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Skin MS: Week 7 > Pediatric Extremity Injuries > Flashcards

Pediatric Extremity Injuries Flashcards

1
Q

Why are children’s fractures important?

A

More common

More often with minimal trauma

Physeal disruptions 15%

May lead to growth disturbance

Physis constantly undergoes change with growth

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2
Q

67% of growth of legs from physis around ________

80% of growth of arm from __________

A

knee

proximal humerus and distal radial physis

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3
Q

Salter Classification

A

Growth plate injury classification

As go up in number, growth distrubance increases

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4
Q

Salter 3, 4 tx

A

require anatomic reduction- intraarticular

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5
Q

Complication of kids fractuers

A

Physeal arrest- close follow-up needed for 1-2 years

Articular injury

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6
Q

Remodeling

A

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)

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7
Q

Remodeling helps w/

A

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

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8
Q

Remodeling doesn’t help

A

Displaced intraarticular fractures

Malrotated fractures

Fractures with angulation out of the plane of motion

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9
Q

General principles of fracture care

A

Determine and Describe injury

Displacement

Angulation

Shortening

Opposition (% portion bones touching)

Open

Closed

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10
Q

Immobilization of Fracture

A

Splint to immobilize joint above and below

If fracture is to be reduced

Appropriate anesthesia

Reverse mechanism of injury

Gentleness important in physeal fractures

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11
Q

SHoulder joint remodeling

A

Broad range of motion

Proximal humeral physis

Large growth potential

Expect remodeling

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12
Q

Complications of distal humerus fracture/surgery

A

Neuropraxia 5-9%

Radial

Anterior interosseous

Vascular Injury

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13
Q

Worry w/ forearm fracutres

A

pronation, supination

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14
Q

Femur fracture tx

A

Lower energy/young children/less initial shortening –> Immediate Spica Cast

10days-3 wk traction - less well tolerated in older children

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15
Q

Femure fracutre, surgery if

A

Multiple trauma

Head Injury

Open fracture

Vascular injury

Pathologic fracture

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16
Q

Distal Femoral Physeal Fractures

A

Occur from valgus stress

Most frequent in adolescents

Watch for growth arrest (Salter)

17
Q

Proximal tibial physis complications

A

High incidence of vascular injury

unstable

Grow valgum then straight

18
Q

Tibial eminence injury

A

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

19
Q

Patellar sleeve fracture

A

Unique to children

Difficult to make diagnosis – can’t see!

Cartilagenous portion on patella avulses

Requires open reduction

20
Q

Tibia fractures

A

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

21
Q

Worry about ______ w/ tibia fractures

A

Compartment syndrome – PAin out of proportion

22
Q

Ankle fracture types

A

Tillaux - pull off ligaments (avulsion)

Triplane - metaphysis into epiphysis

23
Q

Nursemaid’s Elbow

A

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

24
Q

Physeal injury more common in _______ (and why)

A

males (vs. females) because male physis open longer (and physeal plate weakest in adolescents)

25
Q

Distal or proximal humerus more involved

A

distal usually (except proximal humerus)

26
Q

Worry about _______ in supracondyle fracture

A

Nerve (median, radial, ulnar) and artery injury (brachial)

27
Q

Supracondylar Humerus Fracture

A

Above epicondyles - from olecranon breaking it off or direct force

Classified -

type 1 - nondisplaced

type 2 - distal fragment extended

type 3 - marked displaced

28
Q

Tibia fractures - open tx indications

A

Open fracture

Unstable fracture pattern

Compartment syndrome – pain out of proportion

Vascular injury

Skin MS: Week 7 (5 decks)

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