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Dr. Rosalind Oakes 
November 2014
* 
*Significant osteogenic potential and more 
metabolically active 
Promotes union, callus formation and remodelling 
*Pe...
* 
*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 
fr...
* 
*Capitellum (1 year) 
*Radial head (3y) 
*Internal (Medial) 
epicondyle (5y) 
*Trochlea (7y) 
*Olecranon (9y) 
*Externa...
* 
*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 ...
* 
*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 fra...
* 
*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 hyperextens...
* 
*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...
* 
*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-...
* 
* 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 fi...
* 
*Undisplaced Salter-Harris II fractures of the 
distal tibia: non weight bearing below knee 
plaster backslab + clinic ...
* 
*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...
* 
*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 findi...
* 
*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 b...
* 
* 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...
*
* 
*http://kidshealthwa.com/ 
*http://www.rch.org.au/clinicalguide/ 
*http://www.emergucate.com 
*http://ortho-teaching. 
...
* 
*Fell off couch 
*Swelling pain and tenderness, decreased ROM
* 
*16 year old 
*Rolled onto right wrist whilst playing soccer
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
Paediatric Fractures
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Paediatric Fractures

  1. 1. Dr. Rosalind Oakes November 2014
  2. 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. 3. * *Infants diaphyseal *Children metaphyseal *Adoloscents epiphyseal
  4. 4. * *30 month old female. Fell when playing on bed. Complaining of left elbow pain. Decreased ROM. ? Fracture
  5. 5. * * 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/
  6. 6. * *Capitellum (1 year) *Radial head (3y) *Internal (Medial) epicondyle (5y) *Trochlea (7y) *Olecranon (9y) *External (lateral) epicondyle (11y)
  7. 7. * *6 year old girl with deformed right elbow since a fall today
  8. 8. * Collar and cuff Urgent orthopaedic assessment and theatre Reduce, above elbow cast + orthopaedic review
  9. 9. * *10 year old girl presented having fallen onto outstretched hand *Tender distal radius and ulna
  10. 10. * *Compression failure from longitudinal force *Usually at metaphyseal / diaphyseal junction *Stable *Can be managed in a splint – (3 weeks continuous and no sport)
  11. 11. * *4 year old with fall onto outstretched hand *Tender distal radius
  12. 12. * *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)
  13. 13. * *5 year old *Fall from the monkey bars *Tender proximal forearm
  14. 14. * *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
  15. 15. * *Bending mechanism *Fracture does not pass completely through bone *High risk of refracture
  16. 16. * *7 year old with fall whilst doing a cartwheel *Tender left forearm
  17. 17. * *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
  18. 18. * *13 year old male with a fall onto an outstretched hand *Tender radius
  19. 19. * Slipped Above Lower Through Rammed 1 – Though the physis 2 – Involving the metaphysis 3- Involving the epiphysis 4- Through metaphysis and epiphysis 5 - Impacted
  20. 20. * * 8 year old fell playing basketball
  21. 21. * * 8 year old fell playing basketball
  22. 22. * * 9 year old who fell off skateboard *Presents with swelling to the left ankle and unable to weightbear *Previous fibular fracture
  23. 23. * *Undisplaced Salter-Harris II fractures of the distal tibia: non weight bearing below knee plaster backslab + clinic in 7 days
  24. 24. * *7 year old fell from play equipment *Swollen right ankle *Non weight bearing
  25. 25. * *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
  26. 26. * *5 years old fell onto thumb whilst on bouncy castle
  27. 27. * *11 year old boy with swollen painful right ankle since a fall today
  28. 28. * *2 years old *Irritable today and limping *No history of falls
  29. 29. * *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
  30. 30. * *13 year old, externally rotated ankle *Pain on weightbearing
  31. 31. * *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
  32. 32. * * 9 year old who fell off a skateboard awkwardly *Pain ++ mid leg
  33. 33. * *10 year old boy who inverted his foot and presents with pain at the base of the fifth metatarsal
  34. 34. *Case *27 year old who injured her foot whilst playing netball *Tender base of 5th metatarsal
  35. 35. * *High school student suffered sudden onset of run hip pain whilst running
  36. 36. *
  37. 37. * 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.
  38. 38. *
  39. 39. * *http://kidshealthwa.com/ *http://www.rch.org.au/clinicalguide/ *http://www.emergucate.com *http://ortho-teaching. feinberg.northwestern.edu/
  40. 40. * *Fell off couch *Swelling pain and tenderness, decreased ROM
  41. 41. * *16 year old *Rolled onto right wrist whilst playing soccer
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