Paediatric Trauma (including NAI) Flashcards
Which bones are most commonly fractured by paediatric patients? What are some risk factors for paediatric fractures?
Forearm fractures are the most common
- More common in boys
- The older the child the more vulnerable to fracture
- Previous fracture
- Metabolic bone disease
- Season: fractures more common in summer
What are some of the reasons why children’s fractures heal quicker than adults?
- More metabolically active periosteum
- Cellular bone (less minerals more active cells)
- Good blood supply to bone
- Children tend to suffer fractures from low velocity trauma (fall instead of car accident) which damages associated soft tissue less = quicker recovery
What are the 4 types of fracture that can occur in children? Brief description of each?
- Complete fracture: fragments completely dissociated
- Greenstick fracture: bone cracks on tension side but remains intact on compression side - partial fracture
- Buckle (torus): due to longitudinal compression, slight convexity on X-Ray
- Plastic deformity: due to bone being bent, several cracks along the bone gives bent shape - don’t tend to remodel well
How do Buckle fractures tend to be managed?
Splintage or cast
- Don’t tend to require surgery or regular checkup
What are the general parts of the clinical assessment of a paediatric fracture?
- History: what was the mechanism of injury?
- Deformity: visually assess the deformity
- Soft tissue assessment: look at the whole limb, inspect wounds, test sensation, motor function and vascular status
What percentage of paediatric fractures tend to require operative treatment?
Around 5%
95% can be treated by conservative measures
What are some examples of conservative treatments that can be used to repair paediatric fractures?
- Casts
- Braces
- Splints
- Traction
Why do children’s fractures tend to be able to be managed via conservative measures?
Because children’s fractures remodel well due to:
- Appositional growth & resorption: tends to smooth things out
- Differential physeal growth (children grow at the physis (growth plate) which gives them greater remodelling potential)
- Fractures in plane of distal joint movement tend to heal better
How do you reduce a children’s fracture? Why is this the case?
Need to increase the deformity to reduce the fracture
This is because of the periosteal hinge, even if the bones are displaced the periosteum is still attached on one side and acts like a hinge
Why can children need a bent cast to ensure they end up with a straight bone?
Because in some fractures (esp. greenstick) the bone tends to return to it’s displaced position even after reduction
A bent cast can provide uneven force to oppose this
What are some indications for fixation in addition to / instead of casting?
- High likeliness of severe swelling
- If the wound needs to be re-inspected
- Multiple injuries
- Segmental limb injuries (more than one fracture line)
- Very unstable fractures
- If the child is approaching skeletal maturity
Why are physeal fractures so common in children?
Because the physis is the weak spot of the bone, provides a plane of fracture
Physis tends to be weaker than the ligaments so children will get a physeal fracture where adults may only sustain a torn ligament
What is the Salter-Harris classification?
A classification of physeal fractures based on where along and at what angle to the physis the fracture occurred
Used to predict if there will be growth deformity as a result of the fracture
SH 1 & 2 = good prognosis, SH 3&4 = deformity likely
Describe a Salter Harris type 1 & 2 fracture?
SH 1 - fracture is parallel to the growth plate (_)
SH 2 - fracture is parallel to the growth plate for about 50-75% of it’s length, then moves obliquely and creates a fragment (_/)
Describe a Salter Harris type 3 & 4 fracture? How are they treated?
Type 3 - fracture is parallel to the growth plate then moves at a right angle creating a fragment (I) Reduced and then fixated if displaced
Type 4 - Oblique fracture that creates a fragment through the growth plate without running parallel to it ( /) Generally treated by screw fixation
