PAEDS - fractures

Question 1

What is epidemiology of fractures:

Answer 1

Risk Factors
Boys 60% > Girls 40%
Age (older more likely) 
Previous fracture (more likely) 
Metabolic bone disease (predispose to fracture) 
Season (more common in summer) 
80% fractures are in the forearm 
Most are from low velocity, low energy injuries

Question 2

Why do children fractures heal quickly

Answer 2

Metabolically active periosteum

Cellular bone (less mineral content)

Good blood supply

Often low velocity trauma

Question 3

What are the types of fractures

Answer 3

Complete fracture
Greenstick fracture
Buckle (torus)
Plastic deformity

Question 4

Describe Complete fracture

Answer 4

More common in adults

Question 5

Describe Greenstick fracture

Answer 5

Unique to children

Bone cracks on tension side and compression side is fine

Question 6

Describe Buckle (torus)

Answer 6

Longitudinal compression

All seen on xray is sliht convexity of bone

Stable and will not move under physiological loads

Need splint but then no real follow up and will heal well

Question 7

Describe Plastic Deformity

Answer 7

More rare

Seen on forearm

Bone bends but doesn’t return to normal after injury

Don’t remodel from this as periosteaum has been minimally

The bend encourages dislocation

Question 8

Whats the treatment for a children’s fracture

Answer 8

Reduce the fracture (if needed)

Immobilise

Remove cast/splint when healed

Joint stiffness rare

Open fractures debride

Question 9

When do you supplement the cast with fixation in children’s fracture

Answer 9

Severe swelling likely
-	Cast would compress blood supply
Need to re-inspect wound (e.g. open fractures)
Multiple injuries
Segmental limb injuries
Fracture very unstable
Approaching skeletal maturity

Question 10

Whats the risk of fracturing the physeal growth plate

Answer 10

Growth arrest risk if injured

Question 11

How do you assess fractures of the physeal growth plate

Answer 11

The Salter-Harris Classification helps to predict injuries that may affect growth

Question 12

What is a transitional fracture

Answer 12

Transitional fractures are fractures in adolescents where partial closure of the epiphyseal growth plate has occurred. These fractures are most commonly reported in the distal tibia.

Question 13

What is a Tillaux fracture

Answer 13

Can give asymmetrical growth arrest as one side of bone grows faster than the toher