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Musculoskeletal > Paediatric Trauma > Flashcards

Paediatric Trauma Flashcards

1
Q

Describe risk factors for fractures in children?

A
  • Boys 60% Girls 40%
  • Age
  • Previous fracture
  • Metabolic bone disease
  • Season
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2
Q

What are the principles of childrens fractures?

A
  • Heal quickly
    • Metabolically active periosteum
    • Cellular bone
    • Good blood supply
  • Due to this
    • Fixation not usually required
    • Do not over immobilise
    • Do not over treat
  • Most fractures need simple treatment
    • Conservative treatment
      • Cast
      • Braces
      • Splints
      • Traction
    • When operative treatment is required
      • External fixation
        • Monolateral or circular
      • Internal fixation
        • IM nail – rigid or elastic
        • Plate fixation
  • Remodel well in plane of joint movement
  • Reduction as treatment
    • Increase deformity to reduce fracture
    • Bones need bent cast to give straight limb (periosteum tension)
  • Supplement the cast with fixation when
    • Severe swelling likely
    • Need to re-inspect wound (such as open fractures)
    • Multiple injuries
    • Segmental limb injuries
    • Unstable fracture
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3
Q

Why do childrens fractures heal quickly?

A
  • Metabolically active periosteum
  • Cellular bone
  • Good blood supply
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4
Q

How does the principle that childrens fractures heal quickly impact treatment?

A
  • Fixation not usually required
  • Do not over immobilise
  • Do not over treat
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5
Q

What treatment is usually used for childrens fractures?

A
  • Most fractures need simple treatment
    • Conservative treatment
      • Cast
      • Braces
      • Splints
      • Traction
    • When operative treatment is required
      • External fixation
        • Monolateral or circular
      • Internal fixation
        • IM nail – rigid or elastic
        • Plate fixation
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6
Q

When should the cast be supplemented with fixation?

A
  • Severe swelling likely
  • Need to re-inspect wound (such as open fractures)
  • Multiple injuries
  • Segmental limb injuries
  • Unstable fracture
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7
Q

What are the 4 types of fracture in children?

A
  • Complete fracture
  • Greenstick fracture
  • Buckle (torus)
  • Plastic deformity
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8
Q

In what plane does remodelling occur in children?

A

Most evident in plane of joint movement:

  • Appositional periosteal growth/resorption
  • Differential physeal growth
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9
Q

In physeal fractures what does the physis act as?

A

Physis acts as plane of fracture

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10
Q

What are possible complications of physeal fractures?

A
  • Growth arrest risk due to closeness to growth plate
  • Physis weaker than ligaments
  • Can result in progressive deformity
    • Salter-Harris classification used to predict injuries that may affect growth
      • Tells you where fracture is and not how much it is displaced
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11
Q

What is used to predict injuries that may affect growth?

A
  • Salter-Harris classification used to predict injuries that may affect growth
    • Tells you where fracture is and not how much it is displaced
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12
Q

Describe Salter-Harris classification?

A
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13
Q

What does SH classification stand for?

A

Saltire harris classification

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14
Q

Which SH grade is most common?

A
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15
Q

What SH class has most risk of growth disturbances?

A

Most risk of growth disturbance is in III and IV:

  • Or if in femur, even if SH I injury
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16
Q

What is the apophysis?

A

Apophysis is where tendon inserts into bone

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17
Q

How does apophysis injury differ in children compared to adults?

A

Ligament can be stronger than bone, so injury can cause avulsion of ligament, such as:

  • Tibial spine and ACL
  • Tibial tubercle and patella tendon
    • Usually requires operative fixation
18
Q

What are 2 locations where ligament is often stronger than bone?

A
  • Tibial spine and ACL
  • Tibial tubercle and patella tendon
    • Usually requires operative fixation
19
Q

What are the different grades of avultion of ACL?

A
  • I Undisplaced
  • II Hinged
  • III Displaced
20
Q

Describe the treatment for avulsion of ACL?

A
  • I/II long leg cast
  • II/III ORIF
21
Q

What are transitional fractures?

A

Occur in children who have almost stopped growing:

  • Growth plate closing, age 13-14 years
  • Standard sequence of growth plate closing
    • Central > medial > lateral
22
Q

What is the standard sequence of growth plate closing?

A
  • Central > medial > lateral
23
Q

Where does transitional fracture usually occur?

A

Usually occurs above ankle, such as Tilliax fracture which occurs due to the lateral side of growth plate closing last:

  • In adult ligament would tear
  • But in child, ligament stronger than bone so bone pulled off growth plate where the plate hasn’t fused
24
Q

What are possible complications of Tilliax fracture?

A
  • Growth arrest
    • Can be asymmetrical growth arrest
    • Affecting gait – walk on outer side of foot
25
Q

Describe the management of Tilliax fracture?

A
  • Surgical correction
    • External fixator – rarely required
    • ORIF (open reduction/internal fixation)
      • Indications – adolescents, comminuted fractures, injuries involving joint surface, forearm fractures (Monteggia and Galeazi – these both describe fractures of forearm bones)
    • Flexible nailing
      • Need 2 year predicted growth remaining
      • Advantages – allow early ROM, wires out when healed, minimal disruption
26
Q

What does ORIF stand for?

A

Open reduction/internal fixation

27
Q

What are indications for ORIF in transitional fracture?

A
  • Indications – adolescents, comminuted fractures, injuries involving joint surface, forearm fractures (Monteggia and Galeazi – these both describe fractures of forearm bones)
28
Q

What does NAI stand for?

A

Non-accidental injury

29
Q

Describe the epidemiology of NAI?

(% recurrence, % fatality)

A
  • 50% recurrence
  • 10% fatality
30
Q

What are warning signs for NAI?

A
  • Inconsistent history
  • Delay in presentation
  • Fracture pattern does not fit mechanism
  • Bruising
    • Abnormal pattern or places
    • Or not explained by what child is doing
  • Burns
  • Multiple fractures with multiple stages of healing
31
Q

What is done if warning signs for NAI are seen?

A
  • Skeletal survey
    • X-ray of whole skeleton
  • If we see many fractures at different stages usually means NAI if metabolic bone diseases been excluded
32
Q

What are common NAI fracture locations?

A
  • Metaphyseal fractures
  • Humeral shaft fractures
  • Rib fractures
    • Requires large degree of force
33
Q

What is osteomyelitis?

A

Infection of the bone

34
Q

What are the 2 groups of osteomyelitis?

A
  • Acute osteomyelitis
  • Chronic osteomyelitis
35
Q

Describe the aetiology of acute osteomyelitis?

A
  • Mostly staphylococcus
36
Q

Describe the presentation of acute osteomyelitis?

A
  • Insidious onset
    • Fever
    • Unable to weight bear
    • Pain
  • Mainly around knee
37
Q

What investigations are done for acute osteomyelitis?

A
  • Blood culture
  • X-ray
38
Q

Describe the management of acute osteomyelitis?

A
  • Prolonged high dose antibiotics
  • Aim to prevent acute becoming chronic
  • Rarely requires surgery
39
Q

Describe complications of acute osteomyelitis?

A
  • Can threaten limb and life
40
Q

Describe the prognosis of acute osteomy

  • Cured if caught early and treated
  • Can progress to chronic

elitis?

A
  • Cured if caught early and treated
  • Can progress to chronic

Musculoskeletal (40 decks)

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