Paediatric Fractures
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Paediatric Fractures
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Paediatric Fractures
- 1. Dr. Rosalind Oakes November 2014
- 2. * *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.
- 3. * *Infants diaphyseal *Children metaphyseal *Adoloscents epiphyseal
- 4. * *30 month old female. Fell when playing on bed. Complaining of left elbow pain. Decreased ROM. ? Fracture
- 7. * * 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/
- 8. * *Capitellum (1 year) *Radial head (3y) *Internal (Medial) epicondyle (5y) *Trochlea (7y) *Olecranon (9y) *External (lateral) epicondyle (11y)
- 9. * *6 year old girl with deformed right elbow since a fall today
- 12. * Collar and cuff Urgent orthopaedic assessment and theatre Reduce, above elbow cast + orthopaedic review
- 13. * *10 year old girl presented having fallen onto outstretched hand *Tender distal radius and ulna
- 15. * *Compression failure from longitudinal force *Usually at metaphyseal / diaphyseal junction *Stable *Can be managed in a splint – (3 weeks continuous and no sport)
- 16. * *4 year old with fall onto outstretched hand *Tender distal radius
- 18. * *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)
- 19. * *5 year old *Fall from the monkey bars *Tender proximal forearm
- 23. * *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
- 24. * *Bending mechanism *Fracture does not pass completely through bone *High risk of refracture
- 25. * *7 year old with fall whilst doing a cartwheel *Tender left forearm
- 27. * *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
- 28. * *13 year old male with a fall onto an outstretched hand *Tender radius
- 30. * Slipped Above Lower Through Rammed 1 – Though the physis 2 – Involving the metaphysis 3- Involving the epiphysis 4- Through metaphysis and epiphysis 5 - Impacted
- 31. * * 8 year old fell playing basketball
- 32. * * 8 year old fell playing basketball
- 33. * * 9 year old who fell off skateboard *Presents with swelling to the left ankle and unable to weightbear *Previous fibular fracture
- 36. * *Undisplaced Salter-Harris II fractures of the distal tibia: non weight bearing below knee plaster backslab + clinic in 7 days
- 37. * *7 year old fell from play equipment *Swollen right ankle *Non weight bearing
- 39. * *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
- 40. * *5 years old fell onto thumb whilst on bouncy castle
- 42. * *11 year old boy with swollen painful right ankle since a fall today
- 44. * *2 years old *Irritable today and limping *No history of falls
- 46. * *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
- 47. * *13 year old, externally rotated ankle *Pain on weightbearing
- 49. * *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
- 50. * * 9 year old who fell off a skateboard awkwardly *Pain ++ mid leg
- 53. * *10 year old boy who inverted his foot and presents with pain at the base of the fifth metatarsal
- 56. *Case *27 year old who injured her foot whilst playing netball *Tender base of 5th metatarsal
- 57. * *High school student suffered sudden onset of run hip pain whilst running
- 58. *
- 59. * 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.
- 60. *
- 61. * *http://kidshealthwa.com/ *http://www.rch.org.au/clinicalguide/ *http://www.emergucate.com *http://ortho-teaching. feinberg.northwestern.edu/
- 62. * *Fell off couch *Swelling pain and tenderness, decreased ROM
- 65. * *16 year old *Rolled onto right wrist whilst playing soccer
Hinweis der Redaktion
- Incomplete supracondylar fracture seen on the ulna aspect of the distal humerus with bony irregularity noted. Large associated joint effusion with elevation of both fat pads.
- There is a posteriorly angulated supracondylar fracture with a large joint effusion. Radiocapitellar alignment remains satisfactory. No wrist fracture.
- Management Gartland 1: Non and minimally displaced (less than 20 degrees angulation) supracondylar fractures are managed in a collar and cuff with fracture clinic follow up Gartland 2 requires reduction with above elbow cast at 90 degrees with a sling + ortho discussion and f/u Gartland 3 requires carries the highest risk for neurovascular compromise and requires urgent orthopaedic assessment for theatre Assessment Dimpling in the antecubital fossa with significant swelling at the elbow Extension injury: If the proximal humerus moves medially – possible impingement on the brachial artery and median nerve (anterior interosseous nerve most commonly affected Anterior interosseous branch of median nerve has no sensory component – therefore patients only have weakness of OK sign – at distal phalanx joint ) Ecchymosis over anteomedial aspect of forearm suggests brachial artery injury Flexion: ulnar nerve injury Open – puncture wound above or in antecubital region Forearm and wrist fractures are associated in 5%. Clavical involvement also possible
- Buckle fracture of the distal radial diametaphysis with slight dorsal angulation, as well as subtle buckling of the dorsal aspect of the ulnar metaphysis. Normal elbow alignment
- Report: There is a tranverse fracture of the right distal radial diametaphsysis located just over 1cm proximal to the physis. Subtle dorsal angulation. This distal ulna appears intact. No carpal injury.
