Paediatric fractures/dislocations Flashcards

Question

what age does the olecranon ossification center appear on xray?

Answer 1

Immobilisation in an above-elbow backslab with 90 degrees elbow flexion with sling for 3 weeks | followed up by a GP in three weeks. Repeat x-ray is not required. ## Footnote Avoid contact sports for 3 weeks. Only for xray or ortho if ongoing pain beyond 3 weeks

Answer 2

**DW ortho** - risk involved with these fractures. Then, **Reduce fracture** push on elbow and bring to 90 degree. Elbow placement important! Small fracture displacement tolerable **Immobilisation** in an above-elbow backslab with sling for 3 weeks **Refer** to ortho clinic to be seen in 7 days

Answer 3

Admit ortho Needs ORIF ## Footnote Gartland type III injuries have the highest risk of neurovascular injury. However, with appropriate management, Volkmann's ischaemia can be avoided and permanent nerve injury is very rare.

Answer 4

Assist with deciding how displaced If anterior humeral line passed through middle third of capitellum = not displace = Gartland 1 If passes through anterior 3rd = mildly displaced posteriorly = Gartland 2 If missed capitellum altogether, very displace posteriorly = Gartland 3

Answer 5

No Bony remodelling can only fix extension/flexion deformity Needs ortho input

Answer 6

Extension ## Footnote Obs refer to ortho too

Answer 7

Under sedation, gentle traction and reduction aiming for the position with the best hand perfusion

Answer 8

Intercondylar fracture ## Footnote Rare. Ortho admit for ORIF

Answer 9

DW ortho Consider USS, CT, MRI Consider the diagnosis - 2nd most common paeds fracture ## Footnote If > 2mm displacement will get ORIF. Risk of valgus/varus deformity, delayed ulnar nerve palsy, degenerative elbow disease

Answer 10

Elbow dislocation ## Footnote 50% associated with a dislocated elbow

Answer 11

Backslab 90 degrees Ortho clinic in 3 weeks

Answer 12

DW ortho on call ## Footnote Depending of degree if dispacement age and handedness, sporting persuits will help decide if for ORIF

Answer 13

The trochlear ossification center will not appear before the medial epicondyle. Therefore that bone is a displaced epicondyle

Answer 14

Semiflexed Pronated ## Footnote Occurs between 6 months to 6 years

Answer 15

- fracture - osteomyelitis - sepitic arthritis - neurological cause

Answer 16

Oral + IN analgesia **Hyperpronation** and flexion with pressure over radial head If fails, repeat If fails again try **supination** If fails again can go home in sling and represent 24 - 48 hrs. Most spontaneously reduce If this fails. Ortho review

Answer 17

Full extension to be avoided 1 method: downward traction to supinated proximal forearm with elbow at 135 degree against countertraction to distal humerus

Answer 18

radial head dislocation

Answer 19

Immobilisation in above-elbow backslab in 90 degrees elbow flexion with sling Fracture clinic in 1 week

Answer 20

Above-elbow backslab in 90 degrees elbow flexion Refer ortho now Most require reduction/fixation

Answer 21

radial neck ## Footnote Always assess for posterior interosseous nerve injury ( finger extension)

Answer 22

more than 30 degrees angulation more than 10% translation older than 10 years and displaced ## Footnote radial head rarely fractured as cartilagenous

Answer 23

Urgent call to ortho Ortho will reduce radial head

Answer 24

Immature bones. Ulnar fracture may appear as greenstick or bowing only and be missed

Answer 25

Draw a line from the distal ulna to the olecranon on a true lateral forearm radiograph. The ulnar bow is the maximum distance between the drawn line and the dorsal border of the ulna Bowing present if > 1mm

Answer 26

most commonly seen in the ulna. Refer to orthopaedics for advice. Usually requires general anaesthetic manipulation plaster (GAMP) due to prolonged force to correct deformity

