Skeletal Injuries in Children Mark Latimer Consultant 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
Scary Supracondylar Fracture
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 year olds
Trauma vs Infection (Limping Child) History, examination, tests Septic Arthritis: Kocher et al, JBJS[Am] 81: NWB, fever 38.5C, WBC 12+, ESR 40+ or CRP 10+.
Hip Effusions on Plain Film
NAI and Fractures Kemp AM, et al Patterns of skeletal fractures in child abuse: systematic review. 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: Femoral shaft # <3 yrs: Rib # 0.71 Skull # under 6 yrs: 0.30
Other High Risk Groups NAI also occurs above average in: Disabled children Delayed presentation Fractures of different ages Lateral third clavicle Scapula fractures Metaphyseal fractures
Recommendations All high risk groups consider paeds review: Children under 18 months old with fracture Under 3 year olds with humeral shaft fracture Under 3 year olds with femoral fracture
Conclusion History tailored to age Diagnosis based upon age Treatment tailored to age Never forget NAI