- Monteggia _ greenstick fracture of the mid ulnar diaphysis with dorsal angulation and volar dislocation of the radial head
- Greenstick fracture of the ulnar with angulation and plastic bowing of the radius without a demonstrated cortical breech.
- Distal radial salter harris type 2 fracture. Ulnar styloid fracture, Undisplaced scaphoid fracture.
- 2 most common and with increasingly worse prognosis
- Salter harris 2 fracture of the base of the proximal phalanx of the little finger. Dorsomedial angulation of the distal fragment with angulation more prominent medially where there is approximately 30 degrees of medial angulation.
- Salter harris 2 fracture of the base of the proximal phalanx of the little finger. Dorsomedial angulation of the distal fragment with angulation more prominent medially where there is approximately 30 degrees of medial angulation.
- Report Fractures of the distal tibia and fibula, Salter harris 2 to the tibia with no definite epiphyseal fracture. The distal fibular diametaphyseal fracture exhibits no physeal extension.
- The anterior and posterior recesses of the ankle joint (arrowed) are of fluid density and suggest the presence of a large ankle effusion. The age-group, the soft tissue swelling, the inability to weight-bear and the ankle effusion suggest a significant force and raise the possibility of a Salter Harris I injury to the distal fibular growth plate. A Salter Harris I injury to the distal fibular epiphyseal plate will often not be definitively diagnosed on plain film. The diagnosis should be made on a balanced view of the clinical and radiographic evidence. Point tenderness over the distal fibular growth plate is an important diagnostic clue.
- Transverse fracture at the base of the proximal phalanx of the left thumb, extends into the physis, salter harris 2, 30 degrees of radial angulation
- Fracture of the medial mallelous extending to the physis suggesting a salter harris 3. Widened ankle mortise medially. Possible lateral malleolar salter 2 fracture.
- Undisplaced tibial shaft fractures should be put in an above knee backslab and followed up in the Orthopaedic Fracture clinic in 1 week Report: There is an oblique coronally orientated fracture of the left tibia at the junction of mid and distal thirds. Subtle displacement only. Associated undisplaced spiral fracture of the distal shaft of the fibula. Distal growth plates are intact.
- An apophysis is located at a site of ligament or tendon attachment. The apophysis does not contribute to the longitudinal growth of bone. Beware in children the normal unfused apophysis. This should not be mistaken for a fracture, by observing that the apophysis lies longitudinal to the long axis of the metatarsal. A fracture line will run transversely. Avulsion fracture at the base of the fifth metatarsal (insertion of peroneus brevis) is a relatively common fracture in children. These are immobilised in a below knee backslab with Orthopaedic Fracture clinic follow up in 7-10 days.
- The Jones Fracture occurs at the metaphyseal-diaphyseal junction - seen in teenagers Prone to non union Requires patient to be non weight bearing in below knee back slab for 8 weeks plus
- The most common avulsion fractures of the pelvis and its related muslce attachement are (Figure) 1. ASIS -- Sartorius muscle 2. AIIS -- Rectus femoris muscle 3. Ischial tuberosity -- Hamstring muscles 4. Lesser tuberosity -- iliopsoas muslce
- Report There is a transverse fracture of the mid fibular diaphysis with approximately 10 degrees of posterior and lateral angulation. There is associated periosteal reaction in keeping with a subacute injury. Isolated fibula shaft fractures rarely need Orthopaedic intervention even if displaced, but should be immobilised in a backslab and followed up in the Orthopaedic Fracture clinic in 7-10 days Delayed presentation requires careful risk assessment for the possibility of non accidental injury
- Large effusion. Supracondylar fracture extending to the dorsal surface of the distal humerus and also a fracture extending throught the lateral condyle involving the capitellum. (salter harris 4)
- There is a right distal radius fracture noted just proximal to the epiphysis which appears to be mainly compression with dorsal angulation
- Scaphoid