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-MSK Diseases > 15. Paediatric Trauma > Flashcards

15. Paediatric Trauma Flashcards

1
Q

How many bones are in the:

  1. Adult Skeleton?
  2. Child Skeleton (at Birth)?
A
  1. 206

2. 270

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2
Q

What are the 3 broad categories of causes for Paediatric Fractures?

A
  1. Accidental (Sports)
  2. Non-Accidental
  3. Pathological
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3
Q

Where are the majority of Paediatric Fractures located?

A

Upper Limb

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4
Q

When do the different Elbow Ossifications occur?

A

CRITOE:
C - Capitellum - 1 Year Old
R - Radial Head - 3 Years Old
I - Internal (Medial) Epicondyle - 5 Years Old
T - Trochlea - 7 Years Old
O - Olecranon - 9 Years Old
E - External (Lateral) Eptcondyle - 11 Years Old

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5
Q

What is the definition of a Fracture?

A

A Breakage or Breaking in the continuity of Bone / Cartillage

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6
Q

What are the Key Components of describing a Fracture?

A
  1. What Type? (Transverse, Spiral, Buckle etc.)
  2. Of Which Part? (Proximal, Distal, Metaphyseal etc.)
  3. Of Which Bone?
  4. With How Much? (Angulation, Displacement, Shortening etc.)
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7
Q

What are the Different Types of Fracture?

A
  1. Transverse
  2. Oblique
  3. Spiral
  4. Backle
  5. Impacted
  6. Comminuted
  7. Greenstick
  8. Intra / Extra - Articular
  9. Butterfly
  10. Burst
  11. Crush
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8
Q

What is the most common type of fracture in 3-9 year olds?

A

Supracondylar Fracture of the Humerus

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9
Q

What is the most common cause of death in Children?

A

Trauma - 43%

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10
Q

Who more commonly gets Fractures in Paediatrics?

A
  1. Boys (3:2)
  2. Increased Physeal Injury with Age
  3. Those with a Previous Fracture / Metabolic Bone Disease
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11
Q

What are the Principles of Children’s Fractures?

A
  1. They are often simple, incomplete and heal quickly
  2. They remodel well in plane of Joint Movement
  3. They form a Thick Periosteal Hinge
  4. Fractures involving Physes can result in progresive Deformity
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12
Q

What are the common Forearm Fractures in Children?

A
  1. Shaft Fractures
  2. Special Cases:
  3. a) Galeazzi Fracture (Radial Shaft)
  4. b) Monteggia Fracture (Ulna Shaft)
  5. Distal Radial Fractures
    Note - 80% are Proximal Shaft Fractures
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13
Q

What is important in the Assessment of a Forearm Fracture in Paediatrics?

A
  1. History - Mechanism (Low Energy (Buckle / Greenstick vs High Energy (Open / Displaced / Soft Tissue Injury)
  2. Deformity
  3. Soft Tissue - Whole Limb, Wounds, Sensation / Motor Function, Vascular Status
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14
Q

What are the Surgical Indications for a Forearm Fracture in Paediatrics?

A

< 9 years old:

  1. > 15 Angulation
  2. > 45 Malrotation

> 9 years old:

  1. a) > 10 Angulation (Proximal)
  2. b) > 15 Angulation (Distal)
  3. > 30 Malrotation

Both: Open, Segmental, Neurovascular Compromise etc.

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15
Q

What are the Surgical Options for a Forearm Fracture in Paediatrics?

A
  1. External Fixation

2. Open Reduction Internal Fixation (ORIF)

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16
Q

What are complications of Surgery?

A
  1. Compartment Syndrome
  2. Non-Union / Re-fracture
  3. Radioulnar Synostosis
  4. Superficial Radial Nerve Injury
  5. Distal Radio-Ulnar Joint / Radiocapitellar Problems
17
Q

What is the management of a:

  1. Buckle Forearm Fracture?
  2. Greenstick Forearm Fracture?
  3. Complete Forearm Fracture?
A
  1. Cast - 3-4 weeks
  2. Cast - 4-6 weeks
  3. Cast +/- KW - 4-6 weeks
18
Q

What is the Differential for Knee Trauma?

A
  1. Infection
  2. Inflammatory Arthropathy
  3. Neoplasm
    Apophysitis
  4. Hip / Foot Problems
  5. Sickle Cell Anaemia, Haemophilia
19
Q

Where can Bony Injuries occur, in relation to the Knee Joint?

A
  1. Physeal (2 Femoral : 1 Tibial)
  2. Metaphyseal
  3. Tibial Spine / Tubercle
  4. Patellar Fracture (Rare)
  5. Sleeve Fracture
  6. Patellar Dislocation
20
Q

What can cause Injuries at the knee Joint?

A
  1. Hyperextension - Vascular Injury

2. Varus - Common Peroneal Nerve Injury

21
Q

What are the treatment options for a Knee Joint Injury?

A
  1. Cast immobilization
  2. Percutaneous Fix
  3. Open Reduction, Internal Fixation Articular Displacement
22
Q

What is the Treatment for a Patellar Fracture?

A

Open Reduction, Internal Fixation

23
Q

What are the Risk Factors for a Patellar Dislocation?

A
  1. Laxity
  2. Poor Vastus Medialis Oblique (VMO)
  3. Q Angle
  4. Femoral Anteversion
  5. Tibial External Rotation
  6. Patella Alta
24
Q

What is the Management of a Patellar Dislocation?

A
  1. Cast (2 weeks) - Repair Medial Ligament
  2. Mobilise - Lateral Release
  3. Vastus Medialis Oblique (VMO) Exercises - Medialise Tibial Tubercle, Semi Tenodesis
25
Q

What information do you need to know about Osteochondral Lesions?

A
  1. They are caused by a single traumatic indicent / developmental
  2. They are seen in plain films +/- MRI
  3. Type 1 (Cartilage intact) - Immobilize it
  4. Type 2 (Flap) and 3 (Fragment) - Drill / Fixation to fix it
26
Q

How is Anterior Knee Pain diagnosed?

A

Diagnosis of Exclusion - Rule out Inflammatory, Neoplasm etc.

27
Q

What is the most common plane of an Ankle Fracture?

A

Physis as it is weaker than Ligaments

28
Q

What are the different classifications of Ankle Fractures?

A
  1. Mechanistic

2. Anatomical (Salter-Harris)

29
Q

What are the Different Slater-Harris Classifications of Fractures?

A

Type 1 - Fracture Line is within the Physis
Type 2 - Extends from the Physis into the Metaphysis
Type 3 - Fracture enters the Epiphysis from the Physis
Type 4 - Fracture extends across the Physis, from the Articular Surface to the Epiphysis
Type 5 - Fractures are Crush Injuries of the Physis
Note - Type 2 is the most common

30
Q

How is an Ankle Injury assessed?

A
  1. History - Mechanism
  2. Deformity
  3. Soft Tissue
  4. Antero-Posterior + Lateral Radiographs
31
Q

What are the different Pitfalls, with regards to Ankle Injury?

A
  1. The Missed Fracture
  2. The Normal Variant
  3. Persistent Displacement - Sesamoid Healing
32
Q

What is the worries with Transitional Fractures of the Ankle?

A

Growth Plate Closing

33
Q

What are the 2 Overuse Injuries you may see in a child?

A
  1. Osgood-Schlatter’s Disease

2. Sever’s Disease

-MSK Diseases (43 decks)

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