Paediatric Trauma

Question 1

What are the risk factors for fractures?

Answer 1

Age, previous fractures, metabolic bone disease, season and more boys then girls

Question 2

How do children’s bones heal quickly?

Answer 2

Metabolically active periosteum
Cellular bone
Good blood supply
Often low velocity trauma

Question 3

What are the types of fracture in children?

Answer 3

Complete, greenstick, buckle (convexity of bone) and plastic deformity

Question 4

How is a fracture assessed?

Answer 4

History
Deformity
Soft tissues
- whole limb, wounds, sensation , motor function and vascular status

Question 5

What is the conservative treatment for fracture in children?

Answer 5

Casts, braces, splints and traction

Question 6

What is the operative treatment for fractures in children?

Answer 6

External fixation - mono-lateral and circular
Internal fixation - IM nail (rigid or elastic) and plate fixation

Question 7

Describe children’s fracture re-modelling

Answer 7

Most evident in plane of joint movement
Appositional periosteal growth/ resorption
Differential physeal growth
More remodelling in metaphyseal region
Translation> angulation> rotation
Remodels best in plane of movement

Question 8

What is a summary of children’s fracture treatment?

Answer 8

Reduce the fracture
Immobilise
Remove cast/ splint when healed
Joint stiffness is rare
Open fractures debride

Question 9

When should fixation be used for fractures instead of cast?

Answer 9

Severe swelling likely, need to re-inspect wound, multiple injuries, segmental limb injuries, fractures very unstable and approaching skeletal maturity

Question 10

Describe physeal fractures

Answer 10

Physis acts as a plane of fracture
Weaker than ligaments
Growth arrest risk
Can result in progressive deformity

Question 11

What is the Salter Harris Classification?

Answer 11

Helps predict which fractures will affect growth
Salter 1 fracture if through growth plate
Tells you where the fracture is
2 - along growth plate then angles off
1 and 2 less affect growth
Type 3 and 4 have higher risk

Question 12

Which Salter Harris fracture is most common?

Answer 12

SH 2

Question 13

What is the treatment of SH3 fracture if displaced?

Answer 13

Need for anatomical reduction and fixation if displaced

Question 14

What is the management of SH4?

Answer 14

Is rare and seen in ankles
ORIF if displaced
Monitor for growth arrest

Question 15

What is an apophyseal injury of tibial spine?

Answer 15

Avulsion of ACL
Can be undisplaced (plaster), hinged (long leg cast) and displaced (fixation and ORIF)
These are type 1, 2 and 3

Question 16

What is the treatment of tibial tubercle fractures?

Answer 16

Tendon is stronger than bone
Operative fixation usually needed

Question 17

What are transitional fractures?

Answer 17

Growth plate closing - age 13-14 yrs
Usually ankle
Central>medial>lateral fusion

Question 18

What is a Tillaux fracture?

Answer 18

Twisting movement of ankle - force exerted on ligament
In child ligament is stronger than bone so bone pulled from growth plate which hasn’t fused yet

Question 19

Describe fixation surgeries

Answer 19

External fixator is rarely used
ORIF - adolescents, comminuted fracture, injuries involving joint surface, and Monteggia + Galeazzi (MUSGRI)

Question 20

Describe flexible nailing

Answer 20

Need 2yrs predicted growth remaining
Allow early ROM
Wires out when healed
Minimal disruption

Question 21

What are warning signs of non-accidental injury (NAI)?

Answer 21

Inconsistent history, delay in presentation, fracture pattern, bruising, burns, multiple fracture and stages of healing, rib fracture, metaphyseal and humeral shaft fracture

Question 22

Describe acute osteomyelitis

Answer 22

Infection of bone
Insidious onset
Mainly around knee
Most require prolonged antibiotics
Mostly staph. aureus
Can threaten life and limb