Paediatric trauma

Question 1

what are the risk factors for paediatric fractures

Answer 1

• being a boy
• previous fracture
• metabolic bone disease
• age

Question 2

what are the possible outcomes for a fracture of the physeal plate

Answer 2

• growth arrest
• abnormal growth
• deformity

Question 3

what is a Galeazzi fracture

Answer 3

this is a fracture in the distal 1/3rd of the radius, a dislocated distal radio-ulnar joint but an intact ulnar bone

Question 4

what is a Monteggia fracture

Answer 4

this is a fracture of the proximal 1/3rd of the ulnar bone that result in the dislocation of the proximal radial head

Question 5

how are most fractures treated

Answer 5

most fractures are treated using casts but open surgery many be needed to manage some (e.g. to restore normal anatomy, to repair nerve or muscle injury or if there is delayed union)

Question 6

what is meant by ORIF

Answer 6

Open reduction and internal fixation

Question 7

what is flexible nailing and when is it used

Answer 7

this can only be used if there is at least 2 years of bone growth left - the wires are removed when the bones have healed

Question 8

what are the complications of fracture in children

Answer 8

• non-union
• refracture
• radioulnar stenosis
• radial nerve injury/nerve injury
• compartment syndrome

Question 9

what is compartment syndrome

Answer 9

when there is an excessive pressure build up in a closes muscle compartment in the body and this restricts the blood supply to this compartment

Question 10

what is radio-ulnar stenosis

Answer 10

this is when there is an abnormal bony or soft tissue connection between the radius and the ulnar bone in the forearm

Question 11

what is a buckle Torus fracture

Answer 11

this is the incomplete fracture of a shaft in a long bone - it will look like a small bump on the bone and it is more common in children due to the elasticity of the bones

Question 12

what is a greenstick fracture

Answer 12

this is a fracture of the long bone - looks like a stick snapped in two - this is more common in infants due to the softness and the elasticity of the bones

Question 13

what is a bayonet fracture

Answer 13

this is when there is a complete break in the distal radius that displaces the wrist and hand posteriorly

Question 14

what is the growth rate of the femur per year

Answer 14

11mm/y

Question 15

what is the growth rate of the tibia per year

Answer 15

6mm/y

Question 16

what type of injury can result in damage to the common peroneal nerve

Answer 16

varus injury of the knee

Question 17

how are physeal injuries managed

Answer 17

• complete epiphysidesis
• contralateral epiphysidesis
• corrective osteotomy
• resect bar

Question 18

what is meant by epiphysediesis

Answer 18

this is when there is a temporary or permanent fusion of the growth plate to prevent growth - usually done on the health bone so that the damaged bone can catch up

Question 19

how are tibial spine fractures treated

Answer 19

type I and type II are treated using long leg casts and type III are corrected using ORIF

Question 20

how are patellar fractures treated

Answer 20

displaced ones are treated using ORIF and non-displaced ones are treated using cylinder casts

Question 21

what are the risk factors for patella dislocation

Answer 21

• weak vastus medialus
• Q angle
• external rotation of the tibia
• laxity/looseness of the knee joint

Question 22

what classification system is used for ankle fractures

Answer 22

Salter-Harris grading - the higher the grade, the higher the risk of growth arrest

Question 23

what is Osgood-Schlatter’s disease

Answer 23

this is inflammation of the patellar tendon at the point which it inserts onto the tibial tuberosity

Question 24

who does Osgood-Schlatter’s usually affect

Answer 24

those children that do a lot of running and jumping (boys between 10-15)

Question 25

what is the management of Osgood-Schlatter’s

Answer 25

stretching and strengthening the muscles, cold to the affected area, NSAIDs and ibuprofen

Question 26

what is Sever’s disease

Answer 26

this is when there is inflammation in the growth plate of the calcaneus bone