Paediatric Trauma (including NAI) Flashcards
what are the risk factors for kids fractures?
- Boys 60% > Girls 40%
- Age - Older = more likely to of had a fracture
- Previous fracture
- Metabolic bone disease
- Season
Children’s Fracture Principles - childrends fractures heal ______
quickly
Children’s Fracture Principles - childrends fractures heal quickly, how?
- Metabolically active periosteum
- Cellular bone
- Good blood supply
- Often low velocity trauma
Children bone different form adults
Thicker periosteum in children
Children don’t often smoke so good blood supply to bone
what should you avoid when treating fracutres in children?
- Fixation is not usually required
- Do not over immobilise
- Do not over treat
what are the four types of fractures in children?
In adults only really one type of fracture but in children there is 4
Complete Fracture (Complete fracture is the one seen in adults)
Greenstick Fracture
Buckle (Torus) - Buckle due to longitudinal compression – need simple splintage for short period of time and not much follow up
Plastic Deformity - caught in rung of ladder and lots of little cracks, bend causes dislocation at top and bottom of forearm
what type is shown here?
Complete Fracture
what type is shown here?
Greenstick Fracture
what type is shown here?
Buckle (Torus)
what type is shown here?
Plastic Deformity
what is involved in the assessment of a fracture?
- History – Mechanism
- Deformity
- Soft tissues
- Whole limb
- Wounds
- Sensation, Motor function
- Vascular status
DOCUMENT FINDINGS, REPEAT POST-INTERVENTION
Most children’s fractures need simple treatment
what conservative treamtent is avalible?
90% of children fracture done conservatively
Cast
Braces
Splints
Traction
what operative treamtent is avalible?
Elastic nails used in children and mainly rigid ones in adult as can affect growth in children
Most children’s fractures need simple treatment, why is this?
Children’s Fracture Re-model
Most evident in plane of joint movement
- Appositional periosteal growth/resorption
- Differential physeal growth - Can correct angulation
Thick layer of periosteum which is very metabolically active and will smooth out any irregularities in the bone by resorbing the prominises and strengthen the bit where there is a lack of bone
picture - Humeral fracture, mid shaft oblique fracture, displacement stimulates callus formation to stabilise the injury. This process doesn’t happen as well in adults as they have a less active periosteum
what would you do for a femur fracture?
If oblique or spiral in femur they will shorten so use traction
Gallows traction in children
Children’s Fracture Principles:
Remodel well in plane of ____ __________
joint movement
forms callous that gradually changes into bone
Most children’s fractures need simple treatment, such as what?
- Reduce the fracture (if needed)
- Immobilise
- Remove cast/splint when healed
- Joint stiffness rare
- Open fractures debride
Children’s Fracture Principles Reduction - what is it?
Increase the deformity to reduce the fracture
Remember the periosteal hinge
Bark represents the periosteum
why may a curved cast be used?
In greenstick fractures it tends to return to the position it was in even if manipulated so has to be opposed using curved plaster
Bones need bent cast to give a straight limb (Periosteum Tension)
Supplement the cast with fixation when what?
Severe swelling likely
Need to re-inspect wound (e.g. open fractures)
Multiple injuries
Segmental limb injuries - Segmental injuries don’t heal well – 2 different fractures
Fracture very unstable
Approaching skeletal maturity (less period for remodeling)
what are Physeal fractures and its effects?
- Physis acts as a plane of fracture
- Physis weaker than Ligaments
- Growth arrest risk (can get partial or full growth plate arrest)
Growing bones have active physis and skeletal maturity is when these physis close
Fractures involving physes can result in progressive deformity
The Salter-Harris Classification helps to predict injuries that may affect growth
what are the different types?
Distal long bone
Tells you where the fracture is rather than how much it is displaced
1 = fracture in line with growth plate
SH-2 is most common injury around growth plate
Type 1 and 2 there is a good chance these will heal without any growth disturbance particularly if in upper limb
In 3 and 4 there is a much higher risk of growth disturbance, particularly in lower limbs
5 is longitudinal compression of the growth plate
Fractures involving physes can result in progressive deformity and affect growth. Is this more common in upper or lower limbs?
more common in lower limbs
more chance of recovery if in upper limbs
what kind of Salter-Harris fractures involving the physes are most common?
what is shown here?
Ankle SH1
Often difficult to see particularly if undisplaced
