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3RD YEAR SYSTEMS: MSK > Paediatric trauma > Flashcards

Flashcards in Paediatric trauma Deck (17)
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1
Q

Why do children’s fractures heal quickly? (4)

A
  • They have a metabolically active periosteum
  • Cellular bone - efficient burn turnover as still growing
  • Good blood supply – no peripheral vascular disease etc
  • Often low velocity trauma
2
Q

What are 3 types of fractures unique to children?

A
  • The following 3 are unique to children:
    • Greenstick
    • Buckle
    • Plastic deformity

(Complete fracture is more common in adults)

3
Q

Describe a buckle fracture

A
  • It is a compression fracture
  • They happen when one side of the bone buckles, or bends, but doesn’t break all the way through.
  • It is a stable fracture and will not move under normal physiological load.
  • Only requires simple splintage for a short period of time.
4
Q

Describe a plastic deformation fracture

A
  • Most commonly seen in the forearm (bones caught between say rungs of a ladder) - a force is applied as the child falls.
  • Sequence of small cracks in the bone.
  • The bone bends but doesn’t break. Points at the ends of bones in the forearm can then dislocate because of the bend
  • This type of fracture has very specific characteristics - they don’t tend to remodel because the periosteum has been minimally disrupted.
5
Q

What is the preferred treatment of a child’s fracture?

A

Conservative treatment - cast, braces, splints or traction

6
Q

In some cases, operative treatment may be necessary. What are the 2 types of operative treatment?

A

External fixation - pins are put into bone and attached to an external frame. The frame can be monolateral or circular Internal fixation - IM nail or plate fixation

7
Q

Why are simple treatments often sufficient for children?

A
  • Children’s fracture re-model
  • The younger the child, the greater the potential for re-modelling
    • Appositional periosteal growth/resorption
    • Differential physeal growth
8
Q

Summary of management of children’s fracture?

A
  • Reduce if it is significantly displaced or if you predict that, if the fracture was left where it was and after a period of remodelling, it wouldn’t achieve adequate function
  • Immobilise as this reduces pain/ damage to tissues/ damage to nerve or blood supply
  • Remove cast/splint when the fracture has healed
  • Must debride all open fractures to prevent infection
9
Q

How do you reduce the fracture?

A
  • By increasing the deformity
  • Reduction in this sense means to repair a fracture or dislocation to the correct alignment
10
Q

When should you use both a cast and fixation in the management of a child’s fracture?

A
  • If severe swelling is likely If you need to re-inspect the wound
  • Multiple injuries
  • Segmental limb injuries - fractures in 2 different sites in a long bone
  • Fracture very unstable If approaching skeletal maturity - need to be more aggressive with fracture management/fixing fractures as there will be a smaller period for remodelling
11
Q

What is a physeal fracture?

A
  • Growth plate fracture - the physis acts as a plane of fracture. It is often the weakest point of the bone
  • These fractures involve a horizontal fracture line through the physis and a vertical fracture line which runs from the growth plate through the epiphysis to the articular surface.
  • If growth plate is injured then could be growth arrest – complete or partial
12
Q

What is the Salter-Harris Classification used for?

A
  • It helps to predict which fractures are likely to cause problems with growth later on.
  • It tells you where the fracture is, not how much it is displaced.
  • Ranges from SH-1 to SH-5
  • SH-2 is the commonest (50%) and most commonly occurs at the ankle
  • SH 3 is a fracture at 90 degrees to the growth plate – much higher risk of growth disturbance - need for anatomical reduction and fixation if displaced + monitor for growth arrest
  • SH 4 is a rare fracture, also at 90 degrees to the growth plate – management is open reduction and internal fixation if displaced + monitor for growth arrest
13
Q

Who do transitional fractures usually affect?

A

Patients with partially closed growth plates i.e ages 13-14

The growth plate fuses centrally first.

14
Q

When would open reduction internal fixation need to be used?

A
  • Adolescents
  • Comminuted fractures - break or splinter of the bone into more than two fragments.
  • Injuries involving joint surface
15
Q

What is a non-accidental injury?

A

Non-accidental injury or physical abuse is any bodily injury that is deliberately inflicted on a vulnerable person that is considered unacceptable in a given culture at a given time.

16
Q

Warning signs for NAI

A
  • Inconsistent history
  • Delay in presentation
  • Fracture pattern does not fit mechanism
  • Bruising – pattern and different ages
  • Burns
  • Multiple fractures, multiple stages of healing
  • Metaphyseal #, Humeral shaft #, Rib #
  • Unable to walk with # of long bones
17
Q

Osteomyelitis

A
  • Insidious onset
  • Mainly around knee
  • Most require prolonged high dose antibiotics
  • Mostly staphylococcus
  • Rarely require surgery
  • Can threaten life and limb