Fractures

Question 1

Describe Salter Harris classification? + Common sites of occurance

Answer 1

type I: distal radius, femur and tibia

• slipped
• 5-7%
• fracture plane passes all the way through the growth plate, not involving bone
• cannot occur if the growth plate is fused reference required
• good prognosis

type II: distal radius, femur and tibia

• above
• ~ 75% (by far the most common)
• fracture passes across most of the growth plate and up through the metaphysis
• good prognosis

type III: medial maleolus and ankle

• lower
• 7-10%
• fracture plane passes some distance along the growth plate and down through the epiphysis
• poorer prognosis as the proliferative and reserve zones are interrupted

type IV: medial maleolus and ankle

• through or transverse or together
• intra-articular
• 10%
• fracture plane passes directly through the metaphysis, growth plate and down through the epiphysis
• poor prognosis as the proliferative and reserve zones are interrupted

type V

ruined or rammed

uncommon < 1%

crushing type injury does not displace the growth plate but damages it by direct compression

worst prognosis

Question 2

How are growth plate fractures classified

Answer 2

Salter Harris

Question 3

Mx of salter Harris fractures?

Answer 3

1 + 2: extra articulate - closed reduction and plaster of Paris

3 + 4: intra articular open reduction and internal fixation if more than 2mm displacement

Question 4

Decribe common appearance of humeral physis fractures + Mx

Answer 4

• Salter Harris type II
• Mx:
  
  • Remodelling under 12 corrects almost any deforminty therefore no manipulation required
  • collar and cuff: 2- 3 weeks

Question 5

Decribe patterns of injury arround the elbow

Answer 5

• Hyper extension force: supra condilar fracture
• Valgus Force: medial epicondylar fracture +/- pseudo elbow disloctaion
• Varus Force: lateral condylar facture

NB! cant see facture look for Fat Pad Sign

Question 6

Mx of elbow injury?

Answer 6

• Backslab only
• immobilse for 3 weeks only
• activley mobilise no passive → hetrotropic calcification

Question 7

DDx of painful elbow/ no obvious fracture dislocation?

Answer 7

• septic artheritis
• supracondyal fracture undiplaced: look for pat pad sign = periosteal bleeding pushing olecranon fossa fat away
• isolated radial head dislocation: line through radius shouls go through capitellum - all views

Question 8

ossification centres around the elbow?

Answer 8

• C: Capitellum 2 months
• R: Radial Head 4 yrs
• I: Internal (medial) epicondyle 6 yrs
• T: trochlea 8 yrs
• O: Olecranon 10 yrs
• E: External (Lateral) Epicondyle 12 yrs

Question 9

Most common elbow fracture?

Answer 9

Supracondylar fracture

Question 10

Mech of injury in supracondylar?

Answer 10

Hyperextention of the elbow

Question 11

Classification of supracondylar + Mx?

Answer 11

• Grade 1: Undisplaced crack- look for fat pad
  
  • backslab + collar + cuff: 3 weeks
• Grade 2: Angulation/shift w/ contact between bone ends
  
  • clode reduction + backslab
• Grade 3: Displaced fracture - loss of contact
  
  • closed reduction + pinning

Question 12

Complications of Supracondylar fractures?

Answer 12

• Compartment Syndrome
  
  • avoid w/ early reduction and pinning
  • not flexing elbow more than 90º in Grade III
• Cubitus Varus: malunium and abnormal angulation
• Neurovascular injury:
  
  • lateral displcement : median
  • medial: radial nerve

Question 13

Mech of injury Lateral Condylar fracture?

Answer 13

• Varus Force → Satler Harris 4

Question 14

Mx of Lateral Condylar fractures?

Answer 14

• > 2mm needs open reduction + internal fixation (i.e usual Salter Harris 4)