone technique
What are the benefits of flexible nailing
Needs 2yrs predicated growth remaining
Allows early ROM
Wires out when healed
What are the complications of surgery
Compartments syndrome- Volkmann's 5% non union, refracture Radioulnar synostoss PIN injury Superfifical radial injury`
What are the management of distal radial fractures
Buckle cast- 3-4 weeks Greenstick- cast 4-6 weeks Complete cast Risk for reminipulation -complete fracyres failed anatomcial reduction Not B/E pop
What are the differential diagnosis to knee trauma?
Infection Inflammatory arthropathy Neoplasm Apophysis Apophysitis Hip Foot Sickle, heamophilia Anterior knee pain
What bony injuries occur during knee trauma?
Physeal/metaphyseal injuries Tibial spine Tibial tubercle Patellar fracture Sleeve fracture Patellar dislocation Referred pain
What is involved in physeal injuries
Can be femoral or tibial Capsuel and ligaments also involved hyperextnesion causes vascular injury Varus- CPN injury SH not predictive
What is the treatment for a physeal injury
Cast, immobolise
Percutaneous fix
ORIF articular diplacement
ROM early
What is the treatment of physeal arrest
Monitor- harris lines, angulation and length Resect bar Complete epiphysoidesis Contralateral epiphysiodesis Corrective osteotomy
What occurs during tibial spine injuries?
Overlap with ACL Meyers and McKeever I- undiscplaced II hinged III displaced I/II long leg cast II/III ORIF, AxIF
What occurs during a patellar fracture
Rare- cartilagenous to age 4
Sleeve type
Undisplaced-cylinder cast
Displaced- ORIF
Patella dislocation risk factors?
Laxity Poor VMO Q angle Femoral antevesrion Tibial external rotation Patella alta
How do you manage patellar dislocation
Controversial Cast- repair medial ligament Mobilise- lateral release VMO exercises- medial tib tubercle SemiT tenodesis
What are osteochondral lesions?
How are they treated?
Small fracture of the cartilage of the surface of the talus.
Single traumatic injuries that cause a fracture of the talus cartilage
Type I-cartilage intact- immobilise
Type II- flap/Type II fragment- drilling/fix
How do youu diagnose anterior knee pain
diagnosis of exclusion
Inflammatory, neoplasm
Oschar schatts, SLJ?
What is a risk in ankle fractutes
Physis is a plae of fracture
It is weaker than the ligaments and carries a risk of growth arrest
What are the classifications of ankle injuries
Mehanistic- lauge hansen, dias-tachdjan
Anatomical-salterharris, vahvanene and aalto
How are patients with ankle injuries assesed
History-mechanism
Deformity
Soft tissues
AP + lateral radiograpgs- ottowa rules
What are the ottowa rules
X rays are not required unless:
There is pain in malloeolar zone
There is bone tenderness at posterior edge of lateral malleolus
Base of fifth metatarsal
Navicular
Inability to bear weight both immediately and in emergency department
How do you manage an SH1 fracture
Displaced<3cm- pop 6
Displaced >3cm MUA, POP 6
How do you manage an SH2 fracture
most common
Displaced <3mm POP 4+2
Displaced >3mm MUA, POP
How do you manage an SH3 fracture
Supination inversion
Epiphyseal fgt medial
Management- undisplaced- POP 6
Displaced (open) red’n and interfag screw
How do you manage an SH4 fracture
ORIF
Monitor for growth arrest
What is a growth plate transitional fracture
Fracture that occurs around age 13-14
Affects central>medial>lateral fusio
Articuar congruity is favoured over phsyical integrity
What is a tillaux fracture?
External rotation leading to
Anterior tibiofibualr leg avulsion
SH3
can be treated with a closed/ open reduction
What is a triplane fracture?
Caused by a triplane fracture that is evident on external rotation
SH3 on AP and SH2 on lateral leg
CT, ORIF is management process
What are two common overuse injuries?
Osgood-schlatter’s disease and sever’s disease
