Trauma Flashcards
Why do children have unique patterns of fracture
Compressibility of bones
Increased fibrous strength of periosteum
Presence of physes (growth plates)
+ increased risk of non-accidental injury (Consider NAI with every child fracture)
Which fractures are common neonatally
Clavicle – from shoulder dystocia → great prognosis, no specific treatment needed
Humerus or femur – from breech delivery → heals rapidly with immobilisation
What are the types of fracture
Stable fracture = The broken ends of the bone line up and are barely out of place.
Open (compound) fracture = The skin may be pierced by the bone or by a blow that breaks the skin at the time of the fracture.
Transverse fracture = horizontal fracture line.
Oblique fracture = angled pattern.
Comminuted fracture = bone shatters into three or more pieces.
Spiral = bone is broken with a twisting motion, creating a fracture line that wraps around your bone and looks like a corkscrew
Avulsion = a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone
What is a greenstick fracture
Force applied in such a way that bone bends causing an incomplete fracture - common in <10y/o - both cortices affected => lot of pain
Common in the distal radius
note: buckle fracture = cortex remains intact
What is the Salter Harris classification for fractures
classification in relation to the growth plate
T1: Straight across
T2: Above
T3: Lower or BeLow
T4: Two or Through
T5: ERasure of the growth plate or cRush
T2 = most common (followed by T3)
T1 + 2 = good prognosis - no surgery needed , can sometimes need a cast/ splint/ sling
T3 - 5 = poor prognosis as proliferative and reserve zones are affected
T5 - may need surgery
Which fractures are most commonly associated with child abuse
Radial
Humeral
Femoral
Spiral fractures of long bones
Metaphyseal, posterior rib
Multiple fractures at different stages of healing
Fractures in non-walking babies
Uncommon: distal radial, elbow, clavicular, tibial
What is the ottawa ankle rule
X-ray only indicated if:
Pain in malleolar zone AND
- Bone tenderness at the posterior edge or tip of the lateral malleolus (A); OR
- Bone tenderness at the posterior edge or tip of the medial malleolus (B); OR
- An inability to bear weight both immediately and in the ED for four steps
Pain in the mid foot-zone AND
- Bone tenderness at the base of the fifth metatarsal (C); OR
- Bone tenderness at the navicular (D); OR
- An inability to bear weight both immediately and in the ED for four steps
What is the ottawa knee rule
X-ray only indicated if:
Age 55+; OR
Isolated patellar tenderness; OR
Cannot flex to 90 degrees; OR
An inability to bear weight both immediately and in the emergency department for four steps
What is the management for fractures
- Pain relief:
- <16yo: oral ibuprofen/paracetamol
- >16yo: paracetamol ± codeine ± IV morphine - Sedation for manipulation
- First line: nasal/PO midazolam/NO
- Second line: intranasal ketamine - Manipulation and reduction
What is the procedure for manipulation and reduction in the radius and the femur
Radial → elbow plaster cast/k-wire fixation
Femoral:
- Neonates: padded splints or Pavlik’s harness
- <18 months: Gallow’s traction
- 1-6yo: straight leg skin traction
- >4yo: intramedullary nail
Greenstick
Not displaced → splinting
Angulated → manipulation and plaster immobilisation
What is Jackson’s burn model
Zone of 9’s rule
The hand is 1% of the total body surface area
10-15% of TBSA burns requires fluid resuscitation
What is used to calculate fluid resuscitation in children for burns
Parkland’s formula
What is the management for burns
- Immediate assessment of major burns: A-E
- Further assessment and initial management
- Estimation of burn surface area
- Further management
- Relieve pain
- Maintain circulation
- Wound care
- Consider possibility of inflicted injury
- Psychological support
What should be assessed in the A-E assessment for burns
Airway and breathing- check for evidence of airway burns:
- Soot in the nasal or oral cavities
- Cough, hoarseness or stridor
- Coughing up black sputum
- Breathing and/or swallowing difficulty
- Blistering around or in the mouth
- Scorched eyebrows or hair
Early intubation if there is evolving airway swelling, intubation may become impossible with progressive obstruction of the airway
Circulation
- Early circulatory compromise is rarely due to the burn injury and other sources of fluid loss should be sort e.g. major haemorrhage
- In electrical burns, an ECG should be obtained
What is the first aid management for burns
Cool the area with running water for up to 20 minutes but avoid hypothermia
Chemical burns should be copiously irrigated
Plastic (cling film) wraps can be used after cooling to limit evaporation for the burnt area
