accidents and injuries in school
DESCRIPTION
Accidents and Injuries in School. School Environment. Injuries - 3 % - 9 % annually Fractures - 5% - 10% of all school related injuries Rockwood and Wilkins Fractures in Children, 2001. Incidence of Injuries. Age distribution 13 – 17 year old (30%) - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/1.jpg)
Accidents and Injuries in School
![Page 2: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/2.jpg)
School Environment
• Injuries
- 3 % - 9 % annually
• Fractures
- 5% - 10% of all school related
injuries
Rockwood and Wilkins Fractures in Children, 2001
![Page 3: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/3.jpg)
Incidence of Injuries
Age distribution• 13 – 17 year old (30%)• 6 – 9 year old (27%)• 1 – 5 year old (23%)
• M : F 3 : 1
De la Calzada, Caballes and Javier, 1998
![Page 4: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/4.jpg)
Incidence of InjuriesCause
• Fall 78%
• Traffic accidents 11%
De la Calzada, Caballes and Javier, 1998
![Page 5: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/5.jpg)
Incidence of Injuries
Place
• Home 41%
• Streets 22.7%
• School 20.7%
De la Calzada, Caballes and Javier, 1998
![Page 6: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/6.jpg)
Incidence of Fractures in Children
Rockwood and Wilkins Fractures in Children, 2001
![Page 7: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/7.jpg)
Overall Frequency of Fractures
• % children with fractures (0 to 16 years of age)Boys 42% Girls 27%
• % children with a fracture in a year: 1% - 2%
Rockwood and Wilkins Fractures in Children, 2001
![Page 8: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/8.jpg)
• Common Childhood Fractures and Dislocations
• Sports Injuries• Infections• Battered Child
Syndrome
![Page 9: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/9.jpg)
Common Childhood Fractures and Dislocations
![Page 10: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/10.jpg)
Fractures and Dislocations
• What is a fracture?
Injury caused by a break in the
bone
![Page 11: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/11.jpg)
Common Fractures
• Wrist (distal radius)
• Forearm (radio-ulna)
• Elbow (supracondylar)
• Collar bone (clavicle)
• Thigh (femur)
![Page 12: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/12.jpg)
Wrist Fractures
• Common site of forearm fracture
• Adolescence • Fall on an
extended wrist
![Page 13: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/13.jpg)
Wrist Fractures
• Signs and Symptoms
- swelling over
wrist
- tenderness
- painful motion
of wrist
- gross deformity
of wrist
![Page 14: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/14.jpg)
Wrist Fractures
• What to do?
- Splint
- Elevate hand
- Seek medical
consult
![Page 15: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/15.jpg)
Forearm Fractures
• Caused by landing on an outstretched upper extremity
![Page 16: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/16.jpg)
Forearm Fractures
• Signs and Symptoms
- swelling of
forearm
- tenderness
- deformity of
forearm
![Page 17: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/17.jpg)
Forearm Fractures
• What to do?
- Splint
- Elevate hand
- Seek medical
consult
![Page 18: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/18.jpg)
Elbow Fractures
• 5 – 7 years old• Caused by falls
![Page 19: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/19.jpg)
Elbow Fractures
• Signs and Symptoms
- swelling of elbow
- tenderness
- limitation of
elbow motion
- deformity of
elbow
![Page 20: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/20.jpg)
Elbow Fractures
• What to do?
- Splint
- Elevate arm
- Seek medical
consult
![Page 21: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/21.jpg)
Clavicular Fractures
• fall on the shoulder
![Page 22: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/22.jpg)
Clavicular Fractures
• Signs and Symptoms
- swelling of
shoulder
- tenderness
- limitation of
shoulder motion
- gross deformity
of shoulder
![Page 23: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/23.jpg)
Clavicular Fractures
• What to do?
- Sling
- Seek medical
consult
![Page 24: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/24.jpg)
Femoral Shaft Fractures
• Older children – high-energy injuries
• Children younger than walking age
( <1 yo) – 80% caused by child abuse
![Page 25: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/25.jpg)
Femoral Shaft Fractures
• Signs and Symptoms
- swelling of thigh
- tenderness
- limitation of
motion of lower
extremity
- deformity of
thigh
![Page 26: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/26.jpg)
Femoral Shaft Fractures
• What to do?
- Splint
- Keep patient
lying down
- Seek medical
consult
![Page 27: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/27.jpg)
Fractures and Dislocations
• What is a dislocation?
Injury affecting the congruity of
a joint
![Page 28: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/28.jpg)
Common Dislocations
• Elbow
• Shoulder
![Page 29: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/29.jpg)
Elbow Dislocations
• Uncommon in children
• 13 – 14 years old• Sports injuries• Fall on an
outstretched
arm
![Page 30: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/30.jpg)
Elbow Dislocations
• Signs and Symptoms
- swelling of elbow
- tenderness
- limitation of
elbow motion
- deformity of
elbow
![Page 31: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/31.jpg)
Elbow Dislocations
• What to do?
- Splint
- Elevate upper
extremity
- Seek medical
consult
![Page 32: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/32.jpg)
Shoulder Dislocations
• Adolescence• Contact sports,
falls, fights, and motor vehicle accidents
![Page 33: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/33.jpg)
Shoulder Dislocations
• Signs and Symptoms
- swelling of
shoulder
- tenderness
- limitation of
shoulder motion
- gross deformity
of shoulder
![Page 34: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/34.jpg)
Shoulder Dislocations
• What to do?
