Pediatrics Trauma Radiology Review (Dr. Flannery) – When in doubt splint
- Salter Harris: Take home memorize classification and management
- SH1: Clinical Dx – Splint and f/u
- SH2: Splint and f/u, most common
- SH3: Ortho consult
- SH4: OR
- SH5: OR
- Supracondylar Fx : Take home: Type II/III requires OR
- SC Fx type I: Look for posterior/anterior fat pads
- Tx: Posterior splint, f/u ortho
- SC Fx type II: Splint and Ortho consult
- SC Fx type III: OR
- SC Fx type I: Look for posterior/anterior fat pads
- Misc Fx
- Greenstick fracture
- Toddle Fx: Tx with posterior splint and out pt f/u (For non displaced)
- When in doubt splint and f/u ortho
- Buckle Fx: Volar splint
- SCFE
- Klein’s line should intersect the femoral head
- Can be bilateral
- SCIWORA
- Always recheck spinal (ROM/focal findings) after a negative CT cervical
Trauma Board Review (Dr. Patel)
- Hip/Femur fracture
- Most are operative, recognize they are sick patients.
- Fermoral head fx, neck fx, trochanteric (Inter/sub)
- Pain control, Ortho consult, Most cases OR
- Tibial plateau fracture
- Maybe radiographically occult
- Patella alta
- Maisonneuve fracture
- Proximal fibular fx + medial malleolar fracture ( or disruption of deltoid ligatment, IO membrane syndesmosis)
- Lisfranc fracture
- Tarso-metatarsal fracture-dislocation
- Mal-alignment Metatarsals with cuneiforms.
- Calcaneal fractures
- 10% associated lumbar fractures
- Boehler’s angle <20
- Jones fracture: High rate on non-union
- Pseudojones fractures: Bulky dressing and pain control
- Hip dislocations
- MC: Posterior dislocation (90%)
- High rate of AVN femoral head, peroneal nerve dysfx, sciatic nerve injuries)
- Knee dislocation
- 50% will spontaneous reduce!!!
- Need a good Neurovascular evaluation
- ABI < 0.9
- Vascular surgery/ortho eval à Arteriography or CT Angio
- Ankle Sprain:
- Ottawa ankle rule
- Scapular fracture
- Associated with concomitant injuries such as internal thoracic injuries
- Clavicle fracture
- Op: Open fx, unstable floating shoulder, NV compromise.
- Radial head fx
- Monteggia fracture
- Galeazzi fracture
- Scaphoid fx – Thumb spica, risk of non-union and AVN
- Bannette’s fx – Thumb spica,
- Rolando fx
- Posterior shoulder dislocation: Light bulb / Drum stick appearance
- Compartment syndrome
- 6P’s. Money is on pain and paresthesia.
- High pressure injury injection injury
- Limb threatening
- Surgical emergency
Trauma in pregnancy (Dr. Kashani)
- Prepare for difficult airway
- Be aware of Hemodynamic changes
- Rh sensitization
- >20 weeks with abdominal trauma monitor for 4 hrs
- Peri mortem C-section best outcome if performed within 4 – 5 minutes of CPR
Thanks to Chief Mike Hong, DO PGY-4 for writing up today’s CONFERENCE PEARLS