Accidents and Injuries in

School
 School Environment
• Injuries
- 3 % - 9 % annually

• Fractures
- 5% - 10% of all school related
injuries

Rockwood and Wilkins Fractures in Children, 2001

 Incidence of Injuries
Age distribution
• 13 – 17 year old (30%)
• 6 – 9 year old (27%)
• 1 – 5 year old (23%)

• M:F 3:1

De la Calzada, Caballes and Javier, 1998

 Incidence of Injuries
Cause
• Fall 78%
• Traffic accidents 11%

De la Calzada, Caballes and Javier, 1998

 Incidence of Injuries
Place
• Home 41%
• Streets 22.7%
• School 20.7%

De la Calzada, Caballes and Javier, 1998

Incidence of Fractures in
Children

Rockwood and Wilkins Fractures in Children, 2001

 Overall Frequency of
Fractures
• % children with fractures (0 to 16 years of
age)
Boys 42% Girls 27%

• % children with a fracture

in a year:
1% - 2%

Rockwood and Wilkins Fractures in Children, 2001

• Common Childhood
Fractures and Dislocations
• Sports Injuries
• Infections
• Battered Child
Syndrome
Common Childhood Fractures
and Dislocations
Fractures and Dislocations
• What is a fracture?

Injury caused by a
break in the
bone
 Common Fractures
• Wrist (distal radius)
• Forearm (radio-ulna)
• Elbow (supracondylar)
• Collar bone (clavicle)
• Thigh (femur)
 Wrist Fractures
• Common site of
forearm fracture
• Adolescence
• Fall on an
extended wrist
 Wrist Fractures
• Signs and
Symptoms
- swelling over
wrist
- tenderness
- painful motion
of wrist
- gross deformity
of wrist
 Wrist Fractures
• What to do?
- Splint
- Elevate hand
- Seek medical
consult
 Forearm Fractures
• Caused by landing
on an outstretched
upper extremity
 Forearm Fractures
• Signs and
Symptoms
- swelling of
forearm
- tenderness
- deformity of
forearm
 Forearm Fractures
• What to do?
- Splint
- Elevate hand
- Seek medical
consult
 Elbow Fractures
• 5 – 7 years old
• Caused by falls
 Elbow Fractures
• Signs and
Symptoms
- swelling of elbow
- tenderness
- limitation of
elbow motion
- deformity of
elbow
 Elbow Fractures
• What to do?
- Splint
- Elevate arm
- Seek medical
consult
 Clavicular Fractures

• fall on the
shoulder
 Clavicular Fractures
• Signs and
Symptoms
- swelling of
shoulder
- tenderness
- limitation of
shoulder motion
- gross deformity
of shoulder
 Clavicular Fractures
• What to do?
- Sling
- Seek medical
consult
 Femoral Shaft Fractures
• Older children –
high-energy injuries

• Children younger
than walking age
( <1 yo) – 80%
caused by child
abuse
 Femoral Shaft Fractures
• Signs and
Symptoms
- swelling of thigh
- tenderness
- limitation of
motion of lower
extremity
- deformity of
thigh
 Femoral Shaft Fractures
• What to do?
- Splint
- Keep patient
lying down
- Seek medical
consult
Fractures and Dislocations
• What is a
dislocation?

Injury affecting
the congruity of
a joint
 Common Dislocations

• Elbow
• Shoulder
 Elbow Dislocations
• Uncommon in
children
• 13 – 14 years old
• Sports injuries
• Fall on an
outstretched
arm
 Elbow Dislocations
• Signs and
Symptoms
- swelling of elbow
- tenderness
- limitation of
elbow motion
- deformity of
elbow
 Elbow Dislocations
• What to do?
- Splint
- Elevate upper
extremity
- Seek medical
consult
 Shoulder Dislocations
• Adolescence
• Contact sports,
falls, fights, and
motor vehicle
accidents
 Shoulder Dislocations
• Signs and
Symptoms
- swelling of
shoulder
- tenderness
- limitation of
shoulder motion
- gross deformity
of shoulder
 Shoulder Dislocations
• What to do?
- Sling
- Seek medical
consult
Sports Injuries in Children
 Sports Injuries
• Repetitive stress
• Adolescence

