Paediatric Trauma

Question 1

Risk factors for paediatric fractures?

Answer 1

Boys > girls (60:40%)
Age
Previous fractures
Metabolic bone disease
Season- usually summertime because off school, longer periods of day light

Question 2

Why does childrens bone heal quicker than adults?

Answer 2

Good blood supply
Lot more cellular, less mineral content
Children don’t smoke

->because of this quick healing, fixation of fractures is not usually required

Question 3

Complete fractures tend to occur more in adults. Which three types of fracture are only seen in children?

Answer 3

Greenstick fracture
Buckle fracture
Plastic deformation

Question 4

Greenstick fracture?

Answer 4

Bone cracks on one side and not all the way through

->like snapping a twig where is kind of bends and doesn’t fully snap

Question 5

Greenstick fractures tend to re-displace but only when?

Answer 5

All forces on them are taken off

Question 6

Buckle fracture?

Answer 6

Usually due to longitudinal compression

Question 7

What is seen on x-ray of a buckle fracture?

Answer 7

Slight concavity of the bone where the cortex has been compressed

Question 8

Management of buckle fracture?

Answer 8

Simple splintage for a short period of time

Question 9

Where are plastic deformability’s most commonly seen?

Answer 9

Forearm

Question 10

What happens in plastic deformaility?

Answer 10

Bones have been caught between something and a force applied as a child falls meaning a sequence of small cracks along the bone causing it to bend

->e.g. if bones are caught between rungs of a ladder and then the child falls down the ladder

Question 11

Plastic deformity injuries are rare.
What characteristics do we need to be aware of?

Answer 11

-Bone won’t tend to remodel as periosteum is disrupted
-Points at top and bottom of bone can dislocate and bend of the bone now encourages dislocation

Question 12

Do most fractures in children require conservative or operative management?

Answer 12

95% of fractures only require conservative management

Question 13

List some of the conservative treatment measures for paediatric fractures.

Answer 13

Casts
Braces
Splints
Traction

Question 14

What are the two groups of operations for paed fractures?

Answer 14

Internal or external fixation

Question 15

Why do the majority of children’s fracture require simple treatment?

Answer 15

They tend to remodel themselves

Question 16

What type of bone growth occurs at the epiphyseal growth plate?

Answer 16

Longitudinal growth

Question 17

What is one type of children’s fracture that will usually require intervention, usually traction?

Answer 17

Femoral fracture as if they are oblique or spiral, they tend to shorten down the muscle attached (hamstrings and quads)

Question 18

Do children’s fractures usually require physio after the healing process?

Answer 18

Not usually, particularly in the upper limb
Elbow fractures will often require physio

Question 19

If there is an open fracture, what is there risk of?

Answer 19

Infection

Question 20

How are open fractures treated?

Answer 20

Debridement

->the removal of sequestrate and resection of infected bone and soft tissue to improve the healing potential of the remaining healthy tissue

Question 21

Which part of the bone carries out the reduction of a fracture?

Answer 21

Periosteum

Question 22

Give some situations when the cast will need supplementing with fixation for children’s fractures.

Answer 22

Severe swelling likely
Need to re-inspect the wound e.g. open fractures
Multiple injuries
Segmental limb injuries
Fracture very unstable
Approaching skeletal maturity

Question 23

At approximately what age do girls stop growing?

Answer 23

14

Question 24

At approximately what age do boys stop gorwing?

Answer 24

16

Question 25

Physeal fractures?

Answer 25

Growth plate fractures Often the weakest part of the bone

Question 26

What is the problem with physeal/growth plate fractures?

Answer 26

There is a risk of growth arrest

Question 27

Which classification helps to predict injuries which may affect growth?

Answer 27

Salter-Harris Classification ->SH type 3 + 4 injuries are at a much higher risk of growth disturbances, especially in lower limb

Question 28

If a child jumped out of a window and landed on their lower limb but did not have nay immediate injury, what could happen in the future?

Answer 28

There may be compression of the growth plate so may mean no further growth

Question 29

If there is a Salter-Harris type 3 injury, what is required?

Answer 29

Need for anatomical reduction and fixation if the fracture is displaced

Question 30

Apophysis?

Answer 30

Point where tendon inserts into bone

Question 31

Who is more likely to get a transitional fracture?

Answer 31

Ages 13-14 when the growth plates are closing

Question 32

Which order do the different parts of the growth plates close?

Answer 32

Central > Medial > Lateral fusion

Question 33

Describe what happens in a tillaux fracture.

Answer 33

Ligament connecting tibia and fibula is stronger than the actual bones in children so twisting movement can tear off part of the growth plate and growth arrest can occur. ->In adults, the ligament would tear instead but this ligament stronger than the bone in children

Question 34

External fixation as a surgical option is rarely required. ORIF- open reduction and internal fixation- is indicated more often. What are some of the indications of ORIF surgery?

Answer 34

Adolescents Comminuted fractures (broken in two places) Injuries involving the joint surface Monteggia and Galeazzi fractures (fractures to radius and ulna)

Question 35

Before carrying out flexible nailing for fracture treatment, what needs to be made sure?

Answer 35

That the patient has at least 2 years of predicted growth remaining

Question 36

NAI?

Answer 36

Non-accidental injuries ->adult deliberately hurting a child, but often as a result of neglect or individuals with responsibility not knowing how to look after a child properly

Question 37

Warnings of a NAI?

Answer 37

Inconsistent history Delay in presentation Fracture pattern not fitting mechanism Bruising- pattern and different ages Burns Multiple fractures at multiple stages of healing

Question 38

List some specific # sites which are warnings of NAIs.

Answer 38

Metaphyseal # Humeral shaft # Ribs #s Non-ambulant with long bone #

Question 39

Where does acute osteomyelitis usually occur in children?

Answer 39

Around the knee

Question 40

Osteomyelitis?

Answer 40

Infection of bone

Question 41

What do most cases of acute osteomyelitis require?

Answer 41

Prolonged high dose antibiotics, aim to prevent turning chronic

Question 42

Osteomyelitis has an insidious onset- what does this mean?

Answer 42

A condition which comes on slowly and does not have symptoms at first ->frequently, children will fall and injure themselves and be fine but will develop symptoms a couple of days later e.g. pain. Then the child develops systemic symptoms.

Question 43

What is the most common causative microorganism of acute osteomyelitis?

Answer 43

Staph aureus

Question 44

What can osteomyelitis then become?

Answer 44

Septic arthritis if abscess which has burst into a joint

Question 45

What is usually done in patients with acute osteomyelitis prior to commencing the high dose antibiotics?

Answer 45

Blood cultures

Question 46

Infection does not require surgery if caught early enough. If the child does not settle however, what needs to be done?

Answer 46

Decompression of periosteum using intraosseous needles to supply fluid to bone ->note that osteomyelitis can threaten life and limb