Childhood Fracture

Question 1

What factors should you consider in a potential fracture history?

Answer 1

• Mechanism of injury
• Any other injuries/sites of pain
• Any previous injuries?
• FH of fractures, blue sclera, deafness (exclude osteogenesis imperfecta)

Question 2

What could help with making a diagnosis of Non-Accidental Injury (NAI)?

Answer 2

• History of trauma inconsistent with the injuries, a changing or inconsistent history, other unexplained co-existent injuries, or previous hx of injury
• Injuries which do not fit with the developmental age of the child
• Children known to social services
• Poor parent-child bonding
• Parental attempts at excusing or justifying the injury inappropriately or blaming a younger sibling or pet

Question 3

What is the most common paediatric fracture?

Answer 3

Supracondylar fractures (humerus). It occurs by falling onto a hyperextended elbow. Complications include vascular injury e.g. brachial artery and nerve injury e.g. ulnar nerve.

Question 4

How would you identify a supracondylar fracture on an x-ray?

Answer 4

Anterior humeral line. When the arm is at 90 degrees (sagittal view), a line can be drawn down the anterior part of the humerus through the middle third of the capaitellum. The capitellum is displaced posteriorly in supracondylar fractures.

Question 5

How long do children’s fractures take to heal?

Answer 5

4 weeks for upper limb and 6-8 weeks for lower limb. They should restrict activity during this time; it will be painful if they bash/hit the cast, also it could cause wires to move.

Question 6

What is a greenstick fracture?

Answer 6

Children’s bones are softer and more flexible compared to adult bones. Hence, when they are bent, instead of breaking completely into separate pieces they often crack.

Question 7

Where are common sites of childhood fracture?

Answer 7

• Wrist - buckle
• Clavicle
• Distal humerus
• Supracondylar

Question 8

What is the growth plate?

Answer 8

The growth plate is an area of cartilage which proliferates or enlarges, effectively growing and the leading edge calcifies.

Question 9

What happens in a growth plate injury?

Answer 9

The growth may cease and the limb is shortened. If asymmetrical with growth on one side, deformity and angulation may occur.

Question 10

What equipment is suitable to control a displaced fracture?

Answer 10

• Elastic nails
• Moulded plasters
• Plates
• Wires