Paediatric trauma Flashcards
Is a male or female child more likely to experience trauma?
Boys
Risk factor surrounding paediatric trauma?
Risk Factors: > Boys 60% > Girls 40% > Age > Increased physeal injury with age > Previous fracture > Metabolic bone disease
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
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
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
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
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
FACT = Fractures involving physes can result in progressive deformity?
> Deformity - Elbow
Arrest – Knee, Ankle
(Overgrowth – Femur)
Forearm fractures in children site?
> Shaft fractures
> Special cases:
- Galaezzi (Radius)
- Monteggia (Ulna)
> Distal radius fractures
Type of Forearm fractures in children - Low energy?
> Buckle
> Greenstick
Type of Forearm fractures in children - High energy?
> Open
Displaced
Soft tissue injury
Type of Forearm fractures in children - High energy?
> Open
Displaced
Soft tissue injury
Assessment in a child fracture?
> History – Mechanism
> Deformity
> Soft tissues
- Whole limb
- Wounds
- Sensation, Motor fcn
- Vascular status
Outcome in closed fractures in children?
90-95% good functional results
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’
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
