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Systems: MSK AB > Paediatric Trauma > Flashcards

Paediatric Trauma Flashcards

1
Q

What is the commonest cause of death in children?

A

Trauma

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2
Q

What types of trauma can children be involved in?

A
  • Transport
  • Assault
  • Falls, electrical shocks, drowning
  • Other
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3
Q

What are the risk factors for paediatric trauma?

A
  • Boys> girls
  • Age
  • Increased physeal injury with age
  • Previous fractures
  • Metabolic bone idsease
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4
Q

What are the principles regarding children’s fractures?

A
  • They are often simple, incomplete and heal quickly
  • Remodel well in plane of joint movement
  • A thick periosteal hinge is a friend
  • Fractures involving physes can result in progressive deformity
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5
Q

Why do children’s bones heal quickly?

A
  • Metabolically active periosteum
  • Cellular bone
  • Plastic
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6
Q

What should be noted due to fact children’s fractures heal quickly?

A
  • Fixation is usually not required
  • Do not over immobilise
  • Do not over treat
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7
Q

Why do children’s fractures remodel well in the plane of joint movement?

A
  • Appositional periosteal growth/resorption

- Differential physeal growth

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8
Q

In what cases do fractures remodel particularly well in the plane of joint movement?

A
  • Younger children
  • Polar fractures
  • Intact growing physis
  • Sagittal> frontal> X transverse
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9
Q

Where does deformity often occur?

A

Elbow

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10
Q

Where does bone arrest often occur?

A
  • Knee

- Ankle

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11
Q

Where does bone overgrowth often occur?

A

Femur

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12
Q

Give examples of fractures which can occur in the forearm.

A

Shaft fractures
-Can involve the shaft of the radius or ulna

Galeazzi
-Fracture of radius due to stress on ulna

Monteggia
-Fracture of the ulna due to stress on the radius

Distal radius fractures
-Fracture can include styloid process

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13
Q

What is the epidemiology of forearm fractures?

A
  • 25-50% of paediatric fractures
  • 80% occur at the wrist
  • Low energy including buckle and greenstick
  • High energy including open, displaced and soft tissue injury
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14
Q

How are trauma injuries assessed?

A

History
-Mechanism

Deformity

Soft tissues

  • Whole limb
  • Wounds
  • Sensation and motor function
  • Vascular status

Document findings and repeat post- intervention

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15
Q

What are the possible complications of forearm fractures?

A
  • Compartment syndrome
  • 5% non-union
  • 5% refracture
  • Radioulnar synostosis (proximal> distal, high energy, same level, single incision)
  • PIN injury
  • Superficial radial nerve injury
  • DRUJ/ radiocapiellar problems
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16
Q

Buckle fracture

A

Failure of 1 cortex in compression

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17
Q

Greenstick fracture

A

Failure of 1 cortex, other cortex in extension

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18
Q

How are fractures managed?

A

Buckle
-Cast 3-4 weeks

Greenstick
-Cast 4-6 weeks

Complete
-Cast +/-KW 6 weeks

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19
Q

What is the differential of knee trauma?

A
  • Infection
  • Inflammatory arthropathy
  • Neoplasm
  • Apophysitis
  • Hip problem
  • Foot problem
  • Sickle cell, haemophilia
  • ‘Anterior knee pain’
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20
Q

Where can bone injury occur with knee pain?

A
  • Physeal/metaphyseal
  • Tibial spine
  • Tibial tubercle
  • Patellar fracture
  • Sleeve fracture
  • Patellar dislocation
  • Referred
21
Q

Why do physeal injuries occur 2: 1 femeu: tibia?

A

Capsule and ligaments

  • Distal femur below physis
  • Proximal tibia below physis

Growth

  • 11mm/year femur
  • 6mm/year tibia
22
Q

What are possible complications of physeal injury?

A
  • Hyperextension can lead to vascular injury

- Varus can lead to common peroneal nerve injury

23
Q

What is the treatment for physeal injury?

A
  • Cast immobilisation
  • Percutaneous fix
  • ORIF articular displacement
  • ROM early <6/52
24
Q

How is physeal arrest monitored?

A

Monitor

  • Harris lines
  • Angulation and length
25
Q

How is physeal arrest treated?

