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Child Health > Paediatric trauma (MSK cortex) > Flashcards

Paediatric trauma (MSK cortex) Flashcards

1
Q

How are children’s bones differen from adult’s?

A
  • more elastic and pliable
  • tend to buckle or partially fracutre or splinter rather than break
  • periosteum is thicker (tends to remain intact)
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2
Q

When are children’s fractures treated like adult’s?

A

puberty (12-14)

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3
Q

Children’s fractures heal more quickly than adults due to?

A

Thicker peristeum

more osteoblasts

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4
Q

What is remodelling?

A

grow with bone being formed along the line of stress - changing shape

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5
Q

after fracture children can correct angulation up to 10° per year of growth remaining in that bone

A

T

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6
Q

children’s fractures tend to be surgically stabilized less frequently and greater degrees of displacement or angulation can be accepted

A

T

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7
Q

If the fracture position is unaccepatable then manipulation and casting may be all that is required

A

T

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8
Q

What effect do fractures around the physis have?

A

physis = growth plate
disturb growth if one sided
- short limb
-angular deformity

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9
Q

What is a Salter-Harris I fracture?

A

pure physeal separation

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10
Q

What is a Salter-Harris II fracture?

A

Mostly pure physeal seperation with small metaphyseal fragment attached to the physis and epiphysis

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11
Q

What are Salter‐Harris III and IV fractures?

A

intra‐articular and with the fracture splitting the physis

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12
Q

What is a Salter‐Harris V injury

A

compression injury to the physis with subsequent growth arrest

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13
Q

Which salter-harris injury/fracture carries the best prognosis?

A

Salter‐Harris I - least likely to result in growth arrest

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14
Q

Which salter-harris injury/fracture is the commonest?

A

Salter-Harris II

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15
Q

Salter-Harris II has a - prognosis

A

good - likelihood of growth disturbance is low

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16
Q

How should Salter‐Harris III and IV fractures be treated?

A

Often require open reduction and internal fixation as whole bits of bone have been torn off (intraarticular, usually displaced)
reduction - corrects displacement
fixation - encourages growth/healing

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17
Q

Salter‐Harris V injury cannot be diagnosed on initial x‐rays

A

T

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18
Q

When can Salter‐Harris V injury be detected?

A

once angular deformity has occurred.

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19
Q

Signs on on-accidental injury?

A
  • Inconsistent / changing history of events
  • Discrepancy of history between parents / carers
  • History not consistent with injury
  • Injuries not consistent with age of child eg non walking child
  • Multiple bruises of varying ages
  • Atypical injuries eg cigarette burns, genital injuries, torn frenulum, dental injuries, lower limb
  • and trunk burns
  • Rib fractures
  • Metaphyseal fractures in infants
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20
Q

Where do children’s fractures commonly occur?

A
  • distal radius
  • Supracondylar space of elbow
  • Femoral shaft
  • tibia
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21
Q

Which types of fractures commonly occur in the distal radius?

A

buckle, greenstick and Salter‐Harris II
salter harris 2 is fractyre above physis into metaphysis
buckle fracture is plastic deformity on one side (stable)
greenstick fracture is plastic deformity on one side and fracture on other (usually at a funny angle)

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22
Q

Distal radius buckle fracture treatment?

A

External fixation via 3‐4 weeks of splintage (immoblise wrist)

23
Q

Distal radius greenstick fracture treatment?

A

may be angulated if unstable
may require OPEN manipulation if there is significant deformity, particularly in the older child
casting and splintage for healing

24
Q

Distal radius Salter‐Harris II fracture treatment?

A

Angulation with deformity requires manipulation. Growth problems are highly unlikely
closed manipulation and plaster cast usually

25
Q

If a complete fracture is very unstable after reduction, wire stabilization or plate fixation may be employed.

A

T

26
Q

Complete fractures may displace as well as angulate with - displacement and angulation more common than -.

