Paediatric Trauma Flashcards
Risk factors for paediatric fractures?
Boys > girls (60:40%)
Age
Previous fractures
Metabolic bone disease
Season- usually summertime because off school, longer periods of day light
Why does childrens bone heal quicker than adults?
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
Complete fractures tend to occur more in adults. Which three types of fracture are only seen in children?
Greenstick fracture
Buckle fracture
Plastic deformation
Greenstick fracture?
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
Greenstick fractures tend to re-displace but only when?
All forces on them are taken off
Buckle fracture?
Usually due to longitudinal compression
What is seen on x-ray of a buckle fracture?
Slight concavity of the bone where the cortex has been compressed
Management of buckle fracture?
Simple splintage for a short period of time
Where are plastic deformability’s most commonly seen?
Forearm
What happens in plastic deformaility?
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
Plastic deformity injuries are rare.
What characteristics do we need to be aware of?
-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
Do most fractures in children require conservative or operative management?
95% of fractures only require conservative management
List some of the conservative treatment measures for paediatric fractures.
Casts
Braces
Splints
Traction
What are the two groups of operations for paed fractures?
Internal or external fixation
Why do the majority of children’s fracture require simple treatment?
They tend to remodel themselves
What type of bone growth occurs at the epiphyseal growth plate?
Longitudinal growth
What is one type of children’s fracture that will usually require intervention, usually traction?
Femoral fracture as if they are oblique or spiral, they tend to shorten down the muscle attached (hamstrings and quads)
Do children’s fractures usually require physio after the healing process?
Not usually, particularly in the upper limb
Elbow fractures will often require physio
If there is an open fracture, what is there risk of?
Infection
How are open fractures treated?
Debridement
->the removal of sequestrate and resection of infected bone and soft tissue to improve the healing potential of the remaining healthy tissue
Which part of the bone carries out the reduction of a fracture?
Periosteum
Give some situations when the cast will need supplementing with fixation for children’s fractures.
Severe swelling likely
Need to re-inspect the wound e.g. open fractures
Multiple injuries
Segmental limb injuries
Fracture very unstable
Approaching skeletal maturity
At approximately what age do girls stop growing?
14
At approximately what age do boys stop gorwing?
16
Physeal fractures?
Growth plate fractures
Often the weakest part of the bone
What is the problem with physeal/growth plate fractures?
There is a risk of growth arrest
Which classification helps to predict injuries which may affect growth?
Salter-Harris Classification
->SH type 3 + 4 injuries are at a much higher risk of growth disturbances, especially in lower limb
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?
There may be compression of the growth plate so may mean no further growth
If there is a Salter-Harris type 3 injury, what is required?
Need for anatomical reduction and fixation if the fracture is displaced
Apophysis?
Point where tendon inserts into bone
Who is more likely to get a transitional fracture?
Ages 13-14 when the growth plates are closing
Which order do the different parts of the growth plates close?
Central > Medial > Lateral fusion
Describe what happens in a tillaux fracture.
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
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?
Adolescents
Comminuted fractures (broken in two places)
Injuries involving the joint surface
Monteggia and Galeazzi fractures (fractures to radius and ulna)
Before carrying out flexible nailing for fracture treatment, what needs to be made sure?
That the patient has at least 2 years of predicted growth remaining
NAI?
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
Warnings of a NAI?
Inconsistent history
Delay in presentation
Fracture pattern not fitting mechanism
Bruising- pattern and different ages
Burns
Multiple fractures at multiple stages of healing
List some specific # sites which are warnings of NAIs.
Metaphyseal #
Humeral shaft #
Ribs #s
Non-ambulant with long bone #
Where does acute osteomyelitis usually occur in children?
Around the knee
Osteomyelitis?
Infection of bone
What do most cases of acute osteomyelitis require?
Prolonged high dose antibiotics, aim to prevent turning chronic
Osteomyelitis has an insidious onset- what does this mean?
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.
What is the most common causative microorganism of acute osteomyelitis?
Staph aureus
What can osteomyelitis then become?
Septic arthritis if abscess which has burst into a joint
What is usually done in patients with acute osteomyelitis prior to commencing the high dose antibiotics?
Blood cultures
Infection does not require surgery if caught early enough. If the child does not settle however, what needs to be done?
Decompression of periosteum using intraosseous needles to supply fluid to bone
->note that osteomyelitis can threaten life and limb
