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Systems: MSK AB > Paediatric Trauma > Flashcards

Flashcards in Paediatric Trauma Deck (49)
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1

What is the commonest cause of death in children?

Trauma

2

What types of trauma can children be involved in?

-Transport
-Assault
-Falls, electrical shocks, drowning
-Other

3

What are the risk factors for paediatric trauma?

-Boys> girls
-Age
-Increased physeal injury with age
-Previous fractures
-Metabolic bone idsease

4

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

5

Why do children's bones heal quickly?

-Metabolically active periosteum
-Cellular bone
-Plastic

6

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

7

Why do children's fractures remodel well in the plane of joint movement?

-Appositional periosteal growth/resorption
-Differential physeal growth

8

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

9

Where does deformity often occur?

Elbow

10

Where does bone arrest often occur?

-Knee
-Ankle

11

Where does bone overgrowth often occur?

Femur

12

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

13

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

14

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

15

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

16

Buckle fracture

Failure of 1 cortex in compression

17

Greenstick fracture

Failure of 1 cortex, other cortex in extension

18

How are fractures managed?

Buckle
-Cast 3-4 weeks

Greenstick
-Cast 4-6 weeks

Complete
-Cast +/-KW 6 weeks

19

What is the differential of knee trauma?

-Infection
-Inflammatory arthropathy
-Neoplasm
-Apophysitis
-Hip problem
-Foot problem
-Sickle cell, haemophilia
-'Anterior knee pain'

20

Where can bone injury occur with knee pain?

-Physeal/metaphyseal
-Tibial spine
-Tibial tubercle
-Patellar fracture
-Sleeve fracture
-Patellar dislocation
-Referred

21

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

22

What are possible complications of physeal injury?

-Hyperextension can lead to vascular injury
-Varus can lead to common peroneal nerve injury

23

What is the treatment for physeal injury?

-Cast immobilisation
-Percutaneous fix
-ORIF articular displacement
-ROM early <6/52

24

How is physeal arrest monitored?

Monitor
-Harris lines
-Angulation and length

25

How is physeal arrest treated?

-Resect bar
-Complete epiphysiodesis
-Contralateral epiphysiodesis
-Corrective osetotomy

26

What does the tibial spine overlap?

Anterior cruciate ligament

27

How are fractures of the tibial spine classified?

Meyers and McKeever
-I undisplaced
-II hinged
-III displaced

28

What is the treatment for tibial spine fractures?

-Undisplaced or hinged= long leg cast
-Hinged or displaced= ORIF/AxIF

29

How are tibial tubercle fractures classified?

Ogden
-I distal avulsion
-II to proximal tibial physis (not joint)
-III to proximal tibial physis (into joint)

30

Why are patellar fractures rare?

Cartilaginous until age 4