paediatric fractures

Dr. Rosalind Oakes

November 2014

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*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.

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*Infants diaphyseal

*Children metaphyseal

*Adoloscents epiphyseal

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*30 month old female. Fell when playing on

bed. Complaining of left elbow pain.

Decreased ROM. ? Fracture

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* 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/

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*Capitellum (1 year)

*Radial head (3y)

*Internal (Medial)

epicondyle (5y)

*Trochlea (7y)

*Olecranon (9y)

*External (lateral)

epicondyle (11y)

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*6 year old girl with deformed right elbow since

a fall today

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Collar and cuff Urgent

orthopaedic

assessment and

theatre

Reduce, above

elbow cast +

orthopaedic review

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*10 year old girl presented having fallen onto

outstretched hand

*Tender distal radius and ulna

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*Compression failure from longitudinal force

*Usually at metaphyseal / diaphyseal

junction

*Stable

*Can be managed in a splint – (3 weeks

continuous and no sport)

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*4 year old with fall onto outstretched hand

*Tender distal radius

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*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)

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*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

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*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

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*13 year old male with a fall onto an

outstretched hand

*Tender radius

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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

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* 8 year old fell playing

basketball

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* 9 year old who fell off skateboard

*Presents with swelling to the left ankle and

unable to weightbear

*Previous fibular fracture

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*Undisplaced Salter-Harris II fractures of the

distal tibia: non weight bearing below knee

plaster backslab + clinic in 7 days

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*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

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*5 years old fell onto thumb whilst on bouncy

castle

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*11 year old boy with swollen painful right ankle

since a fall today

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*2 years old

*Irritable today and limping

*No history of falls

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*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

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*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

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* 9 year old who fell off a skateboard awkwardly

*Pain ++ mid leg

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*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

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*High school student suffered sudden onset of

run hip pain whilst running

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*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.

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*http://kidshealthwa.com/

*http://www.rch.org.au/clinicalguide/

*http://www.emergucate.com

*http://ortho-

teaching.feinberg.northwestern.edu/

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*Fell off couch

*Swelling pain and tenderness, decreased ROM

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*16 year old

*Rolled onto right wrist whilst playing soccer