Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.

26
Pediatric Trauma Pediatric Trauma Intro: Intro: What makes kids so What makes kids so different? different? OTA Resident Fracture Course

Transcript of Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.

Page 1: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.

Pediatric Trauma Intro: Pediatric Trauma Intro:

What makes kids so What makes kids so different?different?

OTA Resident Fracture Course

Page 2: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.

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

Page 3: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.

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

Page 4: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.
Page 5: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.

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

Page 6: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.
Page 7: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.
Page 8: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.

3. Blood Supply3. Blood Supply

Richer in kidsRicher in kids Perfusion = healingPerfusion = healing Certain exceptionsCertain exceptions

Proximal femurProximal femur Lateral condyleLateral condyle

Page 9: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.
Page 10: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.

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!

Page 11: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.

Images courtesy of Jack Flynn, MD & Chad Price, MD

Page 12: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.

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

Page 13: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.

Salter-Harris Classification for Physeal Fractures

Page 14: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.

Physeal injury can result in a growth arrest leading to LLD or angular deformities…

Page 15: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.

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

Page 16: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.
Page 17: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.

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

Page 18: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.
Page 19: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.

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

Page 20: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.

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

Page 21: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.

Remove any cast Remove any cast if there is if there is increasing painincreasing pain

Page 22: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.

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!

Page 23: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.
Page 24: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.

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

Page 25: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.

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

Page 26: Pediatric Trauma Intro: What makes kids so different? OTA Resident Fracture Course.

Questions?Questions?