Paediatric Trauma

Question 1

epidemiology

Answer 1

boys

upper limb

most common

Question 2

describe childrens bones and pattern of fractures

Answer 2

more elastic and pliable - tend to buckle or partially fracture/splinter with some degree of continuity of fibres

greater potential to remodel

Question 3

why do childrens bones heal quicker than adults

Answer 3

thicker periosteum - rich source of osteoblasts

it also tends to remain intact, which can help stability and assist reduction

Question 4

Wolff’s Law

Answer 4

healthy bone will change shape (adapt) along areas of stress

Question 5

how many degrees of angulation can childrens bones correct

Answer 5

10 degrees per year

Question 6

in general how are childrens fractures managed

Answer 6

surgically stabilised less frequently, and a greater degree of angulation/deformity can be accepted

if fracture position is unacceptable - manipulation and casting may be adequate

less invasive surgery if necesary

Question 7

when to childs fractures start to be treated like adults

Answer 7

puberty - remodelling potential is less

Question 8

fractures around physis

Answer 8

(growth plate)

potential to disturb growth - can cause shortened limb or angular deformity

Question 9

how does growth plate appear on x ray

Answer 9

lucency between metaphysis and epiphysis

may look like a fracture

Question 10

salter harris classification

Answer 10

used to grade growth plate fractures

prognosis is poorer as classification increases

Question 11

describe salter harris classification types

Answer 11

1 - pure physeal separation. best prognosis and least likely to cause growth deformity

2 - small metaphyseal fragment attached to physis and epiphysis

3 and 4 - intra-articular with splitting of physis. reduced and stabilised to minimise growth disturbance and ensure congruent articular surface

5 - compression injury into physis with subsequent growth arrest. cannot be diagnosed on x ray and only detected when angular deformity has occurred

Question 12

what is the most common type of salter harris injury

Answer 12

2

Question 13

features that should raise suspicion of a NAI

Answer 13

• Inconsistent / changing history of events
• Discrepancy of history between parents / carers
• History not consistent with injury
• Injuries not consistent with age of child e.g. non-walking child
• Multiple bruises of varying ages
  
  • Atypical injuries e.g. cigarette burns, genital injuries, torn frenulum, dental injuries, lower limb and trunk burns
• Rib fractures
• Metaphyseal fractures in infants

Question 14

buckle fractures

Answer 14

one side of bone buckles on itself without disrupting the other side

stable, 3-4 weeks splintage

Question 15

greenstick fracture

Answer 15

bone bends and breaks with continuity of some fibres

manipulation and casting if there is significant deformity

Question 16

where do salter harris II fractures commonly occur

Answer 16

around distal radial physis

Question 17

is dorsal or volar displacement more common

Answer 17

dorsal

Question 18

treatment for monteggia and galeazzi

Answer 18

ORIF

high rate of redislocation of radial head or DRUJ if only manipulation and casting used

Question 19

what usually causes supracondylar fracture of elbow

Answer 19

extension injury, less commonly flexion

Question 20

how are supracondylar fractures of the elbow managed

Answer 20

undisplaced - stable, splint

angulated/rotated/displaced - closed reduction and pinning with wires to prevent deformity

Question 21

in supracondylar fractures of the elbow what nerve is at risk of injury

Answer 21

median

Question 22

what does ongoing neuralgic pain after fracture indicate

Answer 22

entrapment of nerve

Question 23

femoral shaft fractures in children <2

Answer 23

more than half are NAI

treat with gallows traction andn early hip spica cast

Question 24

gallows traction

Answer 24

femoral shaft fractures in children <2

good for suspected NAI

children can better tolerate immobility than adults

Question 25

Answer 25

early hip spica cast

Question 26

femoral shaft fracture: 2-6y

Answer 26

thomas splint or hip spica cast

Question 27

femoral shaft fracture: 6 and 12

Answer 27

flexible IM nails

Question 28

femoral shaft fracture: >12

Answer 28

adult IM nail

Question 29

what type of tibial shaft fractures are common in toddlers

Answer 29

undisplaced spiral fractures - short time in cast

Question 30

what is the mainstay of treatment of childrens tibial fractures

Answer 30

management in cast

Question 31

which salter harris fractures are intra articular

Answer 31

III and IV