of 4 /4
Paediatric Orthopaedic Trauma Pulled Elbow Salter- Harris Injuries Definition: subluxation of radial head Symptoms: history of being pulled; mvmt arm after Examination: undistressed at rest; no Epidemiology: 15% long bone fractures in children occur at epiphyseal plate Pathology: epiphyseal plate is less strong than bone, ligaments and tendon Early reduction better; young children have greater growth disturbance; Through epiphysis; diagnosis clinical Reduction easy POP and ortho follow up prognosis excellent Management: if unable to reduce, most will spontaneously reduce in 48hrs; recurrence rate 25-40% Supination/flexion technique: hold arm with thumb on radial head supinate and flex arm I SEPARAT E Through epiphysis and metaphysis Reduction easy if <48hrs prognosis excellent II ABOVE Intra-articular fracture into epiphysis Accurate reduction needed, needs ortho R/V prognosis good III LOW Intra-articular fracture into epiphysis and metaphysis Accurate reduction needed; usually open reduction and internal fixation IV THROUGH Crush / axial loading injury to epiphysis; usually of knee / ankle; often joint effusion; significant MOI / tenderness; may be hard to diagnose V EEEEEK!

Paediatric Orthopaedic Trauma Orthopaedic Trauma

  • Author
    vanhanh

  • View
    245

  • Download
    5

Embed Size (px)

Text of Paediatric Orthopaedic Trauma Orthopaedic Trauma

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