Children's Fractures - 08/11/18

Question 1

What % of children get injured every year?

Answer 1

25%

Question 2

Which gender more commonly gets fractures?

Answer 2

Boys

Question 3

Which limb is most common for childrens fractures?

Answer 3

Upper limb

Question 4

What are 3 fractures that are specific to children?

Answer 4

Greenstick
Torus
Plastic deformation

Question 5

Describe the bony anatomy of childrens bone?

Answer 5

Physis = Growth Plate
On the joint side - epiphysis
Shaft - Diaphysis
Metaphysis is extending to diaphysis

Question 6

What is Wollfs law?

Answer 6

Bone in a healthy person will adapt to the load under which it is places

Question 7

What is hueter volkman law?

Answer 7

Compression forces inhibit growth and tensile forces stimulate growth

Question 8

Is fracture healing better in children or adults?

Answer 8

Children

Question 9

What important aspects of the history are important?

Answer 9

Mechanism
How high?
How Fast?
Forces involved
Predict injuries and exclude or confirm

Question 10

What are features of non accidental injury?

Answer 10

History that does not match the nature of the injury
Vague parental accounts, or account that change
Accusations that child injured themselves intentionally
Delay in seeking help
Child dressed inappropriately for the situation
Any obvious or unsuspected fractures in a child under 2
Injuries in various stages of healing
More injuries than usual
Scattered injuries
Increased intracranial pressure
Suspected intra-abdominal trauma
Any injury that does not fit the description

Question 11

What is important in the LOOK part of the examination?

Answer 11

Deformity
Swelling
Bruising
Assymetry

Question 12

What is important in the FEEL part of the examination?

Answer 12

For point tenderness that correlates with X-ray

Question 13

What is important in the neurovascular exam?

Answer 13

Colour
Capillary refill
Skin temperature
O2 saturations
Pulse
Sensation
Sweating
Skin wrinkling

Question 14

What is the MOVE part of the examination?

Answer 14

Often too painful
DNV
OK sign - medial
Hitchikers thumb - radial
Star fish - ulnar 
Initial force on impact

Question 15

What causes a fracture to displace?

Answer 15

Muscle action and gravity

Initial force on impact

Question 16

What can cause a wrist drop/

Answer 16

Radial nerve impingement

Humeral fracture`

Question 17

What are symptoms of ulnar nerve damage?

Answer 17

Loss of function of hands and fingers

Question 18

What is used in the diagnosis of child fracture?

Answer 18

X-ray if ossified
Ultrasound
Arthrogram for joint injuries
CT or MRI for detail

Question 19

What are the 3 Rs of fracture management?

Answer 19

Reduce
Retain
Rehabilitate

Question 20

What important in the reduce part?

Answer 20

Remodelling potential reduced need for accurate reduction at a young age

Question 21

What is gallows traction?

Answer 21

Suspending legs off of the bed
3 months to 3 years
<48 hours traction and then spica or inpatient traction 2/52

Question 22

What is important in the Retain part?

Answer 22

Broad arm sling support
Collar
Cuff

Question 23

Which fractures definitely need fixed?

Answer 23

Displaced Intraarticular fractures
Displaced growth plate injuries
Open Fractures

Question 24

What is the classification for physeal injuries?

Answer 24

Salter Harris classification

Question 25

SALTER acronym

Answer 25

S- Straight across
A - Above
L - Lower
TH - Through everything
R - cRush

Question 26

What are the indications for external fixation?

Answer 26

Contaminated wounds
Acute vascular injury
Burns
Multiple injuries