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