Paediatric trauma Flashcards by Callum Hill

Is a male or female child more likely to experience trauma?

Boys

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Risk factor surrounding paediatric trauma?

Risk Factors:
> Boys 60% > Girls 40%
> Age
> Increased physeal injury with age
> Previous fracture
> Metabolic bone disease

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Children’s fracture principles - Children’s fractures are often simple, incomplete & heal quickly, why?

Children’s fractures are often simple, incomplete & heal quickly:
> Metabolically active periosteum
> Cellular bone
> Plastic

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Children’s fracture principles - Children’s fractures are often simple, incomplete & heal quickly - Application of management?

> Fixation is not usually required
Do not over immobilise
Do not over treat

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Children’s fracture principles - Remodel well in plane of joint movement, why?

Remodel well in plane of joint movement:
> Appositional periosteal growth/resorption
> Differential physeal growth

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Children’s fracture principles - Remodel well in plane of joint movement - Application of management?

APPLICATION: 
> Younger child
> Polar fractures
> Intact growing physis
> Sagittal>Frontal X Transverse

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FACT = Children’s fracture principles - A thick periosteal hinge is (usually) a friend…but needs to be understood

A thick periosteal hinge is (usually) a friend…but needs to be understood

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FACT = Fractures involving physes can result in progressive deformity?

> Deformity - Elbow
Arrest – Knee, Ankle
(Overgrowth – Femur)

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Forearm fractures in children site?

> Shaft fractures

> Special cases:

Galaezzi (Radius)
Monteggia (Ulna)

> Distal radius fractures

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Type of Forearm fractures in children - Low energy?

> Buckle

> Greenstick

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Type of Forearm fractures in children - High energy?

> Open
Displaced
Soft tissue injury

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Type of Forearm fractures in children - High energy?

> Open
Displaced
Soft tissue injury

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Assessment in a child fracture?

> History – Mechanism

> Deformity

> Soft tissues

Whole limb
Wounds
Sensation, Motor fcn
Vascular status

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Outcome in closed fractures in children?

90-95% good functional results

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Open fracture treatments in children?

Open/Flex nail
> Restored anatomy, early mobilisation

> Hardware migration, nerve injury, delayed union.

> 33% plate, 42% IM complication (Smith et al, JPO 2005)

> ‘Parental pressure for perfection’

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What is the commonest cause of death in children ?

Trauma - 43% of deaths

Epidemiology of fractures in children?

Risk Factors: 
> Boys 60% > Girls 40%
> Age
> Increased physeal injury with age
> Previous fracture
> Metabolic bone disease

Growth plate and trauma in children?

> Remodelling - Limited capacity to remodel in adults

> Physeal arrest Damage to the growth plate can lead to arrest and angular deformities or Length discrepancies

> Displacement - Slipped epiphysis

Bone physiology and trauma in children?

Increased:
Collagen
Porosity
Cellularity
Plasticity

Periosteum physiology and trauma in children?

Periosteum

Metabolically active
Thick & strong

Physiology of Growth plates, Bone and Periosteum?

> Better remodelling in sagittal but not in transverse allows less surgical repair need

What technique is used to repair a fractures in children?

1) Reduce fracture

2) Three point fixation of the thick periosteal hinge using plaster

What is the issue with damaging the physes of con in children?

Can lead to progressive deformity

Why can a fracture of the physes in a femur lead to overgrowth?

Due to increased delivery of blood (Angiogenesis)

Fracture of the radius is called what?

Galeazzi fracture

Fracture of the ulna is called what?

Monteggia fracture

Most common type of forearm fracture?

Distal radius/ulna fractures - 80%

What is the cause of deforming forces within a fracture?

Action/attachments of the muscles - This is hard to predict but should be away

Why is it important to test muscle, sensation and vascular status before intervention in child trauma?

Can use it to determine improvements or damage caused by intervention

Surgical indications in forearm fractures of children - Not needed to learn?

1) <9y: >15 angulation >45 malrotation 2) >9y proximal: - >10 angulation - >30 malrotation distal: - >15 angulation 3) Open # 4) Segmental 5) NV compromise 6) Failed closed Rx

Principles of closed management of a fracture?

> Splint first = Stop pain > Analgesia…Anaesthesia > Reduce: - Disimpact - Bend force over apex > Verify > Well molded above elbow cast 4-6/52 > Check radiographs week 1, 2 & 4 > Change loose casts > Remove when callus evident > Restrict activity 3-4/12

Why do we splint a forearm in a fracture?

Reduces pain

Surgical options in fracture within a child?

> External fixator – rare, soft tissue issues > Flexible nailing > Plates > Screws

Surgical options in fracture within a child - Flexible nailing, when?

> Need 2yrs predicted growth remaining > Nancy - Métaizeau > Allow early ROM > Wires out when healed

Principles of closed management of fractures in a child?

``` > Analgesia…Anaesthesia > Reduce: - Disimpact - Bend force over apex > Well molded above elbow cast 4-6/52 > Check radiographs week 1, 2 & 4 > Change loose casts > Remove when callus evident > Restrict activity 3-4/12 ```