Paediatric Trauma Flashcards
Describe risk factors for fractures in children?
- Boys 60% Girls 40%
- Age
- Previous fracture
- Metabolic bone disease
- Season
What are the principles of childrens fractures?
- heal quickly
- remodel well in plane of joint movement
Why do childrens fractures heal quickly?
- metabolically active periosteum
- cellular bone
- good blood supply
How does the principle that childrens fractures heal quickly impact treatment?
- fixation not usually required
- do not over immobilise
- do not over treat
What treatment is usually used for childrens fractures?
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
When should the cast be supplemented with fixation?
- severe swelling likely
- need to re-inspect wound (such as open fractures)
- multiple injuries
- segmental limb injuries
- unstable fracture
What are the 4 types of fracture in children?
- complete fracture
- greenstick fracture
- buckle (torus)
- plastic deformity
In what plane does remodelling occur in children?
most evident in plane of joint movement:
- appositional periosteal growth/resorption
- differential physeal growth
In physeal fractures what does the physis act as?
Physis acts as plane of fracture
What are possible complications of physeal fractures?
- growth arrest risk due to closeness to growth plate
- physis weaker than ligaments
- can result in progressive deformity
What is used to predict injuries that may affect growth?
Salter-Harris classification tells you where fracture is and not how much it is displaced
Describe Salter-Harris classification?
What does SH classification stand for?
Saltire harris classification
Which SH grade is most common?
What SH class has most risk of growth disturbances?
Most risk of growth disturbance is in III and IV:
- Or if in femur, even if SH I injury
What is the apophysis?
Apophysis is where tendon inserts into bone
How does apophysis injury differ in children compared to adults?
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)
What are 2 locations where ligament is often stronger than bone?
- tibial spine and ACL
- tibial tubercle and patella tendon (usually requires operative fixation)
What are the different grades of avultion of ACL?
- I Undisplaced
- II Hinged
- III Displaced
Describe the treatment for avulsion of ACL?
- I/II long leg cast
- II/III ORIF
What are transitional fractures?
Occur in children who have almost stopped growing:
- Growth plate closing, age 13-14 years
- Standard sequence of growth plate closing
- Central > medial > lateral
What is the standard sequence of growth plate closing?
- Central > medial > lateral
Where does transitional fracture usually occur?
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
What are possible complications of Tilliax fracture?
- Growth arrest
- Can be asymmetrical growth arrest
- Affecting gait – walk on outer side of foot
Describe the management of Tilliax fracture?
Surgical correction
- external fixator – rarely required
- ORIF (open reduction/internal fixation)
- flexible nailing
What does ORIF stand for?
Open reduction/internal fixation
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)
What does NAI stand for?
Non-accidental injury
Describe the epidemiology of NAI?
(% recurrence, % fatality)
- 50% recurrence
- 10% fatality
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
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
What are common NAI fracture locations?
- Metaphyseal fractures
- Humeral shaft fractures
- Rib fractures
- Requires large degree of force
What is osteomyelitis?
Infection of the bone
What are the 2 groups of osteomyelitis?
- Acute osteomyelitis
- Chronic osteomyelitis
Describe the aetiology of acute osteomyelitis?
- Mostly staphylococcus
Describe the presentation of acute osteomyelitis?
- Insidious onset
- Fever
- Unable to weight bear
- Pain
- Mainly around knee
What investigations are done for acute osteomyelitis?
- Blood culture
- X-ray
Describe the management of acute osteomyelitis?
- Prolonged high dose antibiotics
- Aim to prevent acute becoming chronic
- Rarely requires surgery
Describe complications of acute osteomyelitis?
- Can threaten limb and life
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
