Paediatric_Fractures_Flashcards

Question 1

What is a complete fracture in paediatric patients?

Answer 1

A complete fracture is when both sides of the cortex are breached.

Question 2

What is a toddlers fracture?

Answer 2

A toddlers fracture is an oblique tibial fracture in infants.

Question 3

What is a plastic deformity in paediatric fractures?

Answer 3

A plastic deformity is stress on the bone resulting in deformity without cortical disruption.

Question 4

What is a greenstick fracture?

Answer 4

A greenstick fracture is a unilateral cortical breach only.

Question 5

What is a buckle (‘torus’) fracture?

Answer 5

A buckle (‘torus’) fracture is an incomplete cortical disruption resulting in periosteal haematoma only.

Question 6

What are growth plate fractures classified according to?

Answer 6

Growth plate fractures are classified according to the Salter-Harris system.

Question 7

What is a type I growth plate fracture?

Answer 7

A type I growth plate fracture is a fracture through the physis only (x-ray often normal).

Question 8

What is a type II growth plate fracture?

Answer 8

A type II growth plate fracture is a fracture through the physis and metaphysis.

Question 9

What is a type III growth plate fracture?

Answer 9

A type III growth plate fracture is a fracture through the physis and epiphysis to include the joint.

Question 10

What is a type IV growth plate fracture?

Answer 10

A type IV growth plate fracture is a fracture involving the physis, metaphysis, and epiphysis.

Question 11

What is a type V growth plate fracture?

Answer 11

A type V growth plate fracture is a crush injury involving the physis (x-ray may resemble type I, and appear normal).

Question 12

What is the general rule regarding growth plate tenderness?

Answer 12

It is safer to assume that growth plate tenderness is indicative of an underlying fracture even if the x-ray appears normal.

Question 13

What types of growth plate injuries usually require surgery?

Answer 13

Types III, IV, and V growth plate injuries usually require surgery.

Question 14

What are signs of non-accidental injury in paediatric fractures?

Answer 14

Signs of non-accidental injury include delayed presentation, delay in attaining milestones, lack of concordance between proposed and actual mechanism of injury, multiple injuries, injuries at sites not commonly exposed to trauma, and children on the at-risk register.

Question 15

What genetic condition can cause pathological fractures?

Answer 15

Genetic conditions such as osteogenesis imperfecta can cause pathological fractures.

Question 16

What is osteogenesis imperfecta?

Answer 16

Osteogenesis imperfecta is defective osteoid formation due to a congenital inability to produce adequate intercellular substances like osteoid, collagen, and dentine.

Question 17

What are the subtypes of osteogenesis imperfecta?

Answer 17

Subtypes of osteogenesis imperfecta include Type I (normal quality but insufficient quantity of collagen), Type II (poor collagen quantity and quality), Type III (collagen poorly formed, normal quantity), and Type IV (sufficient collagen quantity but poor quality).

Question 18

What is osteopetrosis?

Answer 18

Osteopetrosis is a condition where bones become harder and more dense, typically autosomal recessive, and most common in young adults.

Question 19

What are the initial pain management options for paediatric fractures?

Answer 19

Initial pain management options for paediatric fractures include oral ibuprofen and/or paracetamol for mild to moderate pain and IV opioids for severe pain.

Question 20

What is the management for distal radius fractures in the emergency department?

Answer 20

Management for distal radius fractures in the emergency department may include manipulation, a below-elbow plaster cast, and K-wire fixation if the fracture is completely displaced (off-ended).

Question 21

What is the management for femoral shaft fractures in paediatric patients?

Answer 21

Management for femoral shaft fractures includes admitting all children and considering various treatments according to age and weight, such as simple padded splint, Pavlik’s harness, Gallows traction, straight leg skin traction, elastic intramedullary nail, or submuscular plating.

Question 22

What should be considered in ongoing orthopaedic management of paediatric fractures?

Answer 22

Ongoing orthopaedic management should consider non-accidental injury.

Question 23

summarise fractures

Answer 23

Non accidental injury
Delayed presentation
Delay in attaining milestones
Lack of concordance between proposed and actual mechanism of injury
Multiple injuries
Injuries at sites not commonly exposed to trauma
Children on the at risk register

Pathological fractures

Genetic conditions, such as osteogenesis imperfecta, may cause pathological fractures.

Osteogenesis imperfecta
Defective osteoid formation due to congenital inability to produce adequate intercellular substances like osteoid, collagen and dentine.
Failure of maturation of collagen in all the connective tissues.
Radiology may show translucent bones, multiple fractures, particularly of the long bones, wormian bones (irregular patches of ossification) and a trefoil pelvis.

Subtype of osteogenesis imperfecta
Type I - The collagen is normal quality but insufficient quantity.
Type II - Poor collagen quantity and quality.
Type III - Collagen poorly formed. Normal quantity.
Type IV - Sufficient collagen quantity but poor quality.

Osteopetrosis
Bones become harder and more dense.
Autosomal recessive condition.
It is commonest in young adults.
Radiology reveals a lack of differentiation between the cortex and the medulla described as marble bone.

Fractures

Initial pain management and immobilisation
- Oral ibuprofen and/or paracetamol for mild to moderate pain
- IV opioids for severe pain
 Acute stage assessment and diagnostic imaging

Management in the emergency department
Distal radius fractures
Manipulation
Consider
a below-elbow plaster cast
K-wire fixation if the fracture is completely displaced (off-ended).

Femoral shaft fractures
Admit all children and consider according to age and weight:
Prematurity and birth injuries: simple padded splint
0 to 6 months: Pavlik’s harness or Gallows traction
3 to 18 months: Gallows traction
1 to 6 years: straight leg skin traction with possible conversion to hip
spica cast to enable early discharge
4 to 12 years: elastic intramedullary nail
11 years to skeletal maturity (weight more than 50 kg): elastic intramedullary nails supplemented by endcaps, lateral- entry- antegrade rigid intramedullary nail, or submuscular
plating.

Ongoing orthopaedic management
 Consider non-accidental injury

Question 24

Lazs summary on fractures

Answer 24