A
  • Resect bar
  • Complete epiphysiodesis
  • Contralateral epiphysiodesis
  • Corrective osetotomy
26
Q

What does the tibial spine overlap?

A

Anterior cruciate ligament

27
Q

How are fractures of the tibial spine classified?

A

Meyers and McKeever

  • I undisplaced
  • II hinged
  • III displaced
28
Q

What is the treatment for tibial spine fractures?

A
  • Undisplaced or hinged= long leg cast

- Hinged or displaced= ORIF/AxIF

29
Q

How are tibial tubercle fractures classified?

A

Ogden

  • I distal avulsion
  • II to proximal tibial physis (not joint)
  • III to proximal tibial physis (into joint)
30
Q

Why are patellar fractures rare?

A

Cartilaginous until age 4

31
Q

How are patellar fractures treated?

A
  • Sleeve fracture
  • Undisplaced= cylinder cast
  • Displaced= ORIF
32
Q

What are the risk factors for patellar dislocation?

A
  • Laxity
  • Poor VMO
  • Q angle
  • Femoral anteversion
  • Tibial external rotation
  • Patella alta
33
Q

How are patellar dislocations managed?

A
  • Cast 2/52
  • Mobilise
  • VMO exercises
34
Q

How should osteochondral lesions be managed?

A
  • Single traumatic incident or developmental?
  • Plain films +/- MRI
  • Type 1 (cartilaginous)= immobilise
  • Type 2 (flap) and 3 (fragment)= drilling/fix
35
Q

Anterior knee pain is a diagnosis of…

A

Exclusion

36
Q

What is the epidemiology of ankle injuries?

A

–5% of all children’s fractures
–17% of physeal injuries
–6mm growth p.a. distal tib & fib

37
Q

What are the features of ankle fractures?

A

-Physis as plane of fracture
-Physis weaker than Ligaments
Growth arrest risk

38
Q

How are ankle injuries assessed?

A
  • History (Mechanism)
  • Deformity
  • Soft tissues
  • AP & lateral radiographs (Ottawa rules)
39
Q

How are ankle SH1 injuries managed?

A

-Displaced <3mm: POP 6

–Displaced >3mm: MUA,POP 6

40
Q

How does the growth plate close in the ankle?

A
  • Age 13-14 years
  • Central> medial> lateral fusion
  • Articular congruity over physeal integrity
41
Q

What are the features of a tillaux fracture?

A
  • External rotation
  • Anterior tibiofibular ligament avulsion
  • SH3
  • Closed/open reduction
42
Q

What are the features of ankle SH2 injuries?

A
  • Commonest
  • Displaced <3mm: POP 4+2
  • Displaced >3mm:MUA,POP
  • Pitfall: Persistent displacment
43
Q

What are the features of ankle SH3 injuries?

A
  • Supination inversion
  • Epiphyseal fgt medial
  • Undisplaced: POP6
  • Displace: (Open) reduction and interfrag screw
44
Q

What are the features of ankle SH4 injuries?

A
  • Rare
  • Managed by ORIF
  • Monitor for growth arrest
45
Q

What are the features of triplane ankle fractures?

A
  • External rotation
  • SH3 on AP +SH2 on lateral= SH4
  • 2-3-4 part
  • CT, ORIF
46
Q

Give examples of overuse injuries of the lower limb.

A
  • Osgood Schlatter’s disease

- Sever’s disease

47
Q

In what way can children’s bones be friends?

A
  • Physis: remodelling
  • Bone: simple fractures, quick heal
  • Periosteum: hinge
  • Ligaments: protect joint
  • Cartilage: resilient
48
Q

In what way can children’s bones be foe?

A
  • Physis: slip, arrest and overgrowth
  • Bone: plastic deformity
  • Periosteum: block reduction
  • Ligaments: fracture physis
  • Cartilage: imaging
49
Q

What are the warning signs of non-accidental injury?

A
  • Incongruent history
  • Bruising: patterns
  • Burns
  • Multiple fractures, multiple stages of healing
  • Metaphyseal fractures and humeral shaft fractures
  • Rib fractures
  • Non-ambulant fractures

Systems: MSK AB (43 decks)

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