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Year 2- MSK > Paediatric Trauma > Flashcards

Paediatric Trauma Flashcards

1
Q

Risk factors for paediatric fractures?

A

Boys > girls (60:40%)
Age
Previous fractures
Metabolic bone disease
Season- usually summertime because off school, longer periods of day light

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2
Q

Why does childrens bone heal quicker than adults?

A

Good blood supply
Lot more cellular, less mineral content
Children don’t smoke

->because of this quick healing, fixation of fractures is not usually required

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3
Q

Complete fractures tend to occur more in adults. Which three types of fracture are only seen in children?

A

Greenstick fracture
Buckle fracture
Plastic deformation

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4
Q

Greenstick fracture?

A

Bone cracks on one side and not all the way through

->like snapping a twig where is kind of bends and doesn’t fully snap

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5
Q

Greenstick fractures tend to re-displace but only when?

A

All forces on them are taken off

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6
Q

Buckle fracture?

A

Usually due to longitudinal compression

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7
Q

What is seen on x-ray of a buckle fracture?

A

Slight concavity of the bone where the cortex has been compressed

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8
Q

Management of buckle fracture?

A

Simple splintage for a short period of time

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9
Q

Where are plastic deformability’s most commonly seen?

A

Forearm

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10
Q

What happens in plastic deformaility?

A

Bones have been caught between something and a force applied as a child falls meaning a sequence of small cracks along the bone causing it to bend

->e.g. if bones are caught between rungs of a ladder and then the child falls down the ladder

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11
Q

Plastic deformity injuries are rare.
What characteristics do we need to be aware of?

A

-Bone won’t tend to remodel as periosteum is disrupted
-Points at top and bottom of bone can dislocate and bend of the bone now encourages dislocation

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12
Q

Do most fractures in children require conservative or operative management?

A

95% of fractures only require conservative management

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13
Q

List some of the conservative treatment measures for paediatric fractures.

A

Casts
Braces
Splints
Traction

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14
Q

What are the two groups of operations for paed fractures?

A

Internal or external fixation

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15
Q

Why do the majority of children’s fracture require simple treatment?

A

They tend to remodel themselves

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16
Q

What type of bone growth occurs at the epiphyseal growth plate?

A

Longitudinal growth

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17
Q

What is one type of children’s fracture that will usually require intervention, usually traction?

A

Femoral fracture as if they are oblique or spiral, they tend to shorten down the muscle attached (hamstrings and quads)

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18
Q

Do children’s fractures usually require physio after the healing process?

A

Not usually, particularly in the upper limb
Elbow fractures will often require physio

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19
Q

If there is an open fracture, what is there risk of?

A

Infection

20
Q

How are open fractures treated?

A

Debridement

->the removal of sequestrate and resection of infected bone and soft tissue to improve the healing potential of the remaining healthy tissue

21
Q

Which part of the bone carries out the reduction of a fracture?

A

Periosteum

22
Q

Give some situations when the cast will need supplementing with fixation for children’s fractures.

A

Severe swelling likely
Need to re-inspect the wound e.g. open fractures
Multiple injuries
Segmental limb injuries
Fracture very unstable
Approaching skeletal maturity

23
Q

At approximately what age do girls stop growing?

A

14

24
Q

At approximately what age do boys stop gorwing?

A

16

25
Q

Physeal fractures?

A

Growth plate fractures
Often the weakest part of the bone

26
Q

What is the problem with physeal/growth plate fractures?

A

There is a risk of growth arrest

27
Q

Which classification helps to predict injuries which may affect growth?

A

Salter-Harris Classification

->SH type 3 + 4 injuries are at a much higher risk of growth disturbances, especially in lower limb

28
Q

If a child jumped out of a window and landed on their lower limb but did not have nay immediate injury, what could happen in the future?

A

There may be compression of the growth plate so may mean no further growth

29
Q

If there is a Salter-Harris type 3 injury, what is required?

A

Need for anatomical reduction and fixation if the fracture is displaced

30
Q

Apophysis?

A

Point where tendon inserts into bone

31
Q

Who is more likely to get a transitional fracture?

A

Ages 13-14 when the growth plates are closing

32
Q

Which order do the different parts of the growth plates close?

A

Central > Medial > Lateral fusion

33
Q

Describe what happens in a tillaux fracture.

A

Ligament connecting tibia and fibula is stronger than the actual bones in children so twisting movement can tear off part of the growth plate and growth arrest can occur.

->In adults, the ligament would tear instead but this ligament stronger than the bone in children

34
Q

External fixation as a surgical option is rarely required.
ORIF- open reduction and internal fixation- is indicated more often.
What are some of the indications of ORIF surgery?

A

Adolescents
Comminuted fractures (broken in two places)
Injuries involving the joint surface
Monteggia and Galeazzi fractures (fractures to radius and ulna)

35
Q

Before carrying out flexible nailing for fracture treatment, what needs to be made sure?

A

That the patient has at least 2 years of predicted growth remaining

36
Q

NAI?

A

Non-accidental injuries

->adult deliberately hurting a child, but often as a result of neglect or individuals with responsibility not knowing how to look after a child properly

37
Q

Warnings of a NAI?

A

Inconsistent history
Delay in presentation
Fracture pattern not fitting mechanism
Bruising- pattern and different ages
Burns
Multiple fractures at multiple stages of healing

38
Q

List some specific # sites which are warnings of NAIs.

A

Metaphyseal #
Humeral shaft #
Ribs #s
Non-ambulant with long bone #

39
Q

Where does acute osteomyelitis usually occur in children?

A

Around the knee

40
Q

Osteomyelitis?

A

Infection of bone

41
Q

What do most cases of acute osteomyelitis require?

A

Prolonged high dose antibiotics, aim to prevent turning chronic

42
Q

Osteomyelitis has an insidious onset- what does this mean?

A

A condition which comes on slowly and does not have symptoms at first

->frequently, children will fall and injure themselves and be fine but will develop symptoms a couple of days later e.g. pain. Then the child develops systemic symptoms.

43
Q

What is the most common causative microorganism of acute osteomyelitis?

A

Staph aureus

44
Q

What can osteomyelitis then become?

A

Septic arthritis if abscess which has burst into a joint

45
Q

What is usually done in patients with acute osteomyelitis prior to commencing the high dose antibiotics?

A

Blood cultures

46
Q

Infection does not require surgery if caught early enough. If the child does not settle however, what needs to be done?

A

Decompression of periosteum using intraosseous needles to supply fluid to bone

->note that osteomyelitis can threaten life and limb

47
Q
A

Year 2- MSK (36 decks)

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