Answer 27

Closed reduction with immobilisation in above-elbow cast for 6 weeks. Three point moulding is required Acceptable angulation depends on location and age but in general anything less than 10 degree is acceptable

Answer 28

Apex volar = pronated forearm Apex dorsal = supinated ## Footnote Goal < 10 degree angulation but more may be acceptable if less than 10 years and what part of shaft is fractured

Answer 29

Closed reduction with immobilisation in above-elbow cast for 6 weeks. Three point moulding is required Fracture clinic in 1 week ## Footnote Anything displaced more than 10 degree and not reducible may need ORIF Fracture clinic in 1 week as may lose redction and need ORIF

Answer 30

Closed reduction with immobilisation in below-elbow cast for 6 weeks For young children, above-elbow casts may be applied ## Footnote Accetable angulation: 0 - 5 years = less than 20 degrees 5- 10 years = less than 15 degrees 10 -15 years = less than 10 degress

Answer 31

DW ortho first Increased risk of injury to growth plate

Answer 32

less than 10 years ## Footnote Rules suggested to consider scaphoid views: Older than 10 High velocity injury Single point tenderness and swelling over scaphoid dorsally (snuff box) and volar surface (more specific) Pain/clunk on passive radial deviation of wrist Pain when 1st metacarpal compressed onto scaphoid

Answer 33

No Often distal pole is fractured, has good blood supply ## Footnote heals well with conservative care

Answer 34

Shaft ## Footnote Goals: Index and Middle: less than 10 degrees of angulation Ring: less than 15 degrees of angulation Little: less than 20 degrees of angulation No rotational deformity

Answer 35

open intra-articular oblique (unstable)

Answer 36

Refer ortho Will need operative management

Answer 37

Open fracture (nail bed + fracture phalanx) Refer ortho now

Answer 38

DW ortho now. May need K wire and need to do before healing occurs ## Footnote RCH: Delayed presentations 3-14 days after injury where angulation or joint involvement is present, as malunion may occur before clinic review is possible

Answer 39

Refer to ortho/plastics as nail bed deformity is common if not repaired meticulously

Answer 40

Refer to physiotherapy or sports medicine ## Footnote In trauma pelvic fractures are less common than in adults. Avusion fractures seen on adolescents. Generally no surgical intervention. Refer to physio or sports medicine. If displaced > 3cm refer outpatient ortho, surgery still rare though

Answer 41

ASAP but definitely within 6 hours ## Footnote AVN risk is 5 - 15% in paediatric hip dislocations. If OT free best to do there but if not reduce in ED. Look for associated fractures. Needs CT or MRI (better) post to assess for loose bodies, cartilage injuries and labral entrapments

Answer 42

Femoral block

Answer 43

Non-mobile child with femoral fracture. 80% associated with NAI ## Footnote All femoral fractures should be considered for NAI but in toddler group spiral fracture can be from low mechanism twisting injury. These #'s heal much better than in adults. May be treated conservatively

Answer 44

Significant risk of growth arrest ## Footnote SHI and SH II fractures in other areas of the body usually have a low risk of growth arrest, but in the case of distal femoral physeal fractures, even minimally displaced SHI and SHII type fractures should be followed closely for physeal injury leading to growth arrest. A complete growth arrest can lead to limb length discrepancies. A partial growth arrest can lead to angular deformities at the knee.

Answer 45

Tibial spine fracture. DW ortho now

Answer 46

An ACL tear ## Footnote Tibial spine fractures represent avulsion injuries of the Anterior Cruciate Ligament and can be thought of as the paediatric equivalent of an Adult ACL rupture. This fracture can be missed on an AP film and only visible on the lateral Xray

Answer 47

Refer ortho for consideration of operative managment ## Footnote MOI is forceful kick or jump from hight. Immobilisation with a splint suitable for non displaced

Answer 48

Bi-partite patella. Normal.

