Chapter 138 - Pediatric Polytrauma and Upper Extremity Fractures

Question 1

salter harris fractures occur thru which physeal zone?

Answer 1

hypertrophic

Question 2

what injury mechanism leads to c spine injuries in you kids (<8) following MVC

Answer 2

decelleration leads to distraction injuries -> kids with big heads relative to their trunk

Question 3

when does multiorgan failure occur following trauma in kids vs adults

Answer 3

kids: multiorgan failure IMMEDIATELY
adults: multiorgan failure 48-72 hours later

kids have a dampened systemic inflammatory response and a robust local inflammatory response

Question 4

compartment syndrome resulting from tibial tubercle fractures result from injury to what artery?

Answer 4

anterior tibial recurrent artery

Question 5

what fractures are pathognomonic for NAT?

Answer 5

metaphyseal corner fractures and posterior rib fractures

Question 6

what is the most COMMON fracture in NAT

Answer 6

isolated, transverse long bone fractures

Question 7

congenital pseudarthrosis of the clavicle is related to what condition?

Answer 7

none. isolated issue. thought to be related to external compression of the subclavian artery against the developing clavicle.

Question 8

what is the last physis in the body to fuse?

Answer 8

medial clavicular physis - age 23-25

Question 9

what percentage of humeral growth occurs at the proximal physis?

Answer 9

80%

Question 10

indications for surgical fixation of proximal humerus fracures in kids

Answer 10

<10 yo: any angulation acceptable
10-12yo: >60-75 degrees of angulation
>12yo: up to 45 degrees of angulation or 2/3 cortical displacement

Question 11

most common nerve injury in SCH

Answer 11

• AIN injury in extension type SCH

Question 12

nerve injury associated with posterolateral fracture displacement in SCH

Answer 12

median n

Question 13

second most common nerve injury in SCH

Answer 13

radial nerve
seen with posteromedial fracture displacement

Question 14

nerve injury associated with flexion type SCH

Answer 14

ulnar nerve
can also be iatrogenic 2/2 blind medial pin

Question 15

how long do you cast a non-op SCH?

Answer 15

3 weeks

Question 16

indications for non-op mgment of SCH

Answer 16

• type I
• type II ONLY IF:
  anterior humeral line intersects the capitellum
  no anteromedial comminution
  no varus alignment

Question 17

what elbow position puts ulnar nerve at highest risk with medial pinning in SCH

Answer 17

elbow flexion or hyperflexion

Question 18

what causes Volkmann Ischemic contracture most commonly

Answer 18

compression of the brachial artery post operatively by casting in >90 degrees of flexion

Question 19

most common complication of non-op managed t II or III SCH

Answer 19

recurvatum deformity is the most common complication of non-op managed type II, III fractures and is poorly tolerated 2/2 limited growth potential of the distal humerus

Question 20

ossification centers of the distal humerus

Answer 20

CRITOE
Capitellum - 1yr
Radial head - 4yo (girls)
Medial epicondyle - 6
Trochlea - 8
Olecranon - 10
LE - 10

Question 21

what view to get for lateral condyle fractures

Answer 21

internal oblique view

Question 22

key point to lateral condyle ORIF

Answer 22

DO NOT do a posterior approach
- the retrograde blood supply to the lateral condyle comes from posterior and you will cause osteonecrosis

Question 23

most common non-union of lateral condyle fracture?

Answer 23

cubitus valgus

can be accompanied by tardy ulnar nerve palsy decades later

Question 24

indications for treatment of medial epicondyle fractures

Answer 24

displacement >5mm
entrapped articular fragment

Question 25

if there is an entrapped medial condyle fragment what is the reduction maneuver to try to dislodge it closed?

Answer 25

supination, valgus, and wrist/finger extension

Question 26

distal humeral physeal separations displace in which direction?

Answer 26

posteromedially

Question 27

distal humeral physeal separation is commonly misdiagnosed as what?

Answer 27

an elbow dislocation but elbow dislocations rarely happen in very young children
(distal humeral physeal separations most commonly occur in kids <3, up to 6)

Question 28

when you see a distal humerus physeal separation what should you think of?

Answer 28

NAT!!!

Question 29

surgical indications for pedi radial neck fractures

Answer 29

> 30degrees residual angulation
3-4mm translation
<45 degrees of pro/supination

Question 30

common complications of radial neck fractures in kids (op or non-op)

Answer 30

stiffness!
radial head overgrowth

Question 31

surgical treatment of a pedi olecranon fracture

Answer 31

tension band with absorbable suture as the tension band

Question 32

nursemaid elbow

Answer 32

longitudinal traction with the annular ligament sliding over the radial head

kid holds the elbow extended an pronated

reduction: hyperpronation in extension, or flexion plus supination

Question 33

greenstick fractures typically result from what force?

Answer 33

rotational injuries

Question 34

how does the radial head dislocation with monteggia fractures?

Answer 34

the radial head follows the apex of the ulnar fracture

I: anterior apex ulna -> anterior dislocation
II: ulna apex posterior -> Posterior dislocation (most common)
III: lateral
IV: any ulna fracture + proximal radius FRACTURE DISLOCATION

Question 35

common complication of monteggia fracture

Answer 35

PIN palsy after injury