Paediatric T&O Flashcards
What is a greenstick fracture?
Fracture of one cortex but not the other, with angulation
Salter-Harris classification of epiphyseal fractures
I: Slipped
II: Above physis
III: Lower than physis
IV: Through physis
V: Rammed together (low threshold for MRI if suspected)
Indicates prognosis
Epidemiology of epiphyseal fractures
10% of paed fractures
Happen mainly in 10-16yo because muscles/tendons >> than growing bone
Order of ossification centres of the elbow
Capitellum - 1yo
Radial head - 3yo
Internal (medial) epicondyle - 5yo
Trochlea - 7yo
Olecranon - 9yo
External (lat) epicondyle - 11yo
Most common paediatric elbow injury
Supracondylar humerus fracture from FOOSH, commonly 4-10yo
MUST ASSESS N-V status
requires proper reduction to prevent varus malunion
Gartland classification of supracondylar fractures
I: Subtle, undisplaced, posterior fat pad, for splinting/cast 3-4w
II: Displaced but posterior cortex intact
III/IV: Completely displaced, comminuted/rotated, needs operative management (must check radial and median nerve!)
Red flags for NAI
Posterior rib fractures
Fractures in non-walkign children <1yo (esp long bone)
Multiple Hx of fractures (or diff stages of healing)
Bruising (or diff stages of healing)
Mechanism not compatible
Parental Hx contradictory
Delay in seeking treatment
Types of paediatric fracutre
Plastic deformation
Greenstick fracture
Complete fracture
Buckle/torus fracture (from axial force)
Limping child differential age 0-5
- Painful
- Septic arthritis, osteomyelitis
- DDH + dislocation?
- Painless:
- Cerebral palsy
- Limb length discrepancy
- DDH
Limping child differential age 5-10
Trauma
Perthes
haem disease
Malignancy
JRA/SLE
Limping child differential 10-15
SUFE
Trauma
Presentation of SUFE
Overwight, osteodystrophy, hypothyroid are risk factors
Weight-bearing trauma
Boys 10-15 during growth spurt
Needs operative stabilisation
May lead to knee pain, hip ext rot + abducts during flexion, limited internal rotation
Line drawn through outer femoral neck does not intersect epiphysis
Perthes disease pathophysiology
Idiopathic avascular necrosis of femoral head, 10% bilateral
Femoral head dissolves, reossifies, remodels
Presentation of Perthes
Males 4-8
Risk: 2nd hand smoke, ADHD, low birth weight
Limp, no history of trauma, hip/knee movement painful
Management of Perthes
<6 non-operative (activity modification, physio, analgesia)
>6 or collapsed head –> operative
Pathophysiology of septic arthritis
Haematogenous/bone spread
Proteolytic enzymes –> damage cartilage
Effusion –> bone head necrosis
Knee > hip > elbow/ankle
H. influenzae in kids most common
Risk stratification of septic arthritis
Not weight bearing
Fever
WCC >12
ESR >40
3,40,90,98% risk
Risk factors for septic arthritis in children
Neonates
Prematurity
C-section
Presentation of DDH
Young child, limp
Risk: FH, first-born, breech position, female
Bilateral in 20%
Pathophysiology of DDH
Intrauterine malpositioning and/or ligamentous laxity
Shallow acetabulum –> more prone to hip dislocation
Management of DDH
<6mo pavlik harness for 6w (discontinue if not reduced by 3w)
6-18mo: arthrogram hip spica for 3mo
>18mo: open surgical management
Presentation of transient synovitis
Hip pain
5-10 yo
Associated with recent URTI/viral illness
Able to weight bear, no fever or systemic unwellness
Management of transient synovitis
Analgesia, marked improvement in 24-48h
Osgood-Schlatter’s disease presentation
Boys 12-15yo
Frequent jumpers/sports
Pain + enlarged tibial tubrcle
