Paediatric Fracture Flashcards
What is the anatomy of growing bones (epiphysis, physis, metaphysis and diaphysis)?
*What are three commonly-seen fracture patterns in children?
What is Salter’s Classification?
Slip
Above
beLow
Through
Round
Classification for physeal injuries
I - Fracture passes transversely through physis (separating epiphysis from metaphysis)
II - Transversely through physis, exits through metaphysis; Triangular fragment
III - Crosses physis, exits through epiphysis at joint space (Risk of post-dramatic arthritis & disruption to articular ligaments)
IV - Longitudinal fracture through both physis & metaphysis
V - Crush injury to growth plate
What are key areas to ascertain in history-taking?
Mechanism
Time of injury
Location of injury
Analgesia administered
PMHx
Last meal
Should I be thinking about non accidental injury (NAI)?
How to incorporate mechanism of injury into history taking?
What are features that would raise the suspicion of non-accidental injury (NAI)?
Significant number of fractures in child < 1 year are from abuse
Greater risk of abuse:
first-born / premature infants / stepchildren / learning or physical disabilities
Most common sites: femur, humerus, tibia
Rib fractures most sensitive indicator of NAI
Femoral shaft fractures in non-ambulatory children
Unexplained fractures in different stages of healing
Femoral fracture in child < 1 year
Epiphyseal and metaphyseal fractures of the long bones
What are the particular difficulties of history and examination in paediatric patients who are in pain?
You may only have one chance
Parents could help with examination if child is unwilling to be examined
Figuring out neurovascular presentation
What imaging modalities are of interest in the paediatric fracture patients?
How is the principle of fracture management (reduce, retain, rehabilitate) related to paediatric patients?
How are management and fixation methods applied to common paediatric fractures?
