Dr.

Rosalind Oakes
November 2014
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* Significant osteogenic potential and more
metabolically active
Promotes union, callus formation and remodelling
* Periosteum is thicker
Reduces displacement of fractures and chance of
open fractures
* Unique fracture patterns, greenstick etc.
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* Infants diaphyseal
* Children metaphyseal
* Adoloscents epiphyseal
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* 30 month old female. Fell when playing on
bed. Complaining of left elbow pain.
Decreased ROM. ? Fracture
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* Check true lateral
* Check anatomical alignment
* Anterior humeral line (less than 1/3 of the capitulum lies in
front of the line)
* Radiocapitellar line
* Fat pad signs
* Check cortex
* Check radial head
* Check AP cortex
* Ossification centres

http://dontforgetthebubbles.com/elbow-xr-interpretation/
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* Capitellum (1 year)
* Radial head (3y)
* Internal (Medial)
epicondyle (5y)
* Trochlea (7y)
* Olecranon (9y)
* External (lateral)
epicondyle (11y)
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* 6 year old girl with deformed right elbow since
a fall today
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Collar and cuff Urgent

Reduce, above orthopaedic
elbow cast + assessment and
orthopaedic review theatre
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* 10 year old girl presented having fallen onto
outstretched hand
* Tender distal radius and ulna
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*Compression failure from longitudinal force
*Usually at metaphyseal / diaphyseal
junction
*Stable
* Can be managed in a splint – (3 weeks
continuous and no sport)
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* 4 year old with fall onto outstretched hand
* Tender distal radius
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* Buckle fractures that are not suitable for a
wrist splint:
* Volar angulation
* Cortical disruption (= greenstick fracture)
* Ulna greenstick, complete or styloid fracture
* Greater than 15 degrees angulation or obvious
clinical deformity – will likely need reduction
(refer to Orthopaedic Team urgently)
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* 5 year old
* Fall from the monkey bars
* Tender proximal forearm
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* Ulnar shaft fracture and radial head dislocation
* Rare – only 2% of elbow injuries
* Mechanism is usually hyperextension at the
elbow
* Isolated ulna injuries are rare.. Examine and
xray the joint above and below
* The posterior interosseous nerve is the most
commonly affected – deep extensor muscles
* Requires immediate orthopaedic referral
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* Bending mechanism
* Fracture does not pass completely through bone
* High risk of refracture
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* 7 year old with fall whilst doing a cartwheel
* Tender left forearm
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* Longitudinal force exceeding ability of bone to
recoil
* Creates microcracks
* Can correct if <4 years or <20 degrees, otherwise
surgical intervention necessary
* Complications: May maintain an adjacent fracture
in angulation or prevent reduction of the fracture
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* 13 year old male with a fall onto an
outstretched hand
* Tender radius
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Slipped Above Lower Through Rammed

1 – Though the physis

2 – Involving the metaphysis
3- Involving the epiphysis
4- Through metaphysis and epiphysis
5 - Impacted
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* 8 year old fell playing
basketball
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* 8 year old fell playing
basketball
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* 9 year old who fell off skateboard
* Presents with swelling to the left ankle and
unable to weightbear
* Previous fibular fracture
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* Undisplaced Salter-Harris II fractures of the
distal tibia: non weight bearing below knee
plaster backslab + clinic in 7 days
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* 7 year old fell from play equipment
* Swollen right ankle
* Non weight bearing
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* Most common and most missed
* Diagnosed clinically
* Tenderness over fibula physis (as opposed to
tenderness over the ATFL) +/- swelling
* Xray may be normal or there may be swelling
laterally
* Mx plaster
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* 5 years old fell onto thumb whilst on bouncy
castle
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* 11 year old boy with swollen painful right ankle
since a fall today
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* 2 years old
* Irritable today and limping
* No history of falls
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* Occur in children learning to walk
* Usually after a fall which may not be seen by
parents
* Subtle examination findings, limping but often
no swelling
* Differentials include septic joints
* Undisplaced fractures can be managed in an
above knee back slab and ortho clinic in 10
days
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* 13 year old, externally rotated ankle
* Pain on weightbearing
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* Salter Harris III of the distal tibia –
avlusion of the anterolateral part of the
epiphysis

* If non displaced can be managed with

below knee back slab. Discuss with
orthopaedics as to CT needed to confirm
non displacement – displaced fractures
require an operation
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* 9 year old who fell off a skateboard awkwardly
* Pain ++ mid leg
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* 10 year old boy who inverted his foot and
presents with pain at the base of the fifth
metatarsal
* Case
* 27 year old who
injured her foot whilst
playing netball
* Tender base of 5th
metatarsal
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* High school student suffered sudden onset of
run hip pain whilst running
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15 month male with an
ankle injury 10 days ago
after his brother stood on
his ankle. Swollen at the
time and unable to weight
bear.
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* http://kidshealthwa.com/
* http://www.rch.org.au/clinicalguide/
* http://www.emergucate.com
* http://ortho-
teaching.feinberg.northwestern.edu/
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* Fell off couch
* Swelling pain and tenderness, decreased ROM
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* 16 year old
* Rolled onto right wrist whilst playing soccer