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Charis & Ellie vs MSK part 2 > Paediatric Trauma > Flashcards

Paediatric Trauma Flashcards

1
Q

what are the different orthopaedic injuries children experience?

A

because their bones are more elastic/pliable they tend to buckle or partially fracture/splinter rather than completely break

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2
Q

what children do we suspect NAI in if they get a fracture?

A

neonates and infants - under 2s

not walking yet so hard for them to break a bone

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3
Q

when is conservative management not the first point of call in managing fractures in children?

A

displaced intra-articular fractures
displaced growth plate fractures
open fractures

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4
Q

general principles of fracture management

A

reduce
retain
rehabilitate

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5
Q

What should be looked for in a neurovascular exam?

A 
colour 
cap refill 
skin temp. 
O2 stats 
pulse
sensation 
sweating 
skin wrinkling on immersion in water
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6
Q

how is a neurovascular issue diagnosed?

A

ultrasound
athrogram
CT/MR for detail

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7
Q

what is a broad arm sling for?

A

supports but no traction for shoulder, collar and cuff traction - for humerus

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8
Q

for a diaphyseal fracture?

A

immobilise joint above and below to prevent rotation

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9
Q

for a metaphyseal fracture?

A

immobilise the adjacent joint

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10
Q

risk with distal femur fracture?

A

risk of premature closing of the growth plate

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11
Q

when to use external fixation?

A 
contaminated wounds 
soft tissue problems 
acute vascular injury 
burns 
multiple injuries
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12
Q

what is the periosteum?

A

it increased the width/circumference of growing long bones
rich source of osteoblasts
children - the periosteum is a lot thicker and tends to stay intact
useful for stability and can assist in reduction

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13
Q

what is the advantage of children’s thicker periosteum?

A

allows fractures to heal more quickly in children

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14
Q

what is the effect of children’s greater remodelling ability?

A

children have a greater potential to remodel as they grow with bone being formed along the line of stress
children can correct angulation of up to 10 degrees per year of growth
surgery is therefore performed less in children - if surgery is done less invasive procedures are favoured

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15
Q

what age do fractures get treated the same as adults?

A

once the child’s reached puberty (12-14 years)

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16
Q

Wolf’s law

A

bone in a healthy person/animal will adapt to the loads under which it is placed

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17
Q

Hueter-Volkmann law (used to explain scoliosis)

A

bone growth during skeletal immaturity is delayed by mechanical compression on the growth plate and accelerated by growth plate tension

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18
Q

What is the Salter-Harris classification for?

A

physeal fractures

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19
Q

Salter-Harris 1

A

pure physeal separation (best prognosis, least likely to cause growth arrest)

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20
Q

Salter-Harris 2

A

most common, physeal fractures, has a small metaphyseal fragment attached to the physis and epiphysis
likelihood of growth disturbance is low

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21
Q

Salter-Harris 3 and 4

A

intra-articular fracture splits the physis
greater potential for growth arrest
fractures should be reduced and stabilised to ensure a congruent articular surface and minimise growth disturbance

22
Q

Salter-Harris 5

A

compression injury to the physis
causes growth arrest
can’t be diagnosed initially on x-rays
only detected once angular deformity has occurred
(larger the SH number worse the prognosis)

23
Q

when to suspect NAI?

A

multiple fractures of varying ages (varying amounts of callus/healing)
multiple bruises of varying ages
multiple trips to A&E with different injuries
inconsistent history of events
discrepancy of history between parents/carers
history doesn’t make sense for the injury
age of child doesn’t line up with injury
atypical injuries (cigarette burns, genital injuries, lower limb and trunk burns)
rib fractures
metaphyseal fractures in infants

24
Q

management of NAI?

A

paediatricians involved early
child admitted for safety
full exam and skilled history should be done by an experienced doctor

25
Q

common children’s fractures

A 
distal radius fractures 
forearm fractures 
supracondylar fractures of the elbow 
femoral shaft fractures 
tibial fractures
26
Q

distal radius buckle fractures (these ones involve the periosteum)

A

stable

only need 3-4 weeks of splintage

27
Q

Distal radius - Greenstick fractures

A

may be anguated

may need manipulation and casting if there is significant deformity (esp in an older child)

28
Q

distal radius - salter harris II fractures

A

common around the distal radial physis in older children
angulation with deformity requires manipulation
growth problems are highly unlikely

29
Q

what do complete fractures of the distal radius do?

