Paediatric Trauma Flashcards
What kind of fracture patterns are seen in children’s bones?
Why is this the case?
Children’s bones are more elastic and pliable, so rather than snapping completely the tend to buckle and split
These take the appearance of greenstick and buckle fractures
What is Wollf’s law, in relation to development of child bone?
Wollf’s law is the formation of new bone along lines of stress
” bone in a healthy person or animal will adapt to the loads under which it is placed. If loading on a particular bone increases, the bone will remodel itself over time to become stronger to resist that sort of loading”
What degree of angulation can children’s bones correct for per year?
How does this affect management of paediatric fractures?
Up to 10 degrees of angulation per year
Children’s bones tend to be manipulated and casted a lot more often as there is little need for surgical stabilisaiton
Fractures around what area of bone cause more concern when they occur in children?
Fractures around growth plates (physes)
Damage to growth plates could result in disturbed growth, shortened limbs or angular deformity
What classification system is used to assess fractures involving growth plates?
How does prognosis vary with grade?
Salter-Harris classification
Higher the classification, the worse the prognosis
S - straight through
A - above
L - low or below
T - two or through
ER - erasure of growth plate/crush
Which Salter Harris Grades have the best prognosis?
What do they appear as?
I and II have the best prognosis
I = pure physeal separation
II = same as I, but has a small metaphyseal fragment attached to the growth plate
Which Salter Harris grades are intra-articular?
What’s the prognosis and how should they be managed?
Grades III and IV
Fracture has split the growth plate = greater likelihood of growth abnormality
These fractures need to be reduced and stabilised
Why are Salter Harris grade 5s concerning?
Can’t be diagnosed on initial Xray - only detected once angular deformity has occurred
What signs would raise suspicion of non-accidental injury?
Inconsistent/changing/discrepancy in history
History not conistent with injury
Injuries not consistent with age of child
Multiple bruises of varying ages
Atypical injuries
Rib fractures
Metaphyseal fractures in infants
What fractures are common in a child’s distal radius?
Buckle
Greenstick
Salter Harris II
What fractures are common in a child’s forearm?
Monteggia and Galeazzi
(Unlike most other fractures in children, these are still treated with ORIF
What are “toddler’s fractures”?
Undisplaced spiral fractures of the tibia - particularly common in toddlers
At what age and above are children’s fractures generally treated as if they were in adults?
Age 12
Femoral shaft fractures in what age group is of particular concern?
What is commonly the cause?
Children under 2 - NAI is the cause in over 50% of cases
