Paediatric Trauma Flashcards
how do childrens bones differ to adult bones?
more elastic and palpable and tend to buckle or partially fracture/splinter rather than break completely
thicker periosteum and tends to remain intact
how does the thicker periosteum affect fracture healing in children?
tends to remain intact which can help stability
rich source of osteoblasts in periosteum means fractures heal faster
how do children bones have a greater remodelling potential?
as they grow with bone being formed along the line of stress
- can correct angulation up to 10 degrees per year
how do childrens fractures differ from adult fractures in terms of management?
tend not to need surgical stabilization as often - and less invasive temporary pins wires etc used when it is needed
greater degrees of angulation and displacement can be accepted
if unstable - manipulation and cast often enough
plates and screws rarely used, only in some very unstable fractures
why are childrens fractures more easily managed?
greater remodelling potential
at what age are fractures treated as “adult fractures”?
once puberty reached
- usually 12-14
why are fractures of the physis (growth plate) potentially difficult?
can disturb growth resulting in a shortened limb or angular deformity if only one side of the growth plate effected
how are physeal fractures classified?
salter harris classification
types of physeal fractures?
salter harris 1 = pure physeal separation
salter harris 2 = most common, fracture extends into metaphysis
salter harris 3 = fracture extends down from physis through epiphysis
salter harris 4 = down through metaphysis, growth plate and epiphysis
salter harris 5 = compression injury to they physis with subsequent growth arrest
features of non accidental injury?
multiple fractures at various stages of healing inconsistent story/history injuries not in line with age - i.e non walking child multiple bruises of varying age atypical injuries - cigarette burns etc trunk burns rib fractures metaphyseal fractures
name 3 common distal radial fractures which occur in children
buckle fractures
greenstick
salter harris 2 (distal radius physis)
how is a buckle fracture of the distal radius managed?
usually require only 3-4 weeks splintage
how are greenstick fractures of the distal radius managed?
may need manipulation and casting if significant deformity - particularly in older child
how are salter harris 2 fractures of distal radius physis managed?
manipulation if angulation/deformity
in which direction are distal radial fracture more likely to displace?
dorsally
what prevents overcorrection of dorsal displaced fracture?
dorsal periosteum remains intact
- also aids stability
stable distal radius fracture management?
casting
unstable distal radial fracture management?
wire stabilization or plate fixation
name 2 common forearm fractures which go against the usual principles of childrens fractures, how are they managed instead?
monteggia and galeazzi fractures
anatomic reduction and rigid fixation with plates and screws as redislocation is common if casting is used
how are fractures of both bones of the forearm usually managed and why?
manipulation and casting if instability only in one plane
flexible intramedullary nail if displaced and unstable
what commonly causes supracondylar fractures?
extension - FOOSH = most common
flexion - fall onto point of flexed elbow = less common
how are undisplaced supracondylar fractures managed?
splint
how are angulated, rotated or displaced fractures managed?
require closed reduction and pinning with wires
when is open reduction used in supracondylar fracture?
severely displaced/off ended fractures where brachialis is tethered
how does an off ended extension type fracture commonly displace and what are the risks of this?
posteriorly
stretch and pressure on median nerve and brachial artery (cant make “OK” sign)
when is emergency surgery required for supracondylar fracture?
if radial pulse is absent or reduced in volume
in presence of a nerve injury
types of emergency surgery for supracondylar fracture?
closed reduction with wiring
if pulse doesn’t return - open reduction
how is nerve injury after a supracondylar fracture managed?
urgent theatre management
most improve with time
ongoing neuralgic pain or no improvement suggests entrapment which may need surgical release
what commonly causes femoral shaft fractures in children?
fall onto flexed knee
indirect bending or rotational forces
why does shortening sometimes occur in femoral shaft fractures in children?
overgrowth tends to occur after fracture healing
what is the most common cause of femoral shaft fracture in children less then 2 yrs?
NAI
management of femoral shaft fracture in <2s?
gallows traction and early hip spica
management of femoral shaft fracture in ages 2-6?
Thomas splint
or
hip spica cast
femoral shaft fracture management in ages 6-12?
flexible intramedullary nail
femoral shaft fracture management in ages 12+?
adult type intramedullary nail
what is a toddlers fracture and how is it managed?
undisplaced spiral fracture of the tibial shaft, commonly seen in toddlers
treatment = short time in cast
mainstay of treatment for most tibial fractures in children?
casting
serial X rays while in the cast
what can and cannot be accepted in tibial fracture in children?
acceptable = up to 10 degrees angulation unacceptable = >10 degrees angulation, shortening, malrotation
options for stabilizing very unstable or open fractures of tibia?
intramedullary nails
plates and screws
external fixation
adult type intramedullary nail in adolescents with closed proximal tibial physis
