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Year 3 - Musculoskeletal > Paediatric trauma > Flashcards

Paediatric trauma Flashcards

1
Q

Is a male or female child more likely to experience trauma?

A

Boys

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2
Q

Risk factor surrounding paediatric trauma?

A 
Risk Factors:
> Boys 60% > Girls 40%
> Age
> Increased physeal injury with age
> Previous fracture
> Metabolic bone disease
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3
Q

Children’s fracture principles - Children’s fractures are often simple, incomplete & heal quickly, why?

A

Children’s fractures are often simple, incomplete & heal quickly:
> Metabolically active periosteum
> Cellular bone
> Plastic

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4
Q

Children’s fracture principles - Children’s fractures are often simple, incomplete & heal quickly - Application of management?

A

> Fixation is not usually required
Do not over immobilise
Do not over treat

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5
Q

Children’s fracture principles - Remodel well in plane of joint movement, why?

A

Remodel well in plane of joint movement:
> Appositional periosteal growth/resorption
> Differential physeal growth

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6
Q

Children’s fracture principles - Remodel well in plane of joint movement - Application of management?

A 
APPLICATION: 
> Younger child
> Polar fractures
> Intact growing physis
> Sagittal>Frontal X Transverse
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7
Q

FACT = Children’s fracture principles - A thick periosteal hinge is (usually) a friend…but needs to be understood

A

A thick periosteal hinge is (usually) a friend…but needs to be understood

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8
Q

FACT = Fractures involving physes can result in progressive deformity?

A

> Deformity - Elbow
Arrest – Knee, Ankle
(Overgrowth – Femur)

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9
Q

Forearm fractures in children site?

A

> Shaft fractures

> Special cases:

  • Galaezzi (Radius)
  • Monteggia (Ulna)

> Distal radius fractures

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10
Q

Type of Forearm fractures in children - Low energy?

A

> Buckle

> Greenstick

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11
Q

Type of Forearm fractures in children - High energy?

A

> Open
Displaced
Soft tissue injury

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12
Q

Type of Forearm fractures in children - High energy?

A

> Open
Displaced
Soft tissue injury

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13
Q

Assessment in a child fracture?

A

> History – Mechanism

> Deformity

> Soft tissues

  • Whole limb
  • Wounds
  • Sensation, Motor fcn
  • Vascular status
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14
Q

Outcome in closed fractures in children?

A

90-95% good functional results

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15
Q

Open fracture treatments in children?

A

Open/Flex nail
> Restored anatomy, early mobilisation

> Hardware migration, nerve injury, delayed union.

> 33% plate, 42% IM complication (Smith et al, JPO 2005)

> ‘Parental pressure for perfection’

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16
Q

What is the commonest cause of death in children ?

A

Trauma - 43% of deaths

17
Q

Epidemiology of fractures in children?

A 
Risk Factors: 
> Boys 60% > Girls 40%
> Age
> Increased physeal injury with age
> Previous fracture
> Metabolic bone disease
18
Q

Growth plate and trauma in children?

A

> Remodelling - Limited capacity to remodel in adults

> Physeal arrest Damage to the growth plate can lead to arrest and angular deformities or Length discrepancies

> Displacement - Slipped epiphysis

19
Q

Bone physiology and trauma in children?

A 
Increased:
Collagen
Porosity
Cellularity
Plasticity
20
Q

Periosteum physiology and trauma in children?

A

Periosteum

  • Metabolically active
  • Thick & strong
21
Q

Physiology of Growth plates, Bone and Periosteum?

A

> Better remodelling in sagittal but not in transverse allows less surgical repair need

>

22
Q

What technique is used to repair a fractures in children?

A

1) Reduce fracture

2) Three point fixation of the thick periosteal hinge using plaster

23
Q

What is the issue with damaging the physes of con in children?

A

Can lead to progressive deformity

24
Q

Why can a fracture of the physes in a femur lead to overgrowth?

A

Due to increased delivery of blood (Angiogenesis)

25
Q

Fracture of the radius is called what?

A

Galeazzi fracture

26
Q

Fracture of the ulna is called what?

A

Monteggia fracture

27
Q

Most common type of forearm fracture?

A

Distal radius/ulna fractures - 80%

28
Q

What is the cause of deforming forces within a fracture?

A

Action/attachments of the muscles - This is hard to predict but should be away

29
Q

Why is it important to test muscle, sensation and vascular status before intervention in child trauma?

A

Can use it to determine improvements or damage caused by intervention

30
Q

Surgical indications in forearm fractures of children - Not needed to learn?

A

1) <9y:
>15 angulation
>45 malrotation

2) >9y
proximal:
- >10 angulation
- >30 malrotation

distal:
- >15 angulation

3) Open #
4) Segmental
5) NV compromise
6) Failed closed Rx

31
Q

Principles of closed management of a fracture?

A

> Splint first = Stop pain

> Analgesia…Anaesthesia

> Reduce:

  • Disimpact
  • Bend force over apex

> Verify

> Well molded above elbow cast 4-6/52

> Check radiographs week 1, 2 & 4

> Change loose casts

> Remove when callus evident

> Restrict activity 3-4/12

32
Q

Why do we splint a forearm in a fracture?

A

Reduces pain

33
Q

Surgical options in fracture within a child?

A

> External fixator – rare, soft tissue issues
Flexible nailing
Plates
Screws

34
Q

Surgical options in fracture within a child - Flexible nailing, when?

A

> Need 2yrs predicted growth remaining
Nancy - Métaizeau
Allow early ROM
Wires out when healed

35
Q

Principles of closed management of fractures in a child?

A 
> Analgesia…Anaesthesia
> Reduce: 
- Disimpact
- Bend force over apex
> Well molded above elbow cast 4-6/52
> Check radiographs week 1, 2 &amp; 4
> Change loose casts
> Remove when callus evident
> Restrict activity 3-4/12

Year 3 - Musculoskeletal (30 decks)

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