Skeletal Injuries in Children Mark Latimer Consultant Paediatric Orthopaedic Surgeon Peterborough and Stamford Hospitals NHS Foundation Trust.

Skeletal Injuries in Children

Mark LatimerConsultant Paediatric Orthopaedic Surgeon

Peterborough and Stamford Hospitals NHS Foundation Trust

Aims• How to Assess, Describe, & Treat

• Scary Diagnoses

• Classic Diagnoses by Age

• Trauma vs Infection

• How to Spot NAI

• Cover Your Back

Assessing Young Injured Children• Tailor to age

• Observe function/gait

• Sit on their parent’s lap

• Get to their eye level

• Other side first

• Palpate bones

Supracondylar Fracture

Supracondylar Fracture

Scary Supracondylar Fracture

Slipped Upper Femoral Epiphysis

Slipped Upper Femoral Epiphysis

Slipped Upper Femoral Epiphysis

Other Scary Diagnoses

• Open Fractures/dislocations

• Compartment Syndrome

• High Energy Trauma

• T R A S H Lesions (The Radiographic Appearance Seemed Harmless)

Classic Diagnoses by Age

Babies

1-5 year olds

5-10 year olds

10-16 year olds

Trauma vs Infection (Limping Child)

• History, examination, tests

• Septic Arthritis:Kocher et al, 1999. JBJS[Am] 81: 1662-70.

NWB, fever 38.5C, WBC 12+, ESR 40+ or CRP 10+.

Hip Effusions on Plain Film

Hip Effusions on Plain Film

NAI and Fractures

Kemp AM, et al. 2008.Patterns of skeletal fracturesin child abuse: systematicreview. BMJ 337: a1518.

Risk of a Fracture Indicating NAI

• NAI occurs in:25-50% fractures children <1yr old

• Relative risk of NAI (not RTA):Humeral shaft # <3yrs: 0.48-0.54Femoral shaft # <3 yrs: 0.28-0.43Rib # 0.71Skull # under 6 yrs: 0.30

Other High Risk Groups

NAI also occurs above average in:Disabled childrenDelayed presentationFractures of different agesLateral third clavicle Scapula fracturesMetaphyseal fractures

Recommendations

All high risk groups consider paeds review:

Children under 18 months old with fractureUnder 3 year olds with humeral shaft fractureUnder 3 year olds with femoral fracture

Conclusion

History tailored to age

Diagnosis based upon age

Treatment tailored to age

Never forget NAI