Soft Tissue and Bony Injuries in Children

Callum is a 7 year old boy who was playing football in the park 2 days ago. He fell forwards, putting out both hands to stop himself. Most of his weight was on his right hand. There was a forced hyper extension of both wrists, with worse pain on the right than the left. The right one has been particularly swollen and painful since. The left wrist appears mildly swollen only. He has attended the Emergency Department now because the pain is no better.

Given the history alone, the most likely injury Callum will have sustained to the left wrist is:

Callum was very unlucky; he has sustained a slightly more serious (physeal) injury to the right wrist.

Which one of the following statements best describes the likely consequences of a fracture involving the distal radial physis?

Which one of the following is not a recognised clinical sign of a fracture?

Ryan is a 3 year old boy who was playing in the garden with his older sister when a cry was heard. His parents rushed outside to find he was holding his left arm down straight and his older sister states that she was simply trying to pull him away from the paddling pool because she thought it was dangerous.

In this situation, x-ray:

You go on to examine Ryan. He holds his arm with the elbow fully extended and is very reluctant to flex but allows some passive flexion on examination with increased pain on supination and pronation.

The most likely diagnosis given this information and the history is:

Amy is a 6 year old girl who fell from some monkey bars in the local playground. It appears that she landed on the outstretched hand on the left side and suffered an immediate pain and obvious gross deformity to the left forearm. Brief examination reveals a clinically obvious deformity to the forearm. She is brought straight from triage without further assessment due to pain.

Amy has not suffered an open injury to the forearm. This is primarily because:

X-ray confirms greenstick fractures of the mid shaft of radius and ulnar with significant dorsal angulation of around 40º. Amy was admitted under the Orthopaedic Team for a manipulation under anaesthetic (MUA).

The most likely long term outcome is:

Lucy falls over on the outstretched hand sustaining a hyperflexion injury to the distal radius of her left wrist. She is aged 7 years. X-ray confirms a distal radial buckle fracture with significant dorsal deformity but no distal angulation. The ulna is not involved.

Regarding further management:

After appropriate management of this injury, initially there are long term complications with the way that Lucy’s wrist develops. The forearm heals straight but at 9 months abnormal growth distally leads to a varus deformity at the wrist. The most likely reason for this complication is:

Megan is brought to the ED by her stepmother. She is 6 months old and has stopped crawling due to pain. She says this followed her trapping her leg in the bars of her cot. She will not put down her right leg at all. This has been going on for 10 days. Dad arrives after a while and separately gives the history that Megan walked off a small step in the back garden. X-ray shows an undisplaced spiral distal tibial fracture.

Megan has most likely been injured because of: