paediatric

Definition

Fracture / plastic malformation of proximal ulna with dislocation of radial head

Xray

Radio-capitellar line disrupted

Anatomy

Bones more elastic and malleable

- absorb much more energy

Very thick periosteum

- can be periosteal sleeve fracture

Ossification

Triradiate cartilage fuses 13-16

Iliac / Ilium / ASIS apophysis

- appear as teenager

- fuse a couple of years later

- can confuse with fracture

Classification Key & Conwell 1951

Aetiology

Varies per age group

Trauma

- 60%

Non Accidental Injury

- 15 - 30%

- suspect if non walker / < 1 year

- walking status single best indicator of risk

- paediatric team to investigate

- history taking from parent

- consider metabolic investigations

Meyers & McKeever classification

Type I:   Undisplaced avulsion fracture

Type II:  Anterior portion displaced & hinged

Type IIIA:   Displaced

Type IIIB:   Displaced & Rotated

DDx

Leukemia 

Neuroblastoma 

Wilm's    

Last two usually occur in < 5 year age group

Bone scan is method of choice for screening for metastasis

Leukemia

Epidemiology

Most common form of cancer in children 30%

- ALL 5 x AML

- 3 : 100 000