A

may displace and angulate
dorsal displacement and angulation is more common than volar
doral periosteum tends to remain intact - prevents overcorrection of the deformity and helps stability

30
Q

Management of distal radius fractures

A

casting may be enough if the fracture is relatively stable

if a complete fracture is very unstable after reduction - may need wore stabilisation or plate fixation

31
Q

what is a Monteggia fracture - dislocation?

A

fracture of the proximal ulna with displacement of the radial head

32
Q

What is a Galeazzi fracture - dislocation?

A

fracture of the distal radius with dislocation of the distal radioulnar joint

33
Q

how are Monteggia and Galeazzi fractures managed?

A

anatomic reduction and rigid fixation with plates and screws
because - if only manipulation and casting is used there is a hogh rate of re-dislocation of the radial head/distal radio-ulnar joint (DRUJ)

34
Q

Undisplaced monteggia and galeazzi fractures

A

usually have an intact periosteum and instability

may only be in one plane which can be controlled with a cast after manipulation

35
Q

displaced monteggia and galeazzi fractures

A

usually unstable

flexible IMN are usually used

36
Q

What are supracondylar fractures of the elbow?

A

pretty common - relatively common weak point
extension-type fractures are more common - usually due to a heavy fall onto an outstretched hand
flexion-type injuries are less common, usually due to a fall onto the point of the flexed elbow

37
Q

how are undisplaced supracondylar fractures of the elbow managed?

A

stable and treated with splint

38
Q

how are angulated/rotated/displaced supracondylar fractures of the elbow managed?

A

need closed reduction and pinning with wires to prevent deformity
open reduction may be needed where close reduction isn’t possible (e.g. severely displaced/offended fracture - long bone fracture which is displaced by more than the width of the bone)

39
Q

Test with off-ended extension type fractures in supracondylar fractures of the elbow?

A

patient is unable to make OK sign with hand because the distal fragment displaces posteriorly
causes pressure on the brachial artery and median nerve (mainly anterior interosseous branch of the median nerve)
this result in loss of FPL and FDP to the index

40
Q

How are displaced fractures of supracondylar fractures of the elbow managed?

A

reduce early to avoid swelling - swelling makes reduction more difficult
if the radial pulse is absent/reduced in volume do EMERGENCY SURGERY can do closed reduction with wiring, pulse may return if artery is no longer under stress
sometimes open surgery needed - if brachial artery is trapped in the fracture site OR if the hand remains pulseless after reduction

41
Q

what are the signs of and management of nerve injury and supracondylar fractures of the elbow?

A

neuralgic pain with no improvement - can be entrapment
URGENT theatre management - surgical release
majority are neurapraxias sometimes axonotmesis

42
Q

how do children get femoral shaft fractures?

A

children falling onto flexed knee
indirect bending/rotational forces
in children, overgrowth tends to occur after fracture so some shortening is accepted
femur is a common site of benign/malignant bone tumours so the fracture may be pathological with osteolysis and cortical thinning

43
Q

femoral shaft fractures in less than 2s

A

mostly due to NAI/child abuse

treat with Gallows traction and early hip spica cast

44
Q

femoral shaft fractures in 2-6

A

treat Thomas splint or hip spica cast

45
Q

femoral shaft fractures in 6-12s

A

treat with flexible IMN (can use as the femur is now large enough)
this will show if there is need for traction or cast

46
Q

femoral shaft fracture in over 12s

A

treat with adult type IMN

47
Q

What fracture is known as the toddlers fracture?

A

undisplaced tibial spiral fractures

require a short time in cast

48
Q

what is the standard management for tibial fractures in children?

A

a cast

the risk of compartment syndrome is much less than an adult

49
Q

what level of tibial angulation is accepted in children after fracture?

A

10 degrees

anymore treatment with manipulation and casting

50
Q

management of tibial fracture once in cast?

A

need to do serial X-rays in the cast
make sure fracture doesn’t drift into excessive angulation in the AP/lateral planes
Don’t Accept shortening/malrotation

51
Q

How are unstable/open tibial fractures managed?

A

flexible IMN (adolescents with a closed proximal tibial physis can have an adult type IMN)
plates and screws
or
external fixation

Charis & Ellie vs MSK part 2 (61 decks)

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