Paediatric Trauma Flashcards
Describe risk factors for fractures in children?
- Boys 60% Girls 40%
- Age
- Previous fracture
- Metabolic bone disease
- Season
What are the principles of childrens fractures?
-
Heal quickly
- Metabolically active periosteum
- Cellular bone
- Good blood supply
- Due to this
- Fixation not usually required
- Do not over immobilise
- Do not over treat
-
Most fractures need simple treatment
- Conservative treatment
- Cast
- Braces
- Splints
- Traction
- When operative treatment is required
- External fixation
- Monolateral or circular
- Internal fixation
- IM nail – rigid or elastic
- Plate fixation
- External fixation
- Conservative treatment
- Remodel well in plane of joint movement
-
Reduction as treatment
- Increase deformity to reduce fracture
- Bones need bent cast to give straight limb (periosteum tension)
-
Supplement the cast with fixation when
- Severe swelling likely
- Need to re-inspect wound (such as open fractures)
- Multiple injuries
- Segmental limb injuries
- Unstable fracture
Why do childrens fractures heal quickly?
- Metabolically active periosteum
- Cellular bone
- Good blood supply
How does the principle that childrens fractures heal quickly impact treatment?
- Fixation not usually required
- Do not over immobilise
- Do not over treat
What treatment is usually used for childrens fractures?
- Most fractures need simple treatment
- Conservative treatment
- Cast
- Braces
- Splints
- Traction
- When operative treatment is required
- External fixation
- Monolateral or circular
- Internal fixation
- IM nail – rigid or elastic
- Plate fixation
- External fixation
- Conservative treatment
When should the cast be supplemented with fixation?
- Severe swelling likely
- Need to re-inspect wound (such as open fractures)
- Multiple injuries
- Segmental limb injuries
- Unstable fracture
What are the 4 types of fracture in children?
- Complete fracture
- Greenstick fracture
- Buckle (torus)
- Plastic deformity
In what plane does remodelling occur in children?
Most evident in plane of joint movement:
- Appositional periosteal growth/resorption
- Differential physeal growth
In physeal fractures what does the physis act as?
Physis acts as plane of fracture
What are possible complications of physeal fractures?
- Growth arrest risk due to closeness to growth plate
- Physis weaker than ligaments
- Can result in progressive deformity
- Salter-Harris classification used to predict injuries that may affect growth
- Tells you where fracture is and not how much it is displaced
- Salter-Harris classification used to predict injuries that may affect growth
What is used to predict injuries that may affect growth?
- Salter-Harris classification used to predict injuries that may affect growth
- Tells you where fracture is and not how much it is displaced
Describe Salter-Harris classification?
What does SH classification stand for?
Saltire harris classification
Which SH grade is most common?
What SH class has most risk of growth disturbances?
Most risk of growth disturbance is in III and IV:
- Or if in femur, even if SH I injury
What is the apophysis?
Apophysis is where tendon inserts into bone
How does apophysis injury differ in children compared to adults?
Ligament can be stronger than bone, so injury can cause avulsion of ligament, such as:
- Tibial spine and ACL
- Tibial tubercle and patella tendon
- Usually requires operative fixation
What are 2 locations where ligament is often stronger than bone?
- Tibial spine and ACL
- Tibial tubercle and patella tendon
- Usually requires operative fixation
What are the different grades of avultion of ACL?
- I Undisplaced
- II Hinged
- III Displaced
Describe the treatment for avulsion of ACL?
- I/II long leg cast
- II/III ORIF
What are transitional fractures?
Occur in children who have almost stopped growing:
- Growth plate closing, age 13-14 years
- Standard sequence of growth plate closing
- Central > medial > lateral
What is the standard sequence of growth plate closing?
- Central > medial > lateral
Where does transitional fracture usually occur?
Usually occurs above ankle, such as Tilliax fracture which occurs due to the lateral side of growth plate closing last:
- In adult ligament would tear
- But in child, ligament stronger than bone so bone pulled off growth plate where the plate hasn’t fused
What are possible complications of Tilliax fracture?
- Growth arrest
- Can be asymmetrical growth arrest
- Affecting gait – walk on outer side of foot
