Paediatric Trauma

Question 1

Commonest cause of death in children

Answer 1

Trauma

Question 2

Are paediatric fractures more likely to be complete or incomplete

Answer 2

Incomplete

Question 3

What is a possible outcome of a fracture involving physes

Answer 3

Progressive deformity

Question 4

If a fracture at the physes occurs at the elbow, knee+ ankle or femur what is the result

Answer 4

• Elbow = Deformity
• Knee + ankle = Arrest
• Femur = Overgrowth

Question 5

How common are forearm fracture in paediatrics

Answer 5

25-50% of all paediatric fractures

Question 6

Outcome of low energy impact on paediatric forearm

Answer 6

• Buckle

- Greenstick

Question 7

Outcome of high energy impact on paediatric forearm

Answer 7

• Open
• Displaced
• Soft tissue injury

Question 8

How to assess a possible fracture

Answer 8

-Hx (mechanism)
-Deformity
-Soft tissues
Whole limb
Wounds
Sensation, motor function
Vascular status
-Re-assess post-intervention

Question 9

Surgical indications

Answer 9

• Open#
• Segmental
• NV compromise
• Fail closed Rx

Question 10

Principles of closed management

Answer 10

• Analgesia/anaesthesia
• Reduce
• Check radiographs week 1, 2 & 4
• Change loose casts
• Remove when callus evident

Question 11

2 types of surgical treatments of fractures

Answer 11

• External fixator (rare, soft tissues issues)

- ORIF

Question 12

When to use flexible nailing

Answer 12

• Needs 2yrs predicted growth remaining

- Allow early ROM

Question 13

Where do greenstick, buckle + “bayonet” off ended fractures occur

Answer 13

Wrist (distal radius)

Question 14

Management of buckle + greenstick fractures

Answer 14

• Buckle = Cast 3-4 weeks

- Greenstick = Cast 4-6 weeks

Question 15

Knee trauma DDx

Answer 15

• Infection
• Inflammatory arthropathy
• Neoplasm
• Apophysitis
• Sickle cell, haemophilia

Question 16

6 types of bony knee injury

Answer 16

• Physeal/Metaphyseal
• Tibial spine
• Tibial tubercle
• Patellar fracture
• Sleeve fracture
• Patellar dislocation

Question 17

Rx of physeal injury

Answer 17

• Cast + immobilise
• Percutaneous fix
• ORIF articular displacement
• ROM early

Question 18

3 types of tibial spine injury

Answer 18

• Undisplaced (II)
• Hinged (II)
• Displace (III)

Question 19

Rx of undisplaced + hinged tibial spine fracture

Answer 19

Long leg cast

Question 20

Rx of hinged + displaced tibial spine fracture

Answer 20

ORIF/AxIF

Question 21

Rx of a patellar fracture

Answer 21

• Undisplaced = Cylindrical cast

- Displaced = ORIF

Question 22

Rx of patellar dislocation

Answer 22

• Cast 2 weeks
• Mobilise
• VMO exercises
• Repair medial ligament
• Medialise tibial tubercle

Question 23

How to assess a possible ankle fracture

Answer 23

• Hx (mechanism)
• Deformity
• Soft tissues
• AP & Lateral radiographs (Ottawa rules)

Question 24

What are the Ottawa rules

Answer 24

Guidelines used to decide if a patient with foot/ankle pain should be offered X-rays to diagnose a possible fracture
For ankle
-There is any pain in the malleolar zone
AND 1 of the following:
-Bone tenderness along the distal 6cm of the posterior edge of the tibia/fibula or tip of the medial/lateral malleolus,
-Inability to bear weight both immediately and in the ED for four steps

Question 25

Growth plate of ankle closes at what age

Answer 25

13-14yrs

Question 26

2 overuse injuries

Answer 26

• Osgood-schlatter’s disease

- Sever’s disease

Question 27

Cause of Osgood-schlatter’s and sever’s disease

Answer 27

• Osgood-schlatter’s disease = Inflammation of the patellar ligament at the tibial tuberosity
• Sever’s disease = Growth plate inflammation of the calcaneus

Question 28

Common presentation of Osgood-schlatter’s disease

Answer 28

Characterized by a painful lump just below the knee and is most often seen in young adolescents