Paediatric trauma Flashcards
This deck covas
Kiddies fractures
NAI - non accidental injuries
What are the risk factors for kids fractures
Boys > girls
Increasing age
Previous fractures
Metabolic bone disease (esp Osteog. imperfecta)
Season (summer is worst)
What is the most common place to be fractured?
Forearm
I assume distal radial is the most common of this
Why is it that childrens bones can heal much better after a fracture?
This is why they often dont require invasive treatment, fixation etc
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
What are the main types of fractures seen in children?
Greenstick
Buckle (aka Torus)
Plastic deformity (not really a fracture)
Complete
~Physeal
What is a greenstick fracture?
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
What is a buckle fracture?
Incomplete cortical disruption resulting in periosteal haematoma only
(basically a tiny fracture followed by a kind of bruise of the bone)
What is a plastic deformity?
Stress on bone resulting in deformity (bending) without cortical disruption - ie no actual breaks
How do you assess a fracture in a child?
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)
Give an overview of how bog-standard, closed fractures are treated in children…
How about open fractures?
Reduce (if needed)
Immobilise (cast or splint) until healed
Physio (occasionally needed - eg elbow)
Open fractures - debridement
What are the indications for using fixation for childrens fractures?
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)
Why are fractures to physeal plates:
a) common?
b) not good?
a) physeal plates are weak, weaker than ligaments so fracture easy
b) can cause growth arrest - ie stop growth
How are physeal fractures classified?
Salter-Harris classification
SH-2 is most common
What is the purpose of Salter-Harris classification?
Which types are ‘worst’?
helps to predict injuries that may affect growth
SH-3, 4 & 5 - risk growth arrest/disturbance
Which salter-harris classes commonly require fixation?
(take with pinch of salt as variable depending on which bone etc)
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
What happens in a ‘tibial spine’ injury?
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)
How are tibial spine injuries treated?
Undispaced (I) - long leg cast
Hinged (II) - long leg cast or ORIF
Displaced (III) - ORIF
What happens in tibial tubercle fractures?
How are these treated?
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
What fractures specifically affect children around the ages of 13-14?
Transitional fractures - ones that occur in closing growth plates
Commonly seen in the ankle
In what order do the areas of a growth plate seal?
Central > medial > lateral
What are the indications for ORIF?
Adolescents
Comminuted fractures
Injuries involving joint surface
Monteggia & Galeazzi fractures (MUSGRI)
What are Monteggia & galeazzi fractures?
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)
What are the potential indicators of Non accidental injury (NAI)?
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
What specific fractures may indicate NAI?
Humeral shaft fractures
Ribs
Metaphyseal
Long bone fractures in non-ambulant patient - in ARI, any child <1 with femoral fracture warrants investigation
