Paediatric Trauma Flashcards
What are the risk factors for fractures?
Age, previous fractures, metabolic bone disease, season and more boys then girls
How do children’s bones heal quickly?
Metabolically active periosteum
Cellular bone
Good blood supply
Often low velocity trauma
What are the types of fracture in children?
Complete, greenstick, buckle (convexity of bone) and plastic deformity
How is a fracture assessed?
History
Deformity
Soft tissues
- whole limb, wounds, sensation , motor function and vascular status
What is the conservative treatment for fracture in children?
Casts, braces, splints and traction
What is the operative treatment for fractures in children?
External fixation - mono-lateral and circular
Internal fixation - IM nail (rigid or elastic) and plate fixation
Describe children’s fracture re-modelling
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
What is a summary of children’s fracture treatment?
Reduce the fracture
Immobilise
Remove cast/ splint when healed
Joint stiffness is rare
Open fractures debride
When should fixation be used for fractures instead of cast?
Severe swelling likely, need to re-inspect wound, multiple injuries, segmental limb injuries, fractures very unstable and approaching skeletal maturity
Describe physeal fractures
Physis acts as a plane of fracture
Weaker than ligaments
Growth arrest risk
Can result in progressive deformity
What is the Salter Harris Classification?
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
Which Salter Harris fracture is most common?
SH 2
What is the treatment of SH3 fracture if displaced?
Need for anatomical reduction and fixation if displaced
What is the management of SH4?
Is rare and seen in ankles
ORIF if displaced
Monitor for growth arrest
What is an apophyseal injury of tibial spine?
Avulsion of ACL
Can be undisplaced (plaster), hinged (long leg cast) and displaced (fixation and ORIF)
These are type 1, 2 and 3
What is the treatment of tibial tubercle fractures?
Tendon is stronger than bone
Operative fixation usually needed
What are transitional fractures?
Growth plate closing - age 13-14 yrs
Usually ankle
Central>medial>lateral fusion
What is a Tillaux fracture?
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
Describe fixation surgeries
External fixator is rarely used
ORIF - adolescents, comminuted fracture, injuries involving joint surface, and Monteggia + Galeazzi (MUSGRI)
Describe flexible nailing
Need 2yrs predicted growth remaining
Allow early ROM
Wires out when healed
Minimal disruption
What are warning signs of non-accidental injury (NAI)?
Inconsistent history, delay in presentation, fracture pattern, bruising, burns, multiple fracture and stages of healing, rib fracture, metaphyseal and humeral shaft fracture
Describe acute osteomyelitis
Infection of bone
Insidious onset
Mainly around knee
Most require prolonged antibiotics
Mostly staph. aureus
Can threaten life and limb
