Paediatric Trauma Flashcards
risk factors for paediatric trauma
boys 60%, girls 40% age increased physeal injury with age previous fracture metabolic bone disease
list the children’s fracture principles
- children fractures are often simple, incomplete and heal quickly
- remodel well in plane of joint movement
- a thick periosteal hinge is (usually) a friend but needs to be understood
- fractures involving physes can result in progressive deformity
children’s fracture principles: simple, incomplete, heal quickly
metabolically active periosteum
cellular bone
plastic
applicaton: fixation not usually required, do not over mobilise, do not over treat
children’s fracture principles: remodel
appositional periosteal growth/resorption
differential physeal growth
application: younger child, polar fractures, intact growing physis, sagital > frontal X transverse
children’s fracture principles: progressive deformity
demority - elbow
arrest - knee, ankle
overgrowth - femur
low energy forearm injuries kids
buckle
greenstick
high energy forearm injuries kids
open
displaced
soft tissue injury
complications of forearm injuries kids
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
distal radius fractures kids
o Buckle, Torus § Failure of 1 cortex in compression o Greenstick § Failure of 1 cortex in compression, other cortex in extension o Bayonet, offended
management of distal radius fractures kids
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
what is a Galeazzi fracture?
fracture of the distal 1/3 of the radius with dislocation of the distal radioulnar joint
what is a monteggia fracture?
fracture of the proximal 1/3 of the ulna with dislocation of the proximal head of the radius
knee injury DDx kids
o Infection o Inflammatory arthropathy o Neoplasm o Apophysitis o Hip o Foot o Sickle, haemophilia o “anterior knee pain”
knee bony injury kids
o Physeal/metaphyseal o Tibial spine o Tibial tubercle o Patellar fracture o Sleeve fracture o Patellar dislocation o Referred
growth rate of femur
11mm/y
growth rate of tibia
6mm/y
hyperextension of the knee resuts in what kind of injury?
vascular
treatment of physeal injury of the knee kids
§ Cast immobilise
§ Percutaneous fix
§ ORIF articular displacement
§ ROM early <6/52
physeal arrest after knee injury kids
§ Monitor – Harris lines, angulation and length § Resect var § Complete epiphysiodesis § Contralateral epiphysiodesis § Corrective osteotomy
at what age does the patellar become ossified?
4
types of patellar fracture and treatment
undisplaced - cylinder case
displaced - ORID
risk factors for patella dislocation
laxity poor VMO q angle femoral anteversion tibial external rotation patella alta
patella dislocation management
cast 2/52 repair medial ligament mobilise lateral relase VMO exercises - medialise tibial tubercle semiT tenodesis
trauma - osteochondral lesions
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
anterior knee pain kids
o Dx of exclusion
o R/O inflammatory, neoplasm
o NB OSD, SLJ
ankle fractures account for what % of kids #?
5%
what is the risk with kids ankle injuries? why does this happen?
- Physis as plane of fracture
- Physis weaker than ligaments
- Growth arrest risk
assessment of kids ankle injuries
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
management of SH1 kids
o Displaced <3mm – POP 6
o Displaced >3mm – MUA, POP 6
management of SH2 kids
o Commonest
o Management
§ Displaced <3mm – POP 4+2
§ Displaced >3mm- MUA, POP
management of SH3 kids
o Supination inversion o Epiphyseal fgt medial o Management § Undisplaced – POP 6 § Displaced – (open) reduction and interfragment screw
management of SH1 kids
o Rare
o Management
§ ORIF
§ Monitor for growth arrest
name the transitional fractures affecting the ankle kids
growth plate closing, age 13/14
tillaux
triplane
describe the closure of the growth plate of tibia
§ Central > medial > lateral fusion
§ Articular congruity over physeal integrity
describe tillaux fracture kids
§ External rotation
§ Anterior tibiofib lig avulsion
§ SH3
§ Closed/open reduction
describe triplane fracture kids
§ External rotation
§ SH3 on AP + SH2 on lat = SH4
§ CT, ORIF
§ 2,3,4 part
warning signs of NAI
o Incongruent Hx o Bruising pattern o Burns o Multiple fracture, multiple stages of healing o Metaphyseal #, humeral shaft # o Rib # o Non-ambulant #
