Paediatric Trauma Flashcards
epidemiology
boys
upper limb
most common
describe childrens bones and pattern of fractures
more elastic and pliable - tend to buckle or partially fracture/splinter with some degree of continuity of fibres
greater potential to remodel
why do childrens bones heal quicker than adults
thicker periosteum - rich source of osteoblasts
it also tends to remain intact, which can help stability and assist reduction
Wolff’s Law
healthy bone will change shape (adapt) along areas of stress
how many degrees of angulation can childrens bones correct
10 degrees per year
in general how are childrens fractures managed
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
when to childs fractures start to be treated like adults
puberty - remodelling potential is less
fractures around physis
(growth plate)
potential to disturb growth - can cause shortened limb or angular deformity
how does growth plate appear on x ray
lucency between metaphysis and epiphysis
may look like a fracture
salter harris classification
used to grade growth plate fractures
prognosis is poorer as classification increases
describe salter harris classification types
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
what is the most common type of salter harris injury
2
features that should raise suspicion of a NAI
- 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
buckle fractures
one side of bone buckles on itself without disrupting the other side
stable, 3-4 weeks splintage
greenstick fracture
bone bends and breaks with continuity of some fibres
manipulation and casting if there is significant deformity
where do salter harris II fractures commonly occur
around distal radial physis
is dorsal or volar displacement more common
dorsal
treatment for monteggia and galeazzi
ORIF
high rate of redislocation of radial head or DRUJ if only manipulation and casting used
what usually causes supracondylar fracture of elbow
extension injury, less commonly flexion
how are supracondylar fractures of the elbow managed
undisplaced - stable, splint
angulated/rotated/displaced - closed reduction and pinning with wires to prevent deformity
in supracondylar fractures of the elbow what nerve is at risk of injury
median
what does ongoing neuralgic pain after fracture indicate
entrapment of nerve
femoral shaft fractures in children <2
more than half are NAI
treat with gallows traction andn early hip spica cast
gallows traction
femoral shaft fractures in children <2
good for suspected NAI
children can better tolerate immobility than adults
early hip spica cast
femoral shaft fracture: 2-6y
thomas splint or hip spica cast
femoral shaft fracture: 6 and 12
flexible IM nails
femoral shaft fracture: >12
adult IM nail
what type of tibial shaft fractures are common in toddlers
undisplaced spiral fractures - short time in cast
what is the mainstay of treatment of childrens tibial fractures
management in cast
which salter harris fractures are intra articular
III and IV
