Paediatric Trauma Flashcards
What are the risk factors for trauma?
- Boys 60% > Girls 40%
- Age
- Increased physeal injury with age
- Previous fracture
- Metabolic bone disease
Why are childrens fractures usually less serious than adults?
Children’s fractures are often simple, incomplete and heal quickly. This is due to the metabolically active periosteum (higher turnover of cells), cellular bone (more cells per unit volume) and more bendable/elasticity of children’s bones
What are the implications of unfused growth plates in children?
As the growth plates are not fused in children, remodelling can occur in childrens bones. Physeal arrest can occur due to trauma and the physis can stop growing (either at one point causing angular deformity or throughout causing a complete halt in growth). Physeal displacement can also occur. Length discrepancies are a result of a physeal arrest of the whole physis.
What is meant by an incomplete fracture?
A part of the bone stays in continuity
What is differential physeal growth?
One side of the physis grows more than the other side to correct fractures and prevent angular deformity
Describe the SH classification of fractures
SH-1- fracture across epiphyses
SH-2- fracture across epiphyses then splinters off
SH-3- fracture down shaft hits physis and then follows physis
SH-4- fracture transects phyis
SH-5- fracture crushing entrie length of physis
Where can fractures of the forearms occur?
- Shaft fractures
- Galeazzi fractures (fracture at junction of middle and distal radius
- Monteggia (Injury to shaft causes fracture of proximal ulna)
- Distal radius fractures (80% of forearm fractures)
What are the indications for surgical repair of a forearm fracture?
- Open fracture (at least wash out)
- Segmental (loose bone in middle of fracture)
- Neurovascular compromise
- Failure closure treatment
What are the principles of closed forearm fracture management?
- Analgesia (splintage first line analgesia)
- Anaesthesia in neurovascular compromise
- Set-up theatre
- Disimpact and reduce fracture
- Cast
- Check radiographs in weeks 1, 2 and 4
- Remove when callus evident
In what cases is an external fixator used in forearm fractures?
- Adolescents
- Comminuted
- Monteggia & Galeazzi
- Failed reduction
- 1/3 tubular (x2) in children, 3.5 DCP adolescents
- Limited immobilisation
When can a flexible nail be used to fix a fracture?
When there is an estimated 2 years of growth left
What are the potential complications of a fracture?
- Compartment syndrome (can cause muscle death in forearm and result in Volman’s ischaemic conractur)
- Non-union (5%)
- Refracture (5%)
- Radioulnar synostosis (proximal>distal, high energy, same level, single incision)
- PIN injury- posterior (?) interosseus nerve injury
- Superficial radial nerve injury- supplies anatomical snuffbox with sensation
- DRUJ / Radiocapitellar problems
What is a buckle/torus fracture?
When one of the cortexes of a bone fails in compression
What is a greenstick fracture?
When one cortex fails in compression and the other in extension
What is a bayonet fracture?
Two fractures that lie in close proximity to another
