Flashcards in Paediatric Trauma Deck (49)
What is the commonest cause of death in children?
What types of trauma can children be involved in?
-Falls, electrical shocks, drowning
What are the risk factors for paediatric trauma?
-Increased physeal injury with age
-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
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?
-Intact growing physis
-Sagittal> frontal> X transverse
Where does deformity often occur?
Where does bone arrest often occur?
Where does bone overgrowth often occur?
Give examples of fractures which can occur in the forearm.
-Can involve the shaft of the radius or ulna
-Fracture of radius due to stress on ulna
-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?
-Sensation and motor function
Document findings and repeat post- intervention
What are the possible complications of forearm fractures?
-Radioulnar synostosis (proximal> distal, high energy, same level, single incision)
-Superficial radial nerve injury
-DRUJ/ radiocapiellar problems
Failure of 1 cortex in compression
Failure of 1 cortex, other cortex in extension
How are fractures managed?
-Cast 3-4 weeks
-Cast 4-6 weeks
-Cast +/-KW 6 weeks
What is the differential of knee trauma?
-Sickle cell, haemophilia
-'Anterior knee pain'
Where can bone injury occur with knee pain?
Why do physeal injuries occur 2: 1 femeu: tibia?
Capsule and ligaments
-Distal femur below physis
-Proximal tibia below physis
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?
-ORIF articular displacement
-ROM early <6/52
How is physeal arrest monitored?
-Angulation and length
How is physeal arrest treated?
What does the tibial spine overlap?
Anterior cruciate ligament
How are fractures of the tibial spine classified?
Meyers and McKeever
What is the treatment for tibial spine fractures?
-Undisplaced or hinged= long leg cast
-Hinged or displaced= ORIF/AxIF
How are tibial tubercle fractures classified?
-I distal avulsion
-II to proximal tibial physis (not joint)
-III to proximal tibial physis (into joint)