Paediatric Trauma Flashcards
Commonest cause of death in children
Trauma
Are paediatric fractures more likely to be complete or incomplete
Incomplete
What is a possible outcome of a fracture involving physes
Progressive deformity
If a fracture at the physes occurs at the elbow, knee+ ankle or femur what is the result
- Elbow = Deformity
- Knee + ankle = Arrest
- Femur = Overgrowth
How common are forearm fracture in paediatrics
25-50% of all paediatric fractures
Outcome of low energy impact on paediatric forearm
- Buckle
- Greenstick
Outcome of high energy impact on paediatric forearm
- Open
- Displaced
- Soft tissue injury
How to assess a possible fracture
-Hx (mechanism)
-Deformity
-Soft tissues
Whole limb
Wounds
Sensation, motor function
Vascular status
-Re-assess post-intervention
Surgical indications
- Open#
- Segmental
- NV compromise
- Fail closed Rx
Principles of closed management
- Analgesia/anaesthesia
- Reduce
- Check radiographs week 1, 2 & 4
- Change loose casts
- Remove when callus evident
2 types of surgical treatments of fractures
- External fixator (rare, soft tissues issues)
- ORIF
When to use flexible nailing
- Needs 2yrs predicted growth remaining
- Allow early ROM
Where do greenstick, buckle + “bayonet” off ended fractures occur
Wrist (distal radius)
Management of buckle + greenstick fractures
- Buckle = Cast 3-4 weeks
- Greenstick = Cast 4-6 weeks
Knee trauma DDx
- Infection
- Inflammatory arthropathy
- Neoplasm
- Apophysitis
- Sickle cell, haemophilia
6 types of bony knee injury
- Physeal/Metaphyseal
- Tibial spine
- Tibial tubercle
- Patellar fracture
- Sleeve fracture
- Patellar dislocation
Rx of physeal injury
- Cast + immobilise
- Percutaneous fix
- ORIF articular displacement
- ROM early
3 types of tibial spine injury
- Undisplaced (II)
- Hinged (II)
- Displace (III)
Rx of undisplaced + hinged tibial spine fracture
Long leg cast
Rx of hinged + displaced tibial spine fracture
ORIF/AxIF
Rx of a patellar fracture
- Undisplaced = Cylindrical cast
- Displaced = ORIF
Rx of patellar dislocation
- Cast 2 weeks
- Mobilise
- VMO exercises
- Repair medial ligament
- Medialise tibial tubercle
How to assess a possible ankle fracture
- Hx (mechanism)
- Deformity
- Soft tissues
- AP & Lateral radiographs (Ottawa rules)
What are the Ottawa rules
Guidelines used to decide if a patient with foot/ankle pain should be offered X-rays to diagnose a possible fracture
For ankle
-There is any pain in the malleolar zone
AND 1 of the following:
-Bone tenderness along the distal 6cm of the posterior edge of the tibia/fibula or tip of the medial/lateral malleolus,
-Inability to bear weight both immediately and in the ED for four steps
Growth plate of ankle closes at what age
13-14yrs
2 overuse injuries
- Osgood-schlatter’s disease
- Sever’s disease
Cause of Osgood-schlatter’s and sever’s disease
- Osgood-schlatter’s disease = Inflammation of the patellar ligament at the tibial tuberosity
- Sever’s disease = Growth plate inflammation of the calcaneus
Common presentation of Osgood-schlatter’s disease
Characterized by a painful lump just below the knee and is most often seen in young adolescents
