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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
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 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: 0.48-0.54
Femoral shaft # <3 yrs: 0.28-0.43
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