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charis & ellie vs complete msk > Paediatric Trauma > Flashcards

Paediatric Trauma Flashcards

1
Q

what are the different orthopaedic injuries children experience?

A

Bones more elastic/pliable so tend to buckle or partially fracture/splinter rather than completely break

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2
Q

what children do we suspect NAI in if they get a fracture?

A

neonates and infants - under 2s not walking yet so hard for them to break a bone

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3
Q

when is conservative management not the first point of call in managing fractures in children?

A

-Displaced intra-articular fractures
-Displaced growth plate fractures
-Open fractures

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4
Q

general principles of fracture management

A

reduce retain rehabilitate

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5
Q

What should be looked for in a neurovascular exam?

A

colour
cap refill
skin temp.
O2 stats
pulse
sensation
sweating
skin wrinkling on immersion in water

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6
Q

how is a neurovascular issue diagnosed?

A

ultrasound
athrogram CT/MR for detail

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7
Q

what is a broad arm sling for?

A

Humerus

supports but no traction for shoulder, collar and cuff traction -

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8
Q

Management for a diaphyseal fracture?

A

immobilise joint above and below to prevent rotation

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9
Q

Management for a metaphyseal fracture?

A

immobilise the adjacent joint

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10
Q

risk with distal femur fracture?

A

risk of premature closing of the growth plate

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11
Q

when to use external fixation?

A

-Contaminated wounds
-Soft tissue problems
-Acute vascular injury
-Burns
-Multiple injuries

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12
Q

what is the use of periosteum?

A

A lot thicker and tends to stay intact useful for stability and can assist in reduction

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13
Q

what is the advantage of children’s thicker periosteum?

A

allows fractures to heal more quickly in children

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14
Q

what is the effect of children’s greater remodelling ability?

A

They grow with bone being formed along the line of stress

Children can correct angulation of up to 10 degrees per year of growth

Surgery is therefore performed less in children

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15
Q

what age do fractures get treated the same as adults?

A

Puberty (12-14 years)

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16
Q

Wolf’s law

A

bone in a healthy person/animal will adapt to the loads under which it is placed

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17
Q

Hueter-Volkmann law (used to explain scoliosis)

A

bone growth during skeletal immaturity is delayed by mechanical compression on the growth plate and accelerated by growth plate tension

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18
Q

What is the Salter-Harris classification for?

A

physeal fractures

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19
Q

Salter-Harris 1

A

pure physeal separation (best prognosis, least likely to cause growth arrest)

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20
Q

Salter-Harris 2

A

most common,
- Physeal fractures, has a small metaphyseal fragment attached to the physis and epiphysis
-Likelihood of growth disturbance is low

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21
Q

Salter-Harris 3 and 4

A

-Intra-articular fracture splits the physis
-Greater potential for growth arrest
-Fractures should be reduced and stabilised to ensure a congruent articular surface and minimise growth disturbance

22
Q

Salter-Harris 5

A

-Compression injury to the physis causes growth arrest
-Can’t be diagnosed initially on x-rays only detected once angular deformity has occurred

23
Q
A
24
Q
A
25
Q

common children’s fractures

A
  • Distal radius
    -Forearm
    -Supracondylar fractures of the elbow
    -Femoral shaft fractures
  • Tibial fractures
26
Q
A
27
Q

Distal radius - Greenstick fractures

A

-May be anguated
-May need manipulation and casting if there is significant deformity (esp in an older child)

28
Q

distal radius - salter harris II fractures

A

-Common around the distal radial physis in older children
-Angulation with deformity requires manipulation

29
Q

what do complete fractures of the distal radius do?

A

-May displace and angulate (dorsal more common than volar )

30
Q

Management of distal radius fractures

A

Stable: Casting

Unstable after reduction - may need more stabilisation or plate fixation

31
Q

what is a Monteggia fracture - dislocation?

A

fracture of proximal ulna with displacement of the radial head

32
Q

What is a Galeazzi fracture - dislocation?

A

Fracture of distal radius with dislocation of the distal radioulnar joint

33
Q

How are Monteggia and Galeazzi fractures managed?

A

-Anatomic reduction and rigid fixation with plates and screws

  • if only manipulation and casting is used there is a high rate of re-dislocation of the radial head/distal radio-ulnar joint (DRUJ)
34
Q

Undisplaced monteggia and galeazzi fractures

A

-Usually intact periosteum
-Instability may only be in one plane so can be controlled with a cast after manipulation

35
Q

displaced monteggia and galeazzi fractures

A

usually unstable

flexible IMN usually used

36
Q
A
37
Q

how are undisplaced supracondylar fractures of the elbow managed?

A

stablised and treated with splint

38
Q

how are angulated/rotated/displaced supracondylar fractures of the elbow managed?

A

-Closed reduction + pinning with wires to prevent deformity

-Open reduction may be needed where close reduction isn’t possible

39
Q

Test with off-ended extension type fractures in supracondylar fractures of the elbow?

A

patient is unable to make OK sign with hand

because the distal fragment displaces posteriorly causing pressure on the brachial artery and median nerve (mainly anterior interosseous branch of the median nerve)this result in loss of FPL and FDP to the index

40
Q

How are displaced fractures of supracondylar fractures of the elbow managed?

A

reduce early to avoid swelling -
(swelling makes reduction more difficult)

-If the radial pulse is absent/reduced in volume do EMERGENCY SURGERY

can do closed reduction with wiring, pulse may return if artery is no longer under stress

open surgery needed sometimes - if brachial artery is trapped in the fracture site OR if the hand remains pulseless after reduction

41
Q

what are the signs of and management of nerve injury and supracondylar fractures of the elbow?

A

Signs: neuralgic pain with no improvement -

URGENT theatre management - surgical release majority are neurapraxias sometimes axonotmesis

42
Q

how do children get femoral shaft fractures?

A

-Falling onto flexed knee
-Indirect bending/rotational forces

43
Q

femoral shaft fractures in less than 2s

A

mostly due to NAI/child abuse
Treat with Gallows traction and early hip spica cast

44
Q

Treatment of femoral shaft fractures in 2-6

A

Thomas splint
OR
Hip spica cast

45
Q

Treatment of femoral shaft fractures in 6-12s

A

Flexible IMN (can use as the femur is now large enough)
this will show if there is need for traction or cast

46
Q

femoral shaft fracture in over 12s

A

Adult type IMN

47
Q

What fracture is known as the toddlers fracture?

A

-Undisplaced tibial spiral fractures

Require a short time in cast

48
Q

what is the standard management for tibial fractures in children?

A

a cast

risk of compartment syndrome much less than an adult

49
Q

what level of tibial angulation is accepted in children after fracture?

A

10 degrees

50
Q

management of tibial fracture once in cast?

A

Serial X-rays in the cast
Make sure fracture doesn’t drift into excessive angulation

51
Q

How are unstable/open tibial fractures managed?

A

Flexible IMN (adolescents with a closed proximal tibial physis can have an adult type IMN)

Plates and screws

External fixation

charis & ellie vs complete msk (163 decks)

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