paediatric trauma Flashcards
children’s fracture principals
Children’s fractures are often simple, incomplete & heal quickly
Remodel well in plane of joint movement
A thick periosteal hinge is (usually) a friend
Fractures involving physes can result in progressive deformity.
Deformity - Elbow
Arrest – Knee, Ankle
(Overgrowth – Femur
forearm fractures
Low energy Buckle Greenstick High energy Open, displaced, soft tissue injury
principles of closed management
analgesia.. anaesthesia theatre set up reduce -disimpact -bend force over apex well moulded above elbow cast check radiographs change loose casts remove when callus evident restrict activity
ORIF
Adolescents
Comminuted
Monteggia & Galeazzi failed reduction
1/3 tubular (x2) in children, 3.5 DCP adolescents
Limited immobilisation
Single bone technique
monteggia fracture
fracture of the proximal third of the ulna with dislocation of the proximal head of the radius
Galeazzi fracture
middle to distal one-third of the radius associated with dislocation or subluxation of the distal radioulnar joint (DRUJ)
complications
compartment syndrome- volkmann's non union refracture radioulnar synostosis posterior interosseus nerve injury
distal radius acceptable range
30 degrees angulation
45 degrees rotation
10 degrees angulation
30degrees rotation
management
Buckle - cast 3-4 weeks (?) Greenstick - cast 4-6 weeks Complete - cast +/- KW 4-6 weeks Risk for remanipulation Complete fractures failed anatomic reduction NOT B/E pop
knee trauma differential
Infection Inflammatory arthropathy Neoplasm Apophysitis Hip Foot Sickle, haemophilia ‘Anterior knee pain’
physeal injury
capsule & ligaments
distal femur below physis
prox tibia below physis
growth
femur>tibia
hyperextension-vascular injury
Varus-CPN injury
physeal arrest
Monitor - Harris lines, angulation & length Resect Bar Complete epiphysiodesis Contralateral epiphysiodesis Corrective osteotomy
patellar fracture
undisplaced- cylinder cast
displaced- ORIF
patella dislocation
risk factors laxity poor VMO Q angle, femoral anteversion tibital ext rotation patella alta
osteochondral lesions
type 1 cartilage intact -immobilise type II (flap) & III (fragment)
