Childhood fractures Flashcards
(26 cards)
What should you ask when a child present with a fracture?
Mechanism of injury?
Any other injuries/ sites of pain?
Any previous injuries?
Family history of fractures, blue sclera, deafness (exclude osteogenesis imperfecta)
When is NAI more likely in a child presenting with a fracture?
A history of trauma inconsistent with the injuries, a changing or inconsistent history, other unexplained co-existent injuries, or previous history of injury
Injuries that 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.
What should you examine in a px presenting with a fracture?
With any fracture, especially if there is associated deformity, it is important to check for neurovascular injury.
What is the most common mechanism of injury in forearm fractures?
Usually an indirect injury following a fall on to an outstretched hand. Occasionally caused by a direct trauma.
What is the presentation of a forearm fracture?
Pain, swelling and deformity at the fracture site.
What are the investigations for a forearm fracture in a child?
X-rays of the wrist, elbow and whole forearm should be taken.
What is the management of forearm fractures in children?
Conservative management is still the first line of treatment for paediatric forearm fractures, especially in children less than 10 years old.
Due to a child’s physeal growth potential, varying degrees of fracture angulation can be accepted - depending on the age of the child and his or her ability to remodel.
After reduction, forearm pronation and supination should be checked and the arm placed in a long-arm cast or splint.
Surgical treatment is by open reduction and plating/intramedullary nails, depending on the degree of overriding/angulation.
What is the management of a child with a forearm fracture and ischaemic limb?
In children presenting with an ischaemic limb, the case should be discussed with the local vascular team and if the limb is still ischaemic after fracture reduction, then emergent surgical exploration of the brachial artery is required.
What is the postoperative management of a child with a forearm fracture?
Generally children’s fractures heal more quickly than those in adults. A rough guide is 4 weeks for upper limb fractures and 6-8 weeks for lower limb fractures.
They should restrict activity during this time; it will be painful if they bash/ hit the cast, also it could cause the wires to move.
What is a greenstick fracture?
Greenstick fracture is a fracture of children.
The bone is broken and may be considerably distorted but the periosteum remains intact.
What are the common sites for greenstick fractures?
These fractures are usually either greenstick fracture of distal radius and ulna or greenstick fracture of mid-third of radius and ulna. The latter tends to occur in a child aged under 8 years who falls on an outstretched arm.
When only one bone is broken, the integrity of both proximal and distal radioulnar joints should be checked.
How do you reduce a greenstick fracture?
Reduction involves slow, constant pressure to reduce the deformity, applied over 5-7 minutes until the intact dorsal cortex is broken. Failure to break the cortex may result in increasing deformity whilst in the cast.
What is plastic deformity?
Stress on bone resulting in deformity without cortical disruption
What is a buckle fracture?
Incomplete cortical disruption resulting in periosteal haematoma only
What are the common sites of childhood fractures?
Wrist, buckle; Clavicle; distal humerus and supracondylar fractures.
Which system is used to classify growth plate fractures?
Salter-Harris system
How many types of growth plate fractures are there?
Type I
Fracture through the physis only (X-ray often normal)
Type II
Fracture through the physis and metaphysics
Type III
Fracture through the physis and epiphysis to include the joint
Type IV:
A fracture involving the physis, metaphysis and epiphysis
Type V:
Crush injury involving the physis (x-ray may resemble type I, and appear normal)
What is the major complication of growth plate injury?
When growth plate injury occurs, growth may cease, the limb is shortened.
If asymmetrical with growth on one side deformity and angulation may occur.
What are the causes of pathological fractures in children?
Osteogenesis imperfecta
Osteopetrosis
What is osteogenesis imperfecta?
Defective osteoid formation due to congenital inability to produce adequate intercellular substances like osteoid, collagen and dentine.
Failure of maturation of collagen in all the connective tissues.
Radiology may show translucent bones, multiple fractures, particularly of the long bones, wormian bones (irregular patches of ossification) and a trefoil pelvis.
An autosomal dominant condition.
What are the subtypes of osteogenesis imperfecta?
Type I - The collagen is of normal quality but insufficient quantity.
Type II - Poor collagen quantity and quality.
Type III - Collagen poorly formed. Normal quantity.
Type IV - Sufficient collagen quantity but poor quality.
What is osteopetrosis?
Bones become harder and more dense.
Autosomal recessive condition.
It is commonest in young adults.
Radiology reveals a lack of differentiation between the cortex and the medulla described as marble bone.
What are the clinical features of osteogenesis imperfecta?
Presents in childhood
Fractures following minor trauma
Blue sclera
Deafness secondary to otosclerosis
Dental imperfections are common
-When teeth are affected, some may be more affected than others. There is discolouration with enamel fracturing easily from the dentine, causing rapid erosion in both sets.
Frequently there is early arcus unrelated to hypercholesterolemia.
Cardiac effects are important; they include aortic incompetence, aortic root widening and mitral valve prolapse.
Often there is hypermobility of joints, with flat feet, hyper-extensible large joints and dislocations.
Why do people with OI get blue sclera?
-Blue sclerae is an important sign caused by scleral thinness allowing the pigmented coat of the choroid to become visible.
