Children's Fractures

Question 1

which gender is more affected by fractures in children?

Answer 1

boys

Question 2

when does fracture incidence peak in childhood?

Answer 2

around 6-7 and again around 13

Question 3

how does immature skeleton differ?

Answer 3

in terms of periosteum

Question 4

name 3 fractures specific to children

Answer 4

greenstick
torus
plastic deformation

Question 5

physis vs epiphysis vs metaphysis vs diaphysis?

Answer 5

physis = growth plate
epiphysis = at the end of the bone, grows seperately
metaphysis = thin part between epiphysis and diaphysis, contains the growth plate

Question 6

what is the physis made of?

Answer 6

cartilage

Question 7

what is wollfs law?

Answer 7

bone in a healthy person will adapt to the load under which it is placed

Question 8

what is hueter volkman law?

Answer 8

compression forces inhibit growth and tensile forces stimulate growth

Question 9

fracture healing in child vs adult?

Answer 9

better in child
in adult will basically just heal in the same site - i.e displaced
in child there’s continuous remodelling so will heal in better alignment?

Question 10

important history for fractures in children and why is this important?

Answer 10

mechanism
how high if a fall
how fast
forces involved
predict injuries and exclude/confirm diagnosis

Question 11

features of a non-accidental injury?

Answer 11

history doesnt match injury
vague/inconsistent parental accounts of what happened
any previous or unsuspected fractures in child <2 or pre-walking
injuries in various stages of healing - bruising, burns etc
more injuries than usually seen in children that age
injuries in scattered pattern over body
increased intracranial pressure in infant
suspected intra-abdominal trauma in young child

Question 12

common clinical features of NAI?

Answer 12

metaphyseal corner fractures

scattered sites around body

Question 13

look assessment of fracture?

Answer 13

deformity
swelling
bruising
asymmetry

Question 14

feel examination of a fracture?

Answer 14

point tenderness to correlate with X ray

neurovascular examination

Question 15

features of neurovascular examination?

Answer 15

colour
cap refill
skin temp
O2 saturation
pulse
sensation (can be difficult in young children/babies so sweat can be used)
sweating (loss of sweating in nerve injury - possibly due to fracture)
skin wrinkling on immersion in water (doesn’t happen in nerve damage)

Question 16

move part of fracture examination?

Answer 16

often too painful but can do distal neurovascular assessment

Question 17

how do you document nerve damage?

Answer 17

radial - sensory, motor (whether present)
ulnar - sensory, motor (whether present)
median - sensory, motor (whether present)

Question 18

what can damage to the radial nerve cause?

Answer 18

wrist drop

innervates extensors of wrist, thumb etc

Question 19

symptoms of ulnar nerve damage?

Answer 19

loss of function of hand and fingers

innervates intrinsic hand muscles

Question 20

classic sign of median nerve damage?

Answer 20

cant flex thumb or index finger when making a fist

Question 21

diagnosis of child fracture?

Answer 21

X ray if old enough where bone is ossified
US or arthrogram (joint injury) can also be used if bones not ossified
CT or MRI for more detail

Question 22

how do you assess each forearm nerve quickly?

Answer 22

OK sign = median
hitchhikers thumb = radial
starfish = ulnar

Question 23

what can displace a fracture?

Answer 23

initial force on impact

muscle action and gravity deform fractures once they’ve lost their integrity

Question 24

general principles of fracture management?

Answer 24

reduce
retain
rehabilitate

Question 25

how does age affect need for reduction of a fracture?

Answer 25

remodelling potential reduced need for accurate reduction at a young age
higher remodelling potential when very young/child so reduction less important

Question 26

what is gallows traction?

Answer 26

used for femoral shaft fracture in 3 months - 3 yr olds
suspends legs vertically off the bed
<48 hrs traction then Spica or inpatient traction for 2 week

Question 27

what is flexible nailing?

Answer 27

insertion of a flexible nail into a fractured bone

Question 28

what is flexible nailing used for>

Answer 28

long bones - femur, tibia, humerus, radius and ulna

Question 29

advantages and disadvantaged?

Answer 29

ADVANTAGES
predictable position and rapid healing
early joint mobilisation and weight bearing
DISADVANTAGES
infection risk
risk of anaesthesia as must be done surgically

Question 30

how do you retain a reduced joint?

Answer 30

sling, collar and cuff etc

cast - plaster of paris

Question 31

what is the most common method of fracture retaining?

Answer 31

plaster of paris

Question 32

how do you generally manage metaphyseal fracture?

Answer 32

immobilise adjacent joint (joint below)

Question 33

general management of diaphyseal fracture?

Answer 33

immobilise joint above and below

- prevents rotation

Question 34

what are the exceptions to conservative management of fractures and need to be fixed?

Answer 34

displaced intra-articular fractures
displaced growth plate injuries
open fractures

Question 35

good imaging for intra-articular fracture?

Answer 35

arthrogram - assists visualisation

Question 36

classification of physeal fractures?

Answer 36

salter harris
type 1 = complete physeal fracture
type 2 = physeal fracture that extends into metaphysis
type 3 = physeal fracture that extends through epiphysis
type 4 = physeal fracture plus epiphyseal and metaphyseal fractures
type 5 = compression fracture of the growth plate

Question 37

problems with physeal injury?

Answer 37

mal union

non union

Question 38

when is external fixation used?

Answer 38

contaminated wounds
acute vascular injury
burns
multiple injuries

Question 39

less invasive techniques of fixation?

Answer 39

diaphyseal
metaphyseal
epiphyseal