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
  • remodel well in plane of joint movement
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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

operative treatment

  • 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
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11
Q

What is used to predict injuries that may affect growth?

A

Salter-Harris classification 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
Describe the management of Tilliax fracture?
Surgical correction - external fixator – rarely required - ORIF (open reduction/internal fixation) - flexible nailing
26
What does ORIF stand for?
Open reduction/internal fixation
27
What are indications for ORIF in transitional fracture?
- adolescents - comminuted fractures - injuries involving joint surface - forearm fractures (Monteggia and Galeazi – these both describe fractures of forearm bones)
28
What does NAI stand for?
Non-accidental injury
29
Describe the epidemiology of NAI? | (% recurrence, % fatality)
* 50% recurrence * 10% fatality
30
What are warning signs for NAI?
* 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
What is done if warning signs for NAI are seen?
* 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
What are common NAI fracture locations?
* Metaphyseal fractures * Humeral shaft fractures * Rib fractures * Requires large degree of force
33
What is osteomyelitis?
Infection of the bone
34
What are the 2 groups of osteomyelitis?
* Acute osteomyelitis * Chronic osteomyelitis
35
Describe the aetiology of acute osteomyelitis?
* Mostly staphylococcus
36
Describe the presentation of acute osteomyelitis?
* Insidious onset * Fever * Unable to weight bear * Pain * Mainly around knee
37
What investigations are done for acute osteomyelitis?
* Blood culture * X-ray
38
Describe the management of acute osteomyelitis?
* Prolonged high dose antibiotics * Aim to prevent acute becoming chronic * Rarely requires surgery
39
Describe complications of acute osteomyelitis?
* Can threaten limb and life
40
Describe the prognosis of acute osteomy * Cured if caught early and treated * Can progress to chronic elitis?
* Cured if caught early and treated * Can progress to chronic