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Year 3 MSK > Paediatric trauma > Flashcards

Paediatric trauma Flashcards

1
Q

This deck covas

A

Kiddies fractures

NAI - non accidental injuries

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2
Q

What are the risk factors for kids fractures

A

Boys > girls

Increasing age

Previous fractures

Metabolic bone disease (esp Osteog. imperfecta)

Season (summer is worst)

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3
Q

What is the most common place to be fractured?

A

Forearm

I assume distal radial is the most common of this

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4
Q

Why is it that childrens bones can heal much better after a fracture?

This is why they often dont require invasive treatment, fixation etc

A

Children’s bones heal quickly:

  • metabolically active periosteum
  • cellular structure
  • good blood supply
  • Low velocity impacts

Children’s bones can remodel:

  • ability for apositional growth & resporption
  • differential physeal growth
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5
Q

What are the main types of fractures seen in children?

A

Greenstick

Buckle (aka Torus)

Plastic deformity (not really a fracture)

Complete

~Physeal

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6
Q

What is a greenstick fracture?

A

Bone bends and breaks incompletely - such that there is cortical disrpution on one side, but the other remains in tact

This happens to children more because their bones are soft and less brittle

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7
Q

What is a buckle fracture?

A

Incomplete cortical disruption resulting in periosteal haematoma only

(basically a tiny fracture followed by a kind of bruise of the bone)

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8
Q

What is a plastic deformity?

A

Stress on bone resulting in deformity (bending) without cortical disruption - ie no actual breaks

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9
Q

How do you assess a fracture in a child?

A

Much the same way as an adult…

History - esp mechanism of injury

Deformity - of wrist of wherever

Assess soft tissue - of whole limb:

  • wounds
  • neurovascular status (repeat post-intervention)
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10
Q

Give an overview of how bog-standard, closed fractures are treated in children…

How about open fractures?

A

Reduce (if needed)

Immobilise (cast or splint) until healed

Physio (occasionally needed - eg elbow)

Open fractures - debridement

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11
Q

What are the indications for using fixation for childrens fractures?

A

Fixation indicated if:

  • severe swelling likely (cast would constrict)
  • need to reinspect wounds
  • multiple injuries (polytrauma)
  • segmental fractures
  • very unstable fracture
  • if approaching skeletal maturity (g14, m16)
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12
Q

Why are fractures to physeal plates:

a) common?
b) not good?

A

a) physeal plates are weak, weaker than ligaments so fracture easy
b) can cause growth arrest - ie stop growth

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13
Q

How are physeal fractures classified?

A

Salter-Harris classification

SH-2 is most common

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14
Q

What is the purpose of Salter-Harris classification?

Which types are ‘worst’?

A

helps to predict injuries that may affect growth

SH-3, 4 & 5 - risk growth arrest/disturbance

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15
Q

Which salter-harris classes commonly require fixation?

(take with pinch of salt as variable depending on which bone etc)

A

SH-3 - Need for anatomical reduction and fixation if displaced

SH-4 - ORIF & monitoring for growth arrest

SH-5 - probably does too

ORIF - open reduction & internal fixation

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16
Q

What happens in a ‘tibial spine’ injury?

A

Tibial spine fracture is avulsion of the ACL - where it basically rips off the apophysis (insertion) into the tibial spine

This can be undisplaced (I), hinged (II) or displaced (III)

17
Q

How are tibial spine injuries treated?

A

Undispaced (I) - long leg cast

Hinged (II) - long leg cast or ORIF

Displaced (III) - ORIF

18
Q

What happens in tibial tubercle fractures?

How are these treated?

A

Same as tibial spine fractures - except this deals with the patellar tendon

Avulsion of the patellar tendon’s insertion into the tibial tubercle

Operative fixation

19
Q

What fractures specifically affect children around the ages of 13-14?

A

Transitional fractures - ones that occur in closing growth plates

Commonly seen in the ankle

20
Q

In what order do the areas of a growth plate seal?

A

Central > medial > lateral

21
Q

What are the indications for ORIF?

A

Adolescents

Comminuted fractures

Injuries involving joint surface

Monteggia & Galeazzi fractures (MUSGRI)

22
Q

What are Monteggia & galeazzi fractures?

A

Monteggia - proximal 1/3 ulnar fracture & superior radial head dislocation

Galeazzi - distal 1/3 radius shaft fx AND associated distal radioulnar joint (DRUJ) injury (ulnar dislocation)

23
Q

What are the potential indicators of Non accidental injury (NAI)?

A

Inconsistent history

Mismatch between described mechanism and fracture pattern

Delayed presentation

Specific fractures*

Multiple fractures (esp if at diff stages of healing)

Abnormal bruising

Burns

24
Q

What specific fractures may indicate NAI?

A

Humeral shaft fractures

Ribs

Metaphyseal

Long bone fractures in non-ambulant patient - in ARI, any child <1 with femoral fracture warrants investigation

Year 3 MSK (42 decks)

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