pediatric trauma intro: what makes kids so different? ota resident fracture course
TRANSCRIPT
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Pediatric Trauma Intro: Pediatric Trauma Intro:
What makes kids so What makes kids so different?different?
OTA Resident Fracture Course
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Top 10 reasons kids are Top 10 reasons kids are differentdifferent
1.1. Biologic activityBiologic activity2.2. PeriosteumPeriosteum3.3. Blood supplyBlood supply4.4. RemodelingRemodeling5.5. PhysisPhysis6.6. Mechanical properties of boneMechanical properties of bone7.7. Radiographic interpretationRadiographic interpretation8.8. ImmobilizationImmobilization9.9. Compartment syndromeCompartment syndrome10.10. Non-accidental injuryNon-accidental injury
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1. Biologic Activity1. Biologic Activity
Childhood is a time of Childhood is a time of growth and growth and developmentdevelopment
Machinery already Machinery already “turned on”“turned on”
Rate of healing Rate of healing age age Non-unions rareNon-unions rare
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2. The Periosteum2. The Periosteum
Thicker, more Thicker, more osteogenicosteogenic
Facilitates healingFacilitates healing Minimizes fracture Minimizes fracture
displacementdisplacement Crucial in fracture Crucial in fracture
reductionreduction
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3. Blood Supply3. Blood Supply
Richer in kidsRicher in kids Perfusion = healingPerfusion = healing Certain exceptionsCertain exceptions
Proximal femurProximal femur Lateral condyleLateral condyle
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4. Remodeling4. Remodeling
Allows for closed rx of many Allows for closed rx of many fracturesfractures
Variable Variable AgeAge Distance from physisDistance from physis Plane of deformityPlane of deformity Anatomic regionAnatomic region
Remember: there is a limit!Remember: there is a limit!
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Images courtesy of Jack Flynn, MD & Chad Price, MD
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5. The Physis5. The Physis Mechanical “weak spot”Mechanical “weak spot” Physeal vs. ligamentous Physeal vs. ligamentous
injuriesinjuries 15-30% of all fractures15-30% of all fractures Contributes to rapid Contributes to rapid
healinghealing Risk of growth arrestRisk of growth arrest
Varies by anatomic regionVaries by anatomic region
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Salter-Harris Classification for Physeal Fractures
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Physeal injury can result in a growth arrest leading to LLD or angular deformities…
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6. Mechanical 6. Mechanical PropertiesProperties
Pediatric bones less brittle Pediatric bones less brittle than adultsthan adults
Different fracture patterns Different fracture patterns e.g. incomplete e.g. incomplete “greenstick”, torus“greenstick”, torus
Plastic deformationPlastic deformation
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7. Radiographs Hard to 7. Radiographs Hard to ReadRead
Limited boney landmarksLimited boney landmarks Remember all that cartilage!Remember all that cartilage!
Ossification centers Ossification centers change with timechange with time
Contralateral radiographs, Contralateral radiographs, arthrograms, or MRI often arthrograms, or MRI often useful in difficult casesuseful in difficult cases
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8. Immobilization
Generally safeGenerally safe Risk of stiffness lowRisk of stiffness low Exceptions: Exceptions:
older adolescentsolder adolescents intra-articular knee fracturesintra-articular knee fractures elbow fractureselbow fractures
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8. Immobilization
Generally safeGenerally safe Risk of stiffness lowRisk of stiffness low Exceptions: Exceptions:
older adolescentsolder adolescents intra-articular knee fracturesintra-articular knee fractures elbow fractureselbow fractures
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Remove any cast Remove any cast if there is if there is increasing painincreasing pain
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9. Compartment Syndrome
Harder to get reliable Harder to get reliable examexam
Sentinel finding: Sentinel finding: increasing increasing pain pain medicine requirements medicine requirements after a fractureafter a fracture
Often the next dayOften the next day Low threshold to split cast!Low threshold to split cast!
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10. Non-accidental Injury
Unfortunate mechanismUnfortunate mechanism Femur fx and Femur fx and ““not yet walkinnot yet walkin
gg”” SH II distal humerus in babySH II distal humerus in baby Corner fracturesCorner fractures Make appropriate referrals!Make appropriate referrals!
3 mo old withSH II dist hum fx
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Kids can be the same…Kids can be the same…When is the “pixie dust” gone? When is the “pixie dust” gone? C-spine: age 8C-spine: age 8 Pelvis: when triradiate closesPelvis: when triradiate closes Femur older than 12Femur older than 12 Forearm mid teensForearm mid teens Elbows and knees fracture that get stiffElbows and knees fracture that get stiff
Displaced Intra-articular fracturesDisplaced Intra-articular fractures
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Questions?Questions?