PED FX NON-ACCIDENTAL TRAUMA IN KIDS

Question 1

ends of long bones; under

compressive forcesradiolucent

Answer 1

Physis

Question 2

center of ossification at bony

prominence; traction

Answer 2

Apophysis

Question 3

thicker/stronger-quick callus

Answer 3

Periosteum

Question 4

characteristics of kids bones?

Answer 4

bones less dense, more porous

weak with compressive and tension forces

remodeling at fx site; increases near physis

Question 5

this view is key to check for

subtle buckle fractures

Answer 5

Lateral view

Question 6

what are the unique fxs in kids?

Answer 6

buckle
bow
greenstick
complete

Question 7

what is this fx?

❖Occur in porous metaphysis-force compresses; longitudinal plane

❖Lack swelling, ecchymosis

❖Stable fxs, don’t displace;
splint for pain relief, arrange f/u

Answer 7

buckle

Question 8

what is this fx?

❖Usually in ulna / fibula; radius also

❖Elastic deformation with stress; if forces subside, no true fracture

❖Known as plastic deformation

❖No hemorrhage, limited swelling

❖Comparison views may confirm

Answer 8

bow

Question 9

what is this fx?

❖Angulation past bending limits yields greenstick;
fx on tension side as compression side bends

❖Completion of fx may be necessary

Answer 9

green stick

Question 10

what is this fx?

❖Complete fxs rarely have
comminution

❖Beware of unexplained
spiral fxs especially humerus

Answer 10

complete

Question 11

types of growth plate FX?

Answer 11

II-most common
III-into epiphysis
IV-thru metaphysis/epiphysis
V-crush plate

Question 12

what is this fracture?

❖Typical: toddler lands on shoulder
❖Greensticks occur in mid-third area
❖Treat with comfort measures
❖Sling, ice, meds
❖No figure of 8!
❖Neonates present with healing callus following
difficult delivery
❖Humeral head fractures uncommon

Answer 12

clavicle fx

Question 13

what is this?

❖Common between 4 mos-7 yrs; peak at 15-30 months
❖Girls, left arms affected more
❖Annular ligament torn, dislocated
❖Variety of history; pulling theme
❖No swelling or ecchymosis
❖Kids hold wrist
❖Cry elevates with supination

Answer 13

nursemaids elbow

Question 14

2nd most common fx seen in children?

Answer 14

skull fx; usually linear

Question 15

what is this syndrome?

• Parent or caretaker complains of illnesses or symptoms of child
which are falsified
• Child may undergo unnecessary test, procedures or hospitalizations
• When in hospital, “symptoms” are not observed
• In reality, a form of child abuse

Answer 15

MUNCHAUSEN SYNDROME BY PROXY

Question 16

name this disease?

• Has been used as defense /legal

• X-ray findings: osteopenia, bone deformities, no classic
metaphyseal fractures

• Blue sclera seen in may cases
• Culture fibroblasts - skin biopsy
• DNA based sequencing

Answer 16

OSTEOGENESIS

IMPERFECTA

Question 17

other physical findings?

Answer 17

o Patterned bruises are ominousbelt,
hand, linear

o Burns: stocking glove distribution

o Burns in shape of objects

o Retinal hemorrhages with shaken baby syndrome, subdural
hematomas / cerebral edema