A

dorsal, volar

27
Q

In complete fractures the dorsal periosteum usually remains intact, this prevents what?

A

overcorrection of deformity and aids stability

28
Q

Monteggia and Galeazzi fracture‐dislocations can occur in children and adults

A

T

29
Q

How are Monteggia and Galeazzi fracture‐dislocations managed in children?

A

anatomic reduction and fixation with plates and screws

30
Q

In Monteggia and Galeazzi fracture‐dislocations what increases the risk of re‐dislocation of the radial head or distal radio-ulnar joint ?

A

treatment consisting only of manipulation and casting

31
Q

What are the usual features of angulated fractures of both bones of the forearm?

A

Intact periosteum

Instability in one plane - can be controlled with a cast after manipulation

32
Q

How are displaced fractures of both bones of the forearm treated?

A

flexible intramedullary nail as they are usually unstable

33
Q

Which part of the humerus is weak in the growiing upper limb?

A

supracondylar region of distal humerus

34
Q

In the elbow, which type of fractures are more common?

A

Extension type fractures are more common and occur due to a heavy fall onto the outstretched hand

35
Q

How does an injury of flexion occur in the elbow?

A

fall onto the point of the flexed elbow.

36
Q

How are undisplaced fratures of the elbow treated?

A

a splint

37
Q

How are Angulated, rotated or displaced fractures of the elbow treated?

A

closed reduction and pinning with wires to prevent deformity

38
Q

What is a complication of severely displaced / off‐ended fractures of the elbow?

A

Tethering of brachialis muscle to the fracture site

39
Q

How are severely displaced / off‐ended fractures of the elbow treated?

A

open reduction (due to ttehtering of brachialis muscle) may be required

40
Q

What are the TWO major concerns with reducing elbow fractures?

A
  • Pressure on brachial artery, if radial pulse absent require urgent surgical intervention
    can try closed reduction with wiring before tho
  • Median nerve pressure, predominantly anterior interrosus branch, check if patient can use FPL and FDL to make an OK
    check ONGOING neuralgic pain no improvement with time
41
Q

Neuropraxia requires immediate surgical attention

A

F

Neruopraxia is temporary loss of nerve conduction, improves with time

42
Q

How do femoral shaft fractures most often occur?

A

fall onto a flexed knee or by indirect bending or rotational forces.

43
Q

In femoral shaft fractures, limbs get shorter

A

F

overgrowth often occurs, some surgical shortening can be accepted w young hildred

44
Q

What is the commonest cause of a femoral shaft fracture in children less than 2 years old?

A

Non accidental injury

45
Q

How is a femoral shaft fracture in children less than 2 years old treated?

A

Gallows traction followed by hip sica cast

46
Q

How is a femoral shaft fracture in children aged between 2 and 6 treated?

A

Thomas splint or a hip spica cas

47
Q

How is a femoral shaft fracture in children aged between 6 and 12 treated?

A

flexible intramedullary nails - femur ;large enough for this, no need traction or cast

48
Q

How is a femoral shaft fracture in a children aged 12+ treated?

A

adult type intramedullary nail

49
Q

What is a “toddler’s fracture”?

A

Undisplaced spiral fractures of the tibial shaft

50
Q

How are undisplaced spiral fractures of tibial shaft treated?

A

short time in cast

51
Q

Management in a cast is the mainstay for the majority of children’s tibial fractures. The risk of compartment syndrome is much less than that for an adult

A

T

52
Q

In tibial shaft fractures Up to 10° of angulation may be accepted and greater degrees of angulation may be treated with manipulation and casting

A

T

53
Q

After casting a tibial fractures - what next?

A

Serial xrays in the cast are required to ensure that the fracture does not drift
Shortening or malrotation should not be accepted

54
Q

Unstable or open fractures of the tibial shaft can be treated with?

A

flexible intramedullary nails, or external fixation. Adolescents with a closed physis can have an adult type intramedullary nail.

Child Health (4 decks)

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