paediatric trauma - NAI Flashcards
risk factors for fracture
boys age increased physeal injury with age previous fracture metabolic bone disease
most fractured part of body
forearm
why are kids fractures often simple, incomplete and heal quickly?
metabolically active periosteum
cellular bone
plastic
Application of the fact kids fractures are often simple, incomplete and heal quickly?
fixation not usually required
do not over immobilise
do not overtreat
Do children’s bones remodel well in plane of joint movement?
yes
Thick or thin periosteal hinge?
thick
Effects of fractures at physes
elbow - deformity
arrest with knee/ankle
femur - overgrowth
galeazzi forearm fracture
distal radius fracture and distal ru joint dislocated
monteggia forearm fracture
shaft of ulna fracture and proximal head of radius dislocation
% of part of forearm fractures
80% distal, 15% shaft and 5% head of radius
Low energy forearm fractures
buckle and greenstick
high energy forearm fractures
open, displaced, soft tissue injury
soft tissues in fractures
vascular
wounds
whole limb
sensation and motor
Complications of forearm fractures
compartment syndrome
5% non union and 5% refracture
PIN injury, superficial radial nerve injury
radioulnar systosis
radioulnar systosis
proximal, high energy at same level, single incision
buckle fracture of distal radius
failure of 1 cortex in compression
distal radius greenstick fracture
failure of 1 cortex in compression and other cortex extension
Managing buckle, greenstick and complete forearm fractures
B = cast for 3-4weeks G = cast for 4-6 weeks C = cast +/- KW 6 weeks
knee trauma differential
infection - neoplasm - inflammatory arthropathy - apophysitis - hip?foot? - haemophilia
bony injury of knee areas
physeal/metaphyseal
tibila tubercle or spine
patellar fracture or dislocation
referred
femoral or tibial - physeal injury of knee?
femoral 2: tibial 1
Why is femur more susceptible to physeal injury?
distal femur below physis, prox tibia below physis
femur grows 11mm/yr, tibia 6mm/year
causes of physeal knee injuries
hyperextension
vascular injury
varus
treating knee physeal injury
immobilise with cast, percutaneous fix, ORIF
managing physeal arrest
monitor - harris lines, angulation and length
resect bar, epiphysiodesis (complete or contralateral)
corrective osteotomy
What ligament does the tibial spine overlap with?
ACL
Meyers and mckeever tibial spine fracture and treatment
1 - undisplaced = long leg cast
2= hinged = long leg cast or ORIF
3 - displaced = ORIF
ogden - tibial tubercle fracture
1 = distal avulsion
2 = to proximal tibial physis
3- to proximal tibial physis and into joint
patellar fracture and treatment
rare - cartilaginous to age 4
undisplaced = cylinder cast
displaced = ORIF
patellar dislocation risk factors
tibial external rotation patella alta laxity poor vastus medialis oblique Q angle femoral anteversion
managing patellar dislocation
cast 2/52 ligament
mobilise
VMO exercises
repair VMO, lateral release,
osteochondral lesions imaging
plain films - tunnel view - and MRI
osteochondral lesions type 1,2,3 management
1 = cartilage intact and immobilise 2 = flap and 3=fragment - drill/fix
ankle growth/year
6mm
Ottawa rules
ankle - lateral and medial view
bony tenderness and unable to weight bear
additional views for the ankle to not miss lesions
oblique and mortise
Managing SHI fractures - ankle
displaced <3mm = POP 6
>3mm = MUA, POP 6
SH2 ankle fracture management
<3mm POP 4+2, >3mm = MUA, POP
managing SH3
undisplaced POP 6, displaced - open reduction and screws
managing SH4
ORIF and monitor for growth arrest
tillaux
external rotation, SH3, open or closed reduction
triplane
external rotation, SH3 on AP and SH2 on lat = SH4
CT ORIF
