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Year 3 > Paediatric Trauma > Flashcards

Paediatric Trauma Flashcards

1
Q

risk factors for paediatric trauma

A 
boys 60%, girls 40%
age
increased physeal injury with age
previous fracture
metabolic bone disease
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2
Q

list the children’s fracture principles

A
  1. children fractures are often simple, incomplete and heal quickly
  2. remodel well in plane of joint movement
  3. a thick periosteal hinge is (usually) a friend but needs to be understood
  4. fractures involving physes can result in progressive deformity
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3
Q

children’s fracture principles: simple, incomplete, heal quickly

A

metabolically active periosteum
cellular bone
plastic
applicaton: fixation not usually required, do not over mobilise, do not over treat

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4
Q

children’s fracture principles: remodel

A

appositional periosteal growth/resorption
differential physeal growth
application: younger child, polar fractures, intact growing physis, sagital > frontal X transverse

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5
Q

children’s fracture principles: progressive deformity

A

demority - elbow
arrest - knee, ankle
overgrowth - femur

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6
Q

low energy forearm injuries kids

A

buckle

greenstick

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7
Q

high energy forearm injuries kids

A

open
displaced
soft tissue injury

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8
Q

complications of forearm injuries kids

A 
o Compartment syndrome – Volkmann’s
o 5% non-union
o 5% refracture
o Radioulnar synostosis
§ Proximal > distal
§ High energy, same level
§ Single incision
o PIN injury
o Superficial radial nerve injury
o DRUJ/radiocapitellar problems
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9
Q

distal radius fractures kids

A 
o Buckle, Torus
§ Failure of 1 cortex in
compression
o Greenstick
§ Failure of 1 cortex in compression, other cortex in
extension
o Bayonet, offended
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10
Q

management of distal radius fractures kids

A 
o Buckle – cast 3-4 weeks ?
o Greenstick – cast 4-6 weeks
o Complete – cast +/- KW 6 weeks
o Risk for remanipulation
§ Complete fractures
§ Failed anatomic reduction
§ NOT B/E pop
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11
Q

what is a Galeazzi fracture?

A

fracture of the distal 1/3 of the radius with dislocation of the distal radioulnar joint

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12
Q

what is a monteggia fracture?

A

fracture of the proximal 1/3 of the ulna with dislocation of the proximal head of the radius

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13
Q

knee injury DDx kids

A 
o Infection
o Inflammatory arthropathy
o Neoplasm
o Apophysitis
o Hip
o Foot
o Sickle, haemophilia
o “anterior knee pain”
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14
Q

knee bony injury kids

A 
o Physeal/metaphyseal
o Tibial spine
o Tibial tubercle
o Patellar fracture
o Sleeve fracture
o Patellar dislocation
o Referred
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15
Q

growth rate of femur

A

11mm/y

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16
Q

growth rate of tibia

A

6mm/y

17
Q

hyperextension of the knee resuts in what kind of injury?

A

vascular

18
Q

treatment of physeal injury of the knee kids

A

§ Cast immobilise
§ Percutaneous fix
§ ORIF articular displacement
§ ROM early <6/52

19
Q

physeal arrest after knee injury kids

A 
§ Monitor – Harris lines, angulation and length
§ Resect var
§ Complete epiphysiodesis
§ Contralateral epiphysiodesis
§ Corrective osteotomy
20
Q

at what age does the patellar become ossified?

A

4

21
Q

types of patellar fracture and treatment

A

undisplaced - cylinder case

displaced - ORID

22
Q

risk factors for patella dislocation

A 
laxity
poor VMO
q angle
femoral anteversion
tibial external rotation
patella alta
23
Q

patella dislocation management

A 
cast 2/52
repair medial ligament
mobilise
lateral relase
VMO exercises - medialise tibial tubercle
semiT tenodesis
24
Q

trauma - osteochondral lesions

A

o Single traumatic incident … developmental?
o Plain films (tunnel view) +/- MRI
o Type 1 (cartilage intact) – immobilise
o Type 2 (flap) and 3 (fragment) – drilling/fix

25
Q

anterior knee pain kids

A

o Dx of exclusion
o R/O inflammatory, neoplasm
o NB OSD, SLJ

26
Q

ankle fractures account for what % of kids #?

A

5%

27
Q

what is the risk with kids ankle injuries? why does this happen?

A
  • Physis as plane of fracture
  • Physis weaker than ligaments
  • Growth arrest risk
28
Q

assessment of kids ankle injuries

A 
o Hx – mechanism
o Deformity
o Soft tissues
o AP and lateral radiographs –
Ottawa rules
o Pitfall 1 – the missed fracture
§ Mortise, oblique views
• E
o Pitfall 2 – the normal
variant
§ Ossification,
contralateral limb
29
Q

management of SH1 kids

A

o Displaced <3mm – POP 6

o Displaced >3mm – MUA, POP 6

30
Q

management of SH2 kids

A

o Commonest
o Management
§ Displaced <3mm – POP 4+2
§ Displaced >3mm- MUA, POP

31
Q

management of SH3 kids

A 
o Supination inversion
o Epiphyseal fgt medial
o Management
§ Undisplaced – POP 6
§ Displaced – (open) reduction and interfragment screw
32
Q

management of SH1 kids

A

o Rare
o Management
§ ORIF
§ Monitor for growth arrest

33
Q

name the transitional fractures affecting the ankle kids

A

growth plate closing, age 13/14
tillaux
triplane

34
Q

describe the closure of the growth plate of tibia

A

§ Central > medial > lateral fusion

§ Articular congruity over physeal integrity

35
Q

describe tillaux fracture kids

A

§ External rotation
§ Anterior tibiofib lig avulsion
§ SH3
§ Closed/open reduction

36
Q

describe triplane fracture kids

A

§ External rotation
§ SH3 on AP + SH2 on lat = SH4
§ CT, ORIF
§ 2,3,4 part

37
Q

warning signs of NAI

A 
o Incongruent Hx
o Bruising pattern
o Burns
o Multiple fracture, multiple stages of healing
o Metaphyseal #, humeral shaft #
o Rib #
o Non-ambulant #

Year 3 (164 decks)

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