Paediatric trauma Flashcards
Why are children’s fractures generally simple, incomplete, and quick to heal?
Metabolically active periosteum
Cellular bone
Plastic
Why do children’s fractures remodel well in plane of joint movement?
Appositional periosteal growth/resorption
Differential physeal growth
What are the main types of forearm fractures?
Shaft fractures
Galeazzi
Monteggia
Distal radial fractures
What happens in low energy fractures?
Buckling
Greenstick
What happens in high energy fractures?
Open, displaced, soft tissue injury
What is greenstick?
Failure of one cortex in compression, other cortex in extension
How is buckle fracture managed?
Cast for 3-4 weeks
How is greenstick fracture managed?
Cast for 4-6 weeks
How is complete fracture managed?
Cast 6 weeks
What are differentials for knee trauma?
Infection Inflammatory arthropathy Neoplasm Apophysitis Hip Foot Sickle cell
What bony injuries could lead to knee pain?
Physeal/metaphyseal Tibial spine Tibial tubercle Patellar fracture Sleeve fracture Patellar dislocation Referred pain from hip
How is physeal injury treated?
Cast and immobilise
Percutaneous fix
ORIF articular displacement
Range of movement early
What are the 3 stages of tibial spine injury by Meyers and McKeever’s criteria?
I - Undisplaced
II - Hinged
III - Displaced
What are the 3 stages of tibial tubercle injury by Ogden’s criteria?
I - Distal avulsion
II - To proximal tibial physis - not into joint
III - To proximal tibial physis - into joint
What are risk factors for patellar dislocation?
Laxity Poor VMO Q angle Femoral anteversion Tibial external rotation Patella alta
How is ankle fracture assessed?
History - mechanism
Deformity
Soft tissues
Radiographs
What are ottawa rules for ankle fracture?
Series of Xray films is required only if there is any pain in maleolar or mid-foot zone and any of the following:
Pain at posterior edge of tip or lateral malleolus
Pain at base of fifth metatarsal
Pain at naviculum
Inability to bear weight immediately or in emergency dept.
What is a transitional fracture?
Fracture while growth plate is closing - usually age 13-14
What are warnings of non-accidental injury?
Incongruent history Bruising pattern Burns Multiple fractures, multiple stages of healing Metaphyseal Ribs Non-ambulant
What is mugger relating to monteggia and galeazzi?
Monteggia is ulnar
Galeazzi is radial
What is monteggia?
Ulnar fracture with radial head dislocation - force comes from medial side
What is galeazzi?
Radial fracture with dislocation of distal radioulnar joint
