Paediatric trauma Flashcards
Why do children’s fractures heal quickly? (4)
- They have a metabolically active periosteum
- Cellular bone - efficient burn turnover as still growing
- Good blood supply – no peripheral vascular disease etc
- Often low velocity trauma
What are 3 types of fractures unique to children?
- The following 3 are unique to children:
- Greenstick
- Buckle
- Plastic deformity
(Complete fracture is more common in adults)
Describe a buckle fracture
- It is a compression fracture
- They happen when one side of the bone buckles, or bends, but doesn’t break all the way through.
- It is a stable fracture and will not move under normal physiological load.
- Only requires simple splintage for a short period of time.
Describe a plastic deformation fracture
- Most commonly seen in the forearm (bones caught between say rungs of a ladder) - a force is applied as the child falls.
- Sequence of small cracks in the bone.
- The bone bends but doesn’t break. Points at the ends of bones in the forearm can then dislocate because of the bend
- This type of fracture has very specific characteristics - they don’t tend to remodel because the periosteum has been minimally disrupted.
What is the preferred treatment of a child’s fracture?
Conservative treatment - cast, braces, splints or traction
In some cases, operative treatment may be necessary. What are the 2 types of operative treatment?
External fixation - pins are put into bone and attached to an external frame. The frame can be monolateral or circular Internal fixation - IM nail or plate fixation
Why are simple treatments often sufficient for children?
- Children’s fracture re-model
- The younger the child, the greater the potential for re-modelling
- Appositional periosteal growth/resorption
- Differential physeal growth
Summary of management of children’s fracture?
- Reduce if it is significantly displaced or if you predict that, if the fracture was left where it was and after a period of remodelling, it wouldn’t achieve adequate function
- Immobilise as this reduces pain/ damage to tissues/ damage to nerve or blood supply
- Remove cast/splint when the fracture has healed
- Must debride all open fractures to prevent infection
How do you reduce the fracture?
- By increasing the deformity
- Reduction in this sense means to repair a fracture or dislocation to the correct alignment
When should you use both a cast and fixation in the management of a child’s fracture?
- If severe swelling is likely If you need to re-inspect the wound
- Multiple injuries
- Segmental limb injuries - fractures in 2 different sites in a long bone
- Fracture very unstable If approaching skeletal maturity - need to be more aggressive with fracture management/fixing fractures as there will be a smaller period for remodelling
What is a physeal fracture?
- Growth plate fracture - the physis acts as a plane of fracture. It is often the weakest point of the bone
- These fractures involve a horizontal fracture line through the physis and a vertical fracture line which runs from the growth plate through the epiphysis to the articular surface.
- If growth plate is injured then could be growth arrest – complete or partial
What is the Salter-Harris Classification used for?
- It helps to predict which fractures are likely to cause problems with growth later on.
- It tells you where the fracture is, not how much it is displaced.
- Ranges from SH-1 to SH-5
- SH-2 is the commonest (50%) and most commonly occurs at the ankle
- SH 3 is a fracture at 90 degrees to the growth plate – much higher risk of growth disturbance - need for anatomical reduction and fixation if displaced + monitor for growth arrest
- SH 4 is a rare fracture, also at 90 degrees to the growth plate – management is open reduction and internal fixation if displaced + monitor for growth arrest
Who do transitional fractures usually affect?
Patients with partially closed growth plates i.e ages 13-14
The growth plate fuses centrally first.
When would open reduction internal fixation need to be used?
- Adolescents
- Comminuted fractures - break or splinter of the bone into more than two fragments.
- Injuries involving joint surface
What is a non-accidental injury?
Non-accidental injury or physical abuse is any bodily injury that is deliberately inflicted on a vulnerable person that is considered unacceptable in a given culture at a given time.