- Sling
- Seek medical
consult
![Page 35: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/35.jpg)
Sports Injuries in Children
![Page 36: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/36.jpg)
Sports Injuries
• Repetitive stress
• Adolescence
Data from Sports Clinic, UP-PGH, 2006
![Page 37: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/37.jpg)
Sports Injuries
• Most common type of sports associated with injuries
- basketball
- volleyball
- badminton
Data from Sports Clinic, UP-PGH, 2006
![Page 38: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/38.jpg)
Common Sports Related Injuries
in Children• Acute
– Ankle sprains– Forearm
fractures (greenstick)
– Finger joint dislocations
• Chronic– Back pains– Knee pains– Elbow pains
Data from Sports Clinic, UP-PGH, 2006
![Page 39: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/39.jpg)
Infections
![Page 40: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/40.jpg)
Infections
• Septic Arthritis
• Osteomyelitis
![Page 41: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/41.jpg)
Septic Arthritis
• Inflammation of the joint
• Pus-forming organisms
• Newborn, infants and children
(2 - 3 years old)
Tachdjian Pediatric Orthopedics, 1990
![Page 42: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/42.jpg)
Septic Arthritis
• Involvement
1. Hip joint
2. Knee joint
3. Elbow joint
Tachdjian Pediatric Orthopedics, 1990
![Page 43: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/43.jpg)
Septic Arthritis
![Page 44: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/44.jpg)
Septic Arthritis
• Bacteria enter the joint via:1. Blood stream2. Direct extension3. Direct injection
Tachdjian Pediatric Orthopedics, 1990
![Page 45: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/45.jpg)
Septic Arthritis
• Signs and Symptoms– Acute– Pain– Limitation of motion– Apprehensive, irritable,
loss of appetite, and feverish– Joint - warm and swollen
Tachdjian Pediatric Orthopedics, 1990
![Page 46: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/46.jpg)
Septic Arthritis
• Treatment– Antibiotics– Drainage and debridement– Splint - pain and prevent deformity – Function and congruency of joint
Tachdjian Pediatric Orthopedics, 1990
![Page 47: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/47.jpg)
Osteomyelitis
• Infection of bone • Infants and children• Metaphysis of long
bones
Tachdjian Pediatric Orthopedics, 1990
![Page 48: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/48.jpg)
Osteomyelitis
• Routes of infection– Bloodstream– Direct extension– Open fractures
Tachdjian Pediatric Orthopedics, 1990
![Page 49: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/49.jpg)
Osteomyelitis
• Signs and Symptoms– Pain – High fever, chills, vomiting and dehydration– tenderness over bone
Tachdjian Pediatric Orthopedics, 1990
![Page 50: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/50.jpg)
Osteomyelitis
![Page 51: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/51.jpg)
Osteomyelitis
• Treatment– Antibiotics– Splint or cast– Surgery
Tachdjian Pediatric Orthopedics, 2nd edition
![Page 52: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/52.jpg)
Battered Child Syndrome
![Page 53: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/53.jpg)
Annual Report CPU 2005
![Page 54: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/54.jpg)
Annual Report CPU 2005
![Page 55: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/55.jpg)
Annual Report CPU 2005
![Page 56: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/56.jpg)
Annual Report CPU 2005
fath
er
![Page 57: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/57.jpg)
Common Child Abuse History Risk Factors
• Unexplained injury• Absent, changing, or evolving history• Delay in seeking care• Inappropriate affect (caregiver)• Triggering event - loss of control of
caregiver
Sirotnak et al, 2004
![Page 58: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/58.jpg)
Common Child Abuse History Risk Factors
• Unrealistic expectations (caregiver)
• Crisis or stress (family or caregiver)
• Social or physical isolation (family or caregiver)
• Increasing severity or number of consults
• Abused during childhood (caregiver)
Sirotnak et al, 2004
![Page 59: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/59.jpg)
Physical Examination
• Head and neck• Skin• Chest,
abdomen, and genitalia
• Skeletal trauma
![Page 60: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/60.jpg)
Head and Neck
• swelling, abrasions, lacerations, bruises
• uneven skull• bulging (skull)• bleeding in mouth• tooth decay• bleeding in eyes• deformed ears
![Page 61: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/61.jpg)
Skin
• Bruises, bites and burns
• Pinch and ligature marks
• “Object pattern” marks
• “stocking” and “glove” immersion patterns
![Page 62: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/62.jpg)
Chest, Abdomen, and Genitalia
• Bruises • Unequal breathing• Pain• Deformities• Abrasion or laceration on private parts
![Page 63: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/63.jpg)
Specificity of Fractures for Physical Abuse
![Page 64: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/64.jpg)
What to do?
• If you suspect physical abuse to children:
- Department of Social Welfare and
development
- Child Protection Unit (UP-PGH)
- Women and Child desk (PNP/NBI)
![Page 65: Accidents and Injuries in School](https://reader031.vdocuments.mx/reader031/viewer/2022033016/56812fbc550346895d953f99/html5/thumbnails/65.jpg)
The Philippine College of Physicians wishes to acknowledge the following for their invaluable
efforts in the preparation of this module
Edward H.M. Wang, MD, MSc
Nilo T. Paner, MD
Department of Orthopedics
College of Medicine and Philippine General Hospital
University of the Philippines Manila