Salter-Harris Injuries
Crush / axial loading injury to epiphysis; usually of knee / ankle; often joint effusion;
significant MOI / tenderness; may be hard to diagnose
POP and ortho follow up prognosis poor
V
EEEEEK!
IV
THROUGH
Intra-articular fracture into epiphysis and metaphysis
Accurate reduction needed; usually open reduction and internal fixation
prognosis OK
III
LOW
Intra-articular fracture into epiphysis
Accurate reduction needed, needs ortho R/V prognosis good UNCOMMON
Through epiphysis and metaphysis
Reduction easy if 5yrs
Flucloxacillin 25-50mg/kg QID
Minimum 3/7 IV; total duration minimum 4/52
Flucloxacillin 2g IV QID for 2-4/52 (6/52 if chronic) (+ cefotaxime 2g TDS if ?G-ives)
If MRSA: vancomycin rifampicin
If penicillin allergy: cephazolin
4/52 IV; total duration minimum 6/52
Adults
Paediatric Orthopaedic Trauma
Epidemiology: peak incidence 5-8yrs; most common paediatric elbow fracture; most common
fracture 10 / any rotational deformity / any varus or valgus
deformity / compound
Urgent ortho review if NV
compromise;
immediate ED reduction
if cool / pale hand;
ortho review if no
pulse, but hand
otherwise OK; to
manipulate traction at
20 flexion flexion as
far as possible while still
retaining radial pulse
Other Fractures in Paediatrics
Clavicle: OT needed if medial 1/3, displaced lateral 1/3
Proximal humerus: more common in adolescents; manipulate if >30 displacement
Mid humerus: assess radial nerve; uncommon; usually just POP
Olecranon (appears at 9-10yrs): from fall on elbow; needs ortho review; OT if displaced >5mm;
associated with radial head/neck fracture
Radial head/neck fracture: uncommon in children; neck >head; OT if >60 angulation or >50%
displacement; need ortho review
Elbow dislocation: neuro injury in 10%; posterior most common; ulnar / median nerve injury
Radial / ulnar shaft: OT if any rotational deformity, >10 angulation >8yrs, >15-20 angulation
