Paediatric Trauma Flashcards
(37 cards)
risk factors for paediatric trauma
boys 60%, girls 40% age increased physeal injury with age previous fracture metabolic bone disease
list the children’s fracture principles
- children fractures are often simple, incomplete and heal quickly
- remodel well in plane of joint movement
- a thick periosteal hinge is (usually) a friend but needs to be understood
- fractures involving physes can result in progressive deformity
children’s fracture principles: simple, incomplete, heal quickly
metabolically active periosteum
cellular bone
plastic
applicaton: fixation not usually required, do not over mobilise, do not over treat
children’s fracture principles: remodel
appositional periosteal growth/resorption
differential physeal growth
application: younger child, polar fractures, intact growing physis, sagital > frontal X transverse
children’s fracture principles: progressive deformity
demority - elbow
arrest - knee, ankle
overgrowth - femur
low energy forearm injuries kids
buckle
greenstick
high energy forearm injuries kids
open
displaced
soft tissue injury
complications of forearm injuries kids
o Compartment syndrome – Volkmann’s o 5% non-union o 5% refracture o Radioulnar synostosis § Proximal > distal § High energy, same level § Single incision o PIN injury o Superficial radial nerve injury o DRUJ/radiocapitellar problems
distal radius fractures kids
o Buckle, Torus § Failure of 1 cortex in compression o Greenstick § Failure of 1 cortex in compression, other cortex in extension o Bayonet, offended
management of distal radius fractures kids
o Buckle – cast 3-4 weeks ? o Greenstick – cast 4-6 weeks o Complete – cast +/- KW 6 weeks o Risk for remanipulation § Complete fractures § Failed anatomic reduction § NOT B/E pop
what is a Galeazzi fracture?
fracture of the distal 1/3 of the radius with dislocation of the distal radioulnar joint
what is a monteggia fracture?
fracture of the proximal 1/3 of the ulna with dislocation of the proximal head of the radius
knee injury DDx kids
o Infection o Inflammatory arthropathy o Neoplasm o Apophysitis o Hip o Foot o Sickle, haemophilia o “anterior knee pain”
knee bony injury kids
o Physeal/metaphyseal o Tibial spine o Tibial tubercle o Patellar fracture o Sleeve fracture o Patellar dislocation o Referred
growth rate of femur
11mm/y
growth rate of tibia
6mm/y
hyperextension of the knee resuts in what kind of injury?
vascular
treatment of physeal injury of the knee kids
§ Cast immobilise
§ Percutaneous fix
§ ORIF articular displacement
§ ROM early <6/52
physeal arrest after knee injury kids
§ Monitor – Harris lines, angulation and length § Resect var § Complete epiphysiodesis § Contralateral epiphysiodesis § Corrective osteotomy
at what age does the patellar become ossified?
4
types of patellar fracture and treatment
undisplaced - cylinder case
displaced - ORID
risk factors for patella dislocation
laxity poor VMO q angle femoral anteversion tibial external rotation patella alta
patella dislocation management
cast 2/52 repair medial ligament mobilise lateral relase VMO exercises - medialise tibial tubercle semiT tenodesis
trauma - osteochondral lesions
o Single traumatic incident … developmental?
o Plain films (tunnel view) +/- MRI
o Type 1 (cartilage intact) – immobilise
o Type 2 (flap) and 3 (fragment) – drilling/fix
