paediatric fractures
DESCRIPTION
Paediatric FracturesTRANSCRIPT
Dr. Rosalind Oakes
November 2014
*
*Significant osteogenic potential and more
metabolically active
Promotes union, callus formation and remodelling
*Periosteum is thicker
Reduces displacement of fractures and chance of
open fractures
*Unique fracture patterns, greenstick etc.
*
*Infants diaphyseal
*Children metaphyseal
*Adoloscents epiphyseal
*
*30 month old female. Fell when playing on
bed. Complaining of left elbow pain.
Decreased ROM. ? Fracture
*
* Check true lateral
* Check anatomical alignment
* Anterior humeral line (less than 1/3 of the capitulum lies in front of the line)
* Radiocapitellar line
* Fat pad signs
* Check cortex
* Check radial head
* Check AP cortex
* Ossification centres
http://dontforgetthebubbles.com/elbow-xr-interpretation/
*
*Capitellum (1 year)
*Radial head (3y)
*Internal (Medial)
epicondyle (5y)
*Trochlea (7y)
*Olecranon (9y)
*External (lateral)
epicondyle (11y)
*
*6 year old girl with deformed right elbow since
a fall today
*
Collar and cuff Urgent
orthopaedic
assessment and
theatre
Reduce, above
elbow cast +
orthopaedic review
*
*10 year old girl presented having fallen onto
outstretched hand
*Tender distal radius and ulna
*
*Compression failure from longitudinal force
*Usually at metaphyseal / diaphyseal
junction
*Stable
*Can be managed in a splint – (3 weeks
continuous and no sport)
*
*4 year old with fall onto outstretched hand
*Tender distal radius
*
*Buckle fractures that are not suitable for a
wrist splint:
*Volar angulation
*Cortical disruption (= greenstick fracture)
*Ulna greenstick, complete or styloid fracture
*Greater than 15 degrees angulation or obvious
clinical deformity – will likely need reduction
(refer to Orthopaedic Team urgently)
*
*5 year old
*Fall from the monkey bars
*Tender proximal forearm
**Ulnar shaft fracture and radial head dislocation
*Rare – only 2% of elbow injuries
*Mechanism is usually hyperextension at the
elbow
*Isolated ulna injuries are rare.. Examine and
xray the joint above and below
*The posterior interosseous nerve is the most
commonly affected – deep extensor muscles
*Requires immediate orthopaedic referral
**Bending mechanism
*Fracture does not pass completely through bone
*High risk of refracture
*
*7 year old with fall whilst doing a cartwheel
*Tender left forearm
**Longitudinal force exceeding ability of bone to
recoil
*Creates microcracks
*Can correct if <4 years or <20 degrees, otherwise
surgical intervention necessary
*Complications: May maintain an adjacent fracture
in angulation or prevent reduction of the fracture
*
*13 year old male with a fall onto an
outstretched hand
*Tender radius
*
Slipped Above Lower Through Rammed
1 – Though the physis
2 – Involving the metaphysis
3- Involving the epiphysis
4- Through metaphysis and epiphysis
5 - Impacted
* 8 year old fell playing
basketball
*
* 8 year old fell playing
basketball
*
*
* 9 year old who fell off skateboard
*Presents with swelling to the left ankle and
unable to weightbear
*Previous fibular fracture
*
*Undisplaced Salter-Harris II fractures of the
distal tibia: non weight bearing below knee
plaster backslab + clinic in 7 days
*
*7 year old fell from play equipment
*Swollen right ankle
*Non weight bearing
**Most common and most missed
*Diagnosed clinically
*Tenderness over fibula physis (as opposed to
tenderness over the ATFL) +/- swelling
*Xray may be normal or there may be swelling
laterally
*Mx plaster
*
*5 years old fell onto thumb whilst on bouncy
castle
*
*11 year old boy with swollen painful right ankle
since a fall today
*
*2 years old
*Irritable today and limping
*No history of falls
*
*Occur in children learning to walk
*Usually after a fall which may not be seen by parents
*Subtle examination findings, limping but often no swelling
* Differentials include septic joints
*Undisplaced fractures can be managed in an above knee back slab and ortho clinic in 10 days
*
*13 year old, externally rotated ankle
*Pain on weightbearing
**Salter Harris III of the distal tibia –
avlusion of the anterolateral part of the
epiphysis
*If non displaced can be managed with
below knee back slab. Discuss with
orthopaedics as to CT needed to confirm
non displacement – displaced fractures
require an operation
*
* 9 year old who fell off a skateboard awkwardly
*Pain ++ mid leg
*
*10 year old boy who inverted his foot and
presents with pain at the base of the fifth
metatarsal
*Case
*27 year old who
injured her foot whilst
playing netball
*Tender base of 5th
metatarsal
*
*High school student suffered sudden onset of
run hip pain whilst running
*
*15 month male with an
ankle injury 10 days ago
after his brother stood on
his ankle. Swollen at the
time and unable to weight
bear.
*
*
*http://kidshealthwa.com/
*http://www.rch.org.au/clinicalguide/
*http://www.emergucate.com
*http://ortho-
teaching.feinberg.northwestern.edu/
*
*Fell off couch
*Swelling pain and tenderness, decreased ROM
*
*16 year old
*Rolled onto right wrist whilst playing soccer