Pediatric Extremity Injuries Flashcards
Why are children’s fractures important?
More common
More often with minimal trauma
Physeal disruptions 15%
May lead to growth disturbance
Physis constantly undergoes change with growth
67% of growth of legs from physis around ________
80% of growth of arm from __________
knee
proximal humerus and distal radial physis
Salter Classification
Growth plate injury classification
As go up in number, growth distrubance increases
Salter 3, 4 tx
require anatomic reduction- intraarticular
Complication of kids fractuers
Physeal arrest- close follow-up needed for 1-2 years
Articular injury
Remodeling
Propensity of long bones to return to anatomic position with growth
Osteoclasts and osteoblasts active (possibly also do to intact periosteal sleeve - remembers position when reducing fractures)
Remodeling helps w/
Children with 2 or more years of predicted growth
Fractures near the bone ends e.g.. Distal femur, Distal radius
Deformity in the plane of motion of the joint
Translation or bayonet position without shortening will remodel
Remodeling doesn’t help
Displaced intraarticular fractures
Malrotated fractures
Fractures with angulation out of the plane of motion
General principles of fracture care
Determine and Describe injury
Displacement
Angulation
Shortening
Opposition (% portion bones touching)
Open
Closed
Immobilization of Fracture
Splint to immobilize joint above and below
If fracture is to be reduced
Appropriate anesthesia
Reverse mechanism of injury
Gentleness important in physeal fractures
SHoulder joint remodeling
Broad range of motion
Proximal humeral physis
Large growth potential
Expect remodeling
Complications of distal humerus fracture/surgery
Neuropraxia 5-9%
Radial
Anterior interosseous
Vascular Injury
Worry w/ forearm fracutres
pronation, supination
Femur fracture tx
Lower energy/young children/less initial shortening –> Immediate Spica Cast
10days-3 wk traction - less well tolerated in older children
Femure fracutre, surgery if
Multiple trauma
Head Injury
Open fracture
Vascular injury
Pathologic fracture
Distal Femoral Physeal Fractures
Occur from valgus stress
Most frequent in adolescents
Watch for growth arrest (Salter)
Proximal tibial physis complications
High incidence of vascular injury
unstable
Grow valgum then straight
Tibial eminence injury
Common bicycle injury
Epiphyseal and articular fracture
Where ACL inserts - tears up part of bone
Treatment
Type I- immobilization
Type II- reduction in extension
Type III- open reduction, internal fixation with arthroscopy
Patellar sleeve fracture
Unique to children
Difficult to make diagnosis – can’t see!
Cartilagenous portion on patella avulses
Requires open reduction
Tibia fractures
Toddler’s fractures - can’t see usually on Xray
Proximal tibial metaphyseal fractures
Treat as a break - 10 days - then can see periosteal rxn
Tibia shaft fractures
Majority- closed reduction
Long leg casting, Weight-bearing cast when stable
Worry about ______ w/ tibia fractures
Compartment syndrome – PAin out of proportion
Ankle fracture types
Tillaux - pull off ligaments (avulsion)
Triplane - metaphysis into epiphysis
Nursemaid’s Elbow
Mechanism: longitudinal traction
Responds to simple manipulation
Occasionally requires immobilization if recurrent
**Need the story - otherwise don’t manipulate
**Not a fracture, NEVER HAVE SWELLING
Dislocation of elbow - anular ligament
Physeal injury more common in _______ (and why)
males (vs. females) because male physis open longer (and physeal plate weakest in adolescents)
