Paediatric Trauma and NAI

Question 1

What is a Salter-Harris Fracture?

Answer 1

A fracture that involves the epiphyseal plate or growth plate of a bone - Physis acts as plane for fracture as it is weaker than ligaments

Question 2

What can be a complication of an untreated Salter Harris Fracture?

Answer 2

Premature closure resulting in limb shortening and abnormal growth

Question 3

Which type of fracture is the following?

Answer 3

Salter Harris - Type I

Question 4

What type of fracture is the following?

Answer 4

Salter Harris - Type II

Question 5

What type of fracture is the following?

Answer 5

Salter Harris type III

Question 6

What type of fracture is the following?

Answer 6

Salter Harris - Type IV

Question 7

What type of fracture is the following?

Answer 7

Salter Harris - Type V

Question 8

Which types of Salter harris fractures are of higher risk of premature closure of the the physis?

Answer 8

• Type III
• Type IV
• Type V

Question 9

What is a greenstick fracture?

Answer 9

• Incomplete fractures of long bones - convex surface is overcome and breaks
• Commonly mid-diaphyseal, affecting the forearm and lower leg

Question 10

What is the mechanism of injury of a greenstick fracture?

Answer 10

Occur when force applied to a bone results in bending of the bone such that the structural integrity of the convex surface is overcome

Question 11

What type of fracture is the following?

Answer 11

Greenstick fracture

• Mid-diaphyseal
• Occur with angulation
• Incomplete fracture - cortical breech on one side

Question 12

What is a torus fracture?

Answer 12

Incomplete fracture of the shaft of a long bone, characterised by bulging of the cortex

Also nown as BUCKLE FRACTURE

Question 13

What is the mechanism of injury of a torus fracture?

Answer 13

Compression from an axial load force along the long axis of the bone

Question 14

What type of fracture is the following?

Answer 14

Torus Fracture

• Distinct fracture lines are not seen
• Subtle deformity or buckle of the cortex
• Angulation sometimes only diagnostic clue

Question 15

What is a bowing fracture?

Answer 15

Incomplete fractures of tubular long bones in paediatric patients (especially the radius and ulna)

Question 16

What is the mechanism of injury of a bowing fracture?

Answer 16

Angulated longitudinal force applied to the bone, causing it to bend ⇒ plastic deformity. When force is released, bone remains bowed.

Question 17

What type of fracture is the following?

Answer 17

Bowing Fracture

• Bowing can be visualised providing the view is in a different plane to the direction of bowing - need multiple views of fracture
• No fracture line or visible cortical injury.

Question 18

What are the warning signs of non-accidental injury in children?

Answer 18

• Inconsistant history
• Delay in presentation
• Fracture pattern does not fit mechanism/developmental age
• Bruising – pattern and ages
• Burns
• Multiple fractures, multiple stages of healing
• Metaphyseal and/or Humeral shaft fracture
• Rib fracture
• Non-ambulant fracture of long bones

Question 19

What is the terminology used for different regions of a long bone?

Answer 19

Question 20

How would you manage a fracture in a child?

Answer 20

Reduce fracture (if needed)

Immobilise

Conservative

• Cast
• Braces
• Splints
• Traction

Operative Treatment - External/internal fixation, flexible nail

Question 21

Under what circumstances would you potentially supplement a cast with fixation when treating a fracture in a child?

Answer 21

• Severe swelling likely
• Need to re-inspect the wound
• Multiple injuries
• Segmental limb injuries
• Fracture very unstable
• Approaching skeletal maturity

Question 22

What sites for bruising might raise suspicion for NAI?

Answer 22