Paediatric Trauma Flashcards
(49 cards)
What is the commonest cause of death in children?
Trauma
What types of trauma can children be involved in?
- Transport
- Assault
- Falls, electrical shocks, drowning
- Other
What are the risk factors for paediatric trauma?
- Boys> girls
- Age
- Increased physeal injury with age
- Previous fractures
- Metabolic bone idsease
What are the principles regarding children’s fractures?
- They are often simple, incomplete and heal quickly
- Remodel well in plane of joint movement
- A thick periosteal hinge is a friend
- Fractures involving physes can result in progressive deformity
Why do children’s bones heal quickly?
- Metabolically active periosteum
- Cellular bone
- Plastic
What should be noted due to fact children’s fractures heal quickly?
- Fixation is usually not required
- Do not over immobilise
- Do not over treat
Why do children’s fractures remodel well in the plane of joint movement?
- Appositional periosteal growth/resorption
- Differential physeal growth
In what cases do fractures remodel particularly well in the plane of joint movement?
- Younger children
- Polar fractures
- Intact growing physis
- Sagittal> frontal> X transverse
Where does deformity often occur?
Elbow
Where does bone arrest often occur?
- Knee
- Ankle
Where does bone overgrowth often occur?
Femur
Give examples of fractures which can occur in the forearm.
Shaft fractures
-Can involve the shaft of the radius or ulna
Galeazzi
-Fracture of radius due to stress on ulna
Monteggia
-Fracture of the ulna due to stress on the radius
Distal radius fractures
-Fracture can include styloid process
What is the epidemiology of forearm fractures?
- 25-50% of paediatric fractures
- 80% occur at the wrist
- Low energy including buckle and greenstick
- High energy including open, displaced and soft tissue injury
How are trauma injuries assessed?
History
-Mechanism
Deformity
Soft tissues
- Whole limb
- Wounds
- Sensation and motor function
- Vascular status
Document findings and repeat post- intervention
What are the possible complications of forearm fractures?
- Compartment syndrome
- 5% non-union
- 5% refracture
- Radioulnar synostosis (proximal> distal, high energy, same level, single incision)
- PIN injury
- Superficial radial nerve injury
- DRUJ/ radiocapiellar problems
Buckle fracture
Failure of 1 cortex in compression
Greenstick fracture
Failure of 1 cortex, other cortex in extension
How are fractures managed?
Buckle
-Cast 3-4 weeks
Greenstick
-Cast 4-6 weeks
Complete
-Cast +/-KW 6 weeks
What is the differential of knee trauma?
- Infection
- Inflammatory arthropathy
- Neoplasm
- Apophysitis
- Hip problem
- Foot problem
- Sickle cell, haemophilia
- ‘Anterior knee pain’
Where can bone injury occur with knee pain?
- Physeal/metaphyseal
- Tibial spine
- Tibial tubercle
- Patellar fracture
- Sleeve fracture
- Patellar dislocation
- Referred
Why do physeal injuries occur 2: 1 femeu: tibia?
Capsule and ligaments
- Distal femur below physis
- Proximal tibia below physis
Growth
- 11mm/year femur
- 6mm/year tibia
What are possible complications of physeal injury?
- Hyperextension can lead to vascular injury
- Varus can lead to common peroneal nerve injury
What is the treatment for physeal injury?
- Cast immobilisation
- Percutaneous fix
- ORIF articular displacement
- ROM early <6/52
How is physeal arrest monitored?
Monitor
- Harris lines
- Angulation and length
