paediatric trauma - NAI

Question 1

risk factors for fracture

Answer 1

boys 
age 
increased physeal injury with age
previous fracture 
metabolic bone disease

Question 2

most fractured part of body

Answer 2

forearm

Question 3

why are kids fractures often simple, incomplete and heal quickly?

Answer 3

metabolically active periosteum
cellular bone
plastic

Question 4

Application of the fact kids fractures are often simple, incomplete and heal quickly?

Answer 4

fixation not usually required
do not over immobilise
do not overtreat

Question 5

Do children’s bones remodel well in plane of joint movement?

Answer 5

yes

Question 6

Thick or thin periosteal hinge?

Answer 6

thick

Question 7

Effects of fractures at physes

Answer 7

elbow - deformity
arrest with knee/ankle
femur - overgrowth

Question 8

galeazzi forearm fracture

Answer 8

distal radius fracture and distal ru joint dislocated

Question 9

monteggia forearm fracture

Answer 9

shaft of ulna fracture and proximal head of radius dislocation

Question 10

% of part of forearm fractures

Answer 10

80% distal, 15% shaft and 5% head of radius

Question 11

Low energy forearm fractures

Answer 11

buckle and greenstick

Question 12

high energy forearm fractures

Answer 12

open, displaced, soft tissue injury

Question 13

soft tissues in fractures

Answer 13

vascular
wounds
whole limb
sensation and motor

Question 14

Complications of forearm fractures

Answer 14

compartment syndrome
5% non union and 5% refracture
PIN injury, superficial radial nerve injury
radioulnar systosis

Question 15

radioulnar systosis

Answer 15

proximal, high energy at same level, single incision

Question 16

buckle fracture of distal radius

Answer 16

failure of 1 cortex in compression

Question 17

distal radius greenstick fracture

Answer 17

failure of 1 cortex in compression and other cortex extension

Question 18

Managing buckle, greenstick and complete forearm fractures

Answer 18

B = cast for 3-4weeks
G = cast for 4-6 weeks 
C = cast +/- KW 6 weeks

Question 19

knee trauma differential

Answer 19

infection - neoplasm - inflammatory arthropathy - apophysitis - hip?foot? - haemophilia

Question 20

bony injury of knee areas

Answer 20

physeal/metaphyseal
tibila tubercle or spine
patellar fracture or dislocation
referred

Question 21

femoral or tibial - physeal injury of knee?

Answer 21

femoral 2: tibial 1

Question 22

Why is femur more susceptible to physeal injury?

Answer 22

distal femur below physis, prox tibia below physis

femur grows 11mm/yr, tibia 6mm/year

Question 23

causes of physeal knee injuries

Answer 23

hyperextension
vascular injury
varus

Question 24

treating knee physeal injury

Answer 24

immobilise with cast, percutaneous fix, ORIF

Question 25

managing physeal arrest

Answer 25

monitor - harris lines, angulation and length resect bar, epiphysiodesis (complete or contralateral) corrective osteotomy

Question 26

What ligament does the tibial spine overlap with?

Answer 26

ACL

Question 27

Meyers and mckeever tibial spine fracture and treatment

Answer 27

1 - undisplaced = long leg cast 2= hinged = long leg cast or ORIF 3 - displaced = ORIF

Question 28

ogden - tibial tubercle fracture

Answer 28

1 = distal avulsion 2 = to proximal tibial physis 3- to proximal tibial physis and into joint

Question 29

patellar fracture and treatment

Answer 29

rare - cartilaginous to age 4 undisplaced = cylinder cast displaced = ORIF

Question 30

patellar dislocation risk factors

Answer 30

``` tibial external rotation patella alta laxity poor vastus medialis oblique Q angle femoral anteversion ```

Question 31

managing patellar dislocation

Answer 31

cast 2/52 ligament mobilise VMO exercises repair VMO, lateral release,

Question 32

osteochondral lesions imaging

Answer 32

plain films - tunnel view - and MRI

Question 33

osteochondral lesions type 1,2,3 management

Answer 33

``` 1 = cartilage intact and immobilise 2 = flap and 3=fragment - drill/fix ```

Question 34

ankle growth/year

Answer 34

6mm

Question 35

Ottawa rules

Answer 35

ankle - lateral and medial view | bony tenderness and unable to weight bear

Question 36

additional views for the ankle to not miss lesions

Answer 36

oblique and mortise

Question 37

Managing SHI fractures - ankle

Answer 37

displaced <3mm = POP 6 | >3mm = MUA, POP 6

Question 38

SH2 ankle fracture management

Answer 38

<3mm POP 4+2, >3mm = MUA, POP

Question 39

managing SH3

Answer 39

undisplaced POP 6, displaced - open reduction and screws

Question 40

managing SH4

Answer 40

ORIF and monitor for growth arrest

Question 41

tillaux

Answer 41

external rotation, SH3, open or closed reduction

Question 42

triplane

Answer 42

external rotation, SH3 on AP and SH2 on lat = SH4 | CT ORIF