Answer 49

Sky-line view ## Footnote IF first time, needs outpatient MRI of knee even if the radiological evaluation is normal. Osteochondral fractures occur in 25 -75% of cases and usually require surgical management. The MRI scan is not urgent and in most cases can be performed as an outpatient investigation within 7 days of the injury. It is very reasonable for this to be arranged in a primary care setting.

Answer 50

- patella does not reduce - loose body or osteochondral fragment - multiple dislocations despite having good physiotherapy for several months. ## Footnote If there is no lesion present patients may rehabilitate (via physiotherapy) and only be referred for ongoing instability or locking

Answer 51

Aspiration of the knee should be considered after consultation with orthopaedics. In this situation an osteochondral injury is likely and the MRI scan should be obtained early.

Answer 52

Anaglesia Ice Reduce Exclude osteochondral defect Exclude massive haemathrosis Brace in full extension. If unable to fully extend then hinged brace at 20-30 deg MRI should be performed within 7 days in the first-time dislocator (GP to organise) | Zimmer splint or Richard slint appropirate

Answer 53

Pt lies prone to relax hamstrings Push patella to midline while extending knee

Answer 54

Examination: exessive anterior knee tenderness Xray: patella alta ## Footnote Peak age in adolescence

Answer 55

Displaced: refer ortho now Non-displaced: immobilised Richard’s splint + crutches. Fracture clinic 10 days

Answer 56

- non-displaced spiral fracture of the distal two-thirds of the tibial shaft - intact fibula - occurring gnerally 9 month - 3 years - periosteum remains intact

Answer 57

- do not require reduction - long leg back slab - fracture clinic ## Footnote Some studies has compared using CAM boot and no immobilisation with favourable outcomes. Trend towards recommending immobilisation in a CAM boot, short-leg cast, or splint rather than in a long-leg cast Management may change in future

Answer 58

- If displaced, closed reduction then, - Above-knee cast for 4-6 weeks, knee flexed to 30-40 degrees and the ankle in neutral dorsiflexion - non-weight bearing. ## Footnote If fibula fractured DW ortho but may still be able to go home in cast

Answer 59

- open fractures - extreme swelling/compartment syndrome - neurovascular injury - unable to achieve or maintain reduction - associated with ipsilateral leg injuries ## Footnote Discuss with ortho if tibia and fibular fractured

Answer 60

transverse proximal tibial metaphysis # ## Footnote occur when a second, usually heavier individual causes the jumping surface to recoil upwards as the unsuspecting victim is descending. The combined excessive load is thought to produce the characteristic fracture which is most often seen in children 2 to 5 years of age Treatment is usually closed reduction and casting in extension with a varus mold. Though DW ortho

Answer 61

- open - unstable OR excessive bilateral tenderness + swelling suggesting possible mortice instability - displaced or angulated distal tibial # - Salter Harris 3 or 4 # - triplane or tillaux fracures ## Footnote Triplane Fractures, children 10-17 years are complex salter harris IV fracture pattern in multiple planes. As seen in picture Tillaux Fractures Salter-Harris III fracture of the anterolateral distal tibia epiphysis age 12 - 14

Answer 62

Tillaux fracture Salter Harris 3 # ## Footnote Occurs in adolescents after partial closure of physis. Will be non weightbearing with significant anterolateral ankle swelling + tenderness Refer to ortho

Answer 63

Tri-plane # with a fibuar # ## Footnote triplane ankle account 5-15% paediatric ankle fractures, along with Tillaux fractures, most common ankle fractures in adolescents. **complex salter harris IV** fracture pattern in multiple planes. Occurs before the complete closure of the distal tibial physis (hence why they occur in adolescents whose epiphyseal plates are closing) classically seen in 10-17-year-olds. They are slightly more common in males.

Answer 64

Not validated in this age group ## Footnote Sprains in paeds rare. If maximal tenderness is over physis, may represent Salter-Harris 1 #. Place in cast 2-3 weeks

Paediatric fractures/dislocations Flashcards

(95 cards)