Paediatric orthopaedic trauma Flashcards
(41 cards)
What children are most likely to get traumatic injuries
boys more likely
Increased hyseal injury with age
Previous fracture
Metabolic bone disease
What are the principles of children’s fractures
Often simple, incomplete and heal quickly
Metabolically active periosteum
Cellular bone
Plastic
Fixation is not typically required
Do not over immobilise
Do not over treat
What occurs at the growth plates
Remodelling
Physeal arrest- fusion of the epiphyseal plates
Displacement
Lenght discrepancies
What is involved at the growth plates
Collagen
Porosity
Cellularity
Plasticity
What occurs at the periosteum?
Metbolically active
thick and strong
How should remodelling take place in a childs fracture
Remodel well in plane of joint movement
Appostional periosteal growth/resorption
Differential physeal growth
Application younger child, polar fractures, intact growing physis, saggital> frontal, X transverse
What can occur during a physeal fracture
Progressive deformity
Deformity- elbow
Arrest- knee,ankle
Overgrowth-femur
What bone is most commonly fractured in children?
What kind of fractures can occur
Forearm
Low energy- buckle, greenstick
High energy- open, displaced, soft tissue injury
Explain the different types of forearm fractures
Shaft fractures-
Galeazzi- fractures of the dital third of radius including RU joint
Monteggia- fracture of the proximal head of the ulna with dislocation of the proximal radius head
Distal radius fractures
What deforming forces can affect a forearm fracture
Biceps supinator- displace fracture superiorly
Supinator- supiante/pronate fracture
Pronator teres- pronate fracture
Pronator quadratus- pronate fracture
How do you assess a fracture?
History
Deformity
Soft tissues- whole limb, wounds, sensation, motor, vascular status.
Document findings, repeat post intervention
What are the different treatment outcomes?
Closed (non surgical)- good 90-95% functional results
Open/flex nail- resotred anatomy, early mobilisaiton, nerve injury, delayed union
What are indications for surgery
Open fracture
segmental fracture
nerurovascularly compromised
Failed close treatment
What are the principles of closed management
Analgesia, anaesthesia Theatre set up Reudce (disempact, bend force over apex) Verift Check radiographs week 1,2 &4 Change loose casrs Remoce when callus evident Restrict activity
What surgical options are available?
External fixator, rare, soft tissue injuries ORIF(internal fixation) Adolesccents communciated fracture Limietd immboilisation singe bone technique
What are the benefits of flexible nailing
Needs 2yrs predicated growth remaining
Allows early ROM
Wires out when healed
What are the complications of surgery
Compartments syndrome- Volkmann's 5% non union, refracture Radioulnar synostoss PIN injury Superfifical radial injury`
What are the management of distal radial fractures
Buckle cast- 3-4 weeks Greenstick- cast 4-6 weeks Complete cast Risk for reminipulation -complete fracyres failed anatomcial reduction Not B/E pop
What are the differential diagnosis to knee trauma?
Infection Inflammatory arthropathy Neoplasm Apophysis Apophysitis Hip Foot Sickle, heamophilia Anterior knee pain
What bony injuries occur during knee trauma?
Physeal/metaphyseal injuries Tibial spine Tibial tubercle Patellar fracture Sleeve fracture Patellar dislocation Referred pain
What is involved in physeal injuries
Can be femoral or tibial Capsuel and ligaments also involved hyperextnesion causes vascular injury Varus- CPN injury SH not predictive
What is the treatment for a physeal injury
Cast, immobolise
Percutaneous fix
ORIF articular diplacement
ROM early
What is the treatment of physeal arrest
Monitor- harris lines, angulation and length Resect bar Complete epiphysoidesis Contralateral epiphysiodesis Corrective osteotomy
What occurs during tibial spine injuries?
Overlap with ACL Meyers and McKeever I- undiscplaced II hinged III displaced I/II long leg cast II/III ORIF, AxIF
