1. Skeletal Injuries in Children Mark Latimer Consultant Paediatric Orthopaedic Surgeon Peterborough and Stamford Hospitals NHS Foundation Trust

2. Aims How to Assess, Describe, & Treat Scary Diagnoses Classic Diagnoses by Age Trauma vs Infection How to Spot NAI Cover Your Back

3. 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

4. Supracondylar Fracture

6. Scary Supracondylar Fracture

7. Slipped Upper Femoral Epiphysis

10. Other Scary Diagnoses Open Fractures/dislocations Compartment Syndrome High Energy Trauma T R A S H Lesions (The Radiographic Appearance Seemed Harmless)

11. Classic Diagnoses by Age Babies 1-5 year olds 5-10 year olds 10-16 year olds

12. 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+.

13. Hip Effusions on Plain Film

15. NAI and Fractures Kemp AM, et al. 2008. Patterns of skeletal fractures in child abuse: systematic review. BMJ 337: a1518.

16. 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

17. 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

18. 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

19. Conclusion History tailored to age Diagnosis based upon age Treatment tailored to age Never forget NAI