Data from Sports Clinic, UP-PGH, 2006

 Sports Injuries
• Most common
type of sports
associated with
injuries
- basketball
- volleyball
- badminton

Data from Sports Clinic, UP-PGH, 2006

 Common Sports Related
Injuries
in Children
• Acute • Chronic
– Ankle sprains – Back pains
– Forearm – Knee pains
fractures – Elbow pains
(greenstick)
– Finger joint
dislocations

Data from Sports Clinic, UP-PGH, 2006

Infections
 Infections
• Septic Arthritis
• Osteomyelitis
 Septic Arthritis
• Inflammation of the joint
• Pus-forming organisms
• Newborn, infants and children
(2 - 3 years old)

Tachdjian Pediatric Orthopedics, 1990

 Septic Arthritis
• Involvement
1. Hip joint
2. Knee joint
3. Elbow joint

Tachdjian Pediatric Orthopedics, 1990

Septic Arthritis
 Septic Arthritis
• Bacteria enter the joint via:
1. Blood stream
2. Direct extension
3. Direct injection

Tachdjian Pediatric Orthopedics, 1990

 Septic Arthritis
• Signs and Symptoms
– Acute
– Pain
– Limitation of motion
– Apprehensive, irritable,
loss of appetite, and feverish
– Joint - warm and swollen

Tachdjian Pediatric Orthopedics, 1990

 Septic Arthritis
• Treatment
– Antibiotics
– Drainage and debridement
– Splint - pain and prevent deformity
– Function and congruency of joint

Tachdjian Pediatric Orthopedics, 1990

 Osteomyelitis
• Infection of bone
• Infants and children
• Metaphysis of long
bones

Tachdjian Pediatric Orthopedics, 1990

 Osteomyelitis
• Routes of infection
– Bloodstream
– Direct extension
– Open fractures

Tachdjian Pediatric Orthopedics, 1990

 Osteomyelitis
• Signs and Symptoms
– Pain
– High fever, chills,
vomiting and
dehydration
– tenderness over bone

Tachdjian Pediatric Orthopedics, 1990

Osteomyelitis
 Osteomyelitis
• Treatment
– Antibiotics
– Splint or cast
– Surgery

Tachdjian Pediatric Orthopedics, 2nd edition

Battered Child Syndrome
Annual Report CPU 2005
Annual Report CPU 2005
Annual Report CPU 2005
 er
th
fa

Annual Report CPU 2005

Common Child Abuse History
Risk Factors
• Unexplained injury
• Absent, changing, or evolving history
• Delay in seeking care
• Inappropriate affect (caregiver)
• Triggering event - loss of control of
caregiver

Sirotnak et al, 2004

Common Child Abuse History
Risk Factors
• Unrealistic expectations (caregiver)
• Crisis or stress (family or caregiver)
• Social or physical isolation (family or
caregiver)
• Increasing severity or number of consults
• Abused during childhood (caregiver)
Sirotnak et al, 2004
 Physical Examination
• Head and neck
• Skin
• Chest,
abdomen, and
genitalia
• Skeletal trauma
 Head and Neck
• swelling, abrasions,
lacerations, bruises
• uneven skull
• bulging (skull)
• bleeding in mouth
• tooth decay
• bleeding in eyes
• deformed ears
 Skin
• Bruises, bites and
burns
• Pinch and ligature
marks
• “Object pattern”
marks
• “stocking” and
“glove” immersion
patterns
 Chest, Abdomen, and
Genitalia
• Bruises
• Unequal breathing
• Pain
• Deformities
• Abrasion or
laceration on
private parts
Specificity of Fractures for
Physical Abuse
 What to do?
• If you suspect physical abuse to
children:
- Department of Social Welfare and
development
- Child Protection Unit (UP-PGH)
- Women and Child desk (PNP/NBI)
The Philippine College of Physicians wishes to
acknowledge the following for their invaluable
efforts in the preparation of this module

Edward H.M. Wang, MD, MSc

Nilo T. Paner, MD
Department of Orthopedics
College of Medicine and Philippine
General Hospital
University of the Philippines Manila