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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%)

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school environment
School Environment
  • Injuries

- 3 % - 9 % annually

  • Fractures

- 5% - 10% of all school related

injuries

Rockwood and Wilkins Fractures in Children, 2001

incidence of injuries
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 injuries4
Incidence of Injuries

Cause

  • Fall 78%
  • Traffic accidents 11%

De la Calzada, Caballes and Javier, 1998

incidence of injuries5
Incidence of Injuries

Place

  • Home 41%
  • Streets 22.7%
  • School 20.7%

De la Calzada, Caballes and Javier, 1998

incidence of fractures in children
Incidence of Fractures in Children

Rockwood and Wilkins Fractures in Children, 2001

overall frequency of fractures
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

slide8
Common Childhood Fractures and Dislocations
  • Sports Injuries
  • Infections
  • Battered Child

Syndrome

fractures and dislocations
Fractures and Dislocations
  • What is a fracture?

Injury caused by a break in the bone

common fractures
Common Fractures
  • Wrist (distal radius)
  • Forearm (radio-ulna)
  • Elbow (supracondylar)
  • Collar bone (clavicle)
  • Thigh (femur)
wrist fractures
Wrist Fractures
  • Common site of forearm fracture
  • Adolescence
  • Fall on an extended wrist
wrist fractures13
Wrist Fractures
  • Signs and Symptoms

- swelling over

wrist

- tenderness

- painful motion

of wrist

- gross deformity

of wrist

wrist fractures14
Wrist Fractures
  • What to do?

- Splint

- Elevate hand

- Seek medical

consult

forearm fractures
Forearm Fractures
  • Caused by landing on an outstretched upper extremity
forearm fractures16
Forearm Fractures
  • Signs and Symptoms

- swelling of

forearm

- tenderness

- deformity of

forearm

forearm fractures17
Forearm Fractures
  • What to do?

- Splint

- Elevate hand

- Seek medical

consult

elbow fractures
Elbow Fractures
  • 5 – 7 years old
  • Caused by falls
elbow fractures19
Signs and Symptoms

- swelling of elbow

- tenderness

- limitation of

elbow motion

- deformity of

elbow

Elbow Fractures
elbow fractures20
Elbow Fractures
  • What to do?

- Splint

- Elevate arm

- Seek medical

consult

clavicular fractures
Clavicular Fractures
  • fall on the shoulder
clavicular fractures22
Clavicular Fractures
  • Signs and Symptoms

- swelling of

shoulder

- tenderness

- limitation of

shoulder motion

- gross deformity

of shoulder

clavicular fractures23
Clavicular Fractures
  • What to do?

- Sling

- Seek medical

consult

femoral shaft fractures
Femoral Shaft Fractures
  • Older children – high-energy injuries
  • Children younger than walking age

( <1 yo) – 80% caused by child abuse

femoral shaft fractures25
Signs and Symptoms

- swelling of thigh

- tenderness

- limitation of

motion of lower

extremity

- deformity of

thigh

Femoral Shaft Fractures
femoral shaft fractures26
Femoral Shaft Fractures
  • What to do?

- Splint

- Keep patient

lying down

- Seek medical

consult

fractures and dislocations27
Fractures and Dislocations
  • What is a dislocation?

Injury affecting the congruity of a joint

common dislocations
Common Dislocations
  • Elbow
  • Shoulder
elbow dislocations
Elbow Dislocations
  • Uncommon in children
  • 13 – 14 years old
  • Sports injuries
  • Fall on an

outstretched

arm

elbow dislocations30
Elbow Dislocations
  • Signs and Symptoms

- swelling of elbow

- tenderness

- limitation of

elbow motion

- deformity of

elbow

elbow dislocations31
Elbow Dislocations
  • What to do?

- Splint

- Elevate upper

extremity

- Seek medical

consult

shoulder dislocations
Shoulder Dislocations
  • Adolescence
  • Contact sports, falls, fights, and motor vehicle accidents
shoulder dislocations33
Shoulder Dislocations
  • Signs and Symptoms

- swelling of

shoulder

- tenderness

- limitation of

shoulder motion

- gross deformity

of shoulder

shoulder dislocations34
Shoulder Dislocations
  • What to do?

- Sling

- Seek medical

consult

sports injuries
Sports Injuries
  • Repetitive stress
  • Adolescence

Data from Sports Clinic, UP-PGH, 2006

sports injuries37
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

Ankle sprains

Forearm fractures (greenstick)

Finger joint dislocations

Chronic

Back pains

Knee pains

Elbow pains

Common Sports Related Injuries in Children

Data from Sports Clinic, UP-PGH, 2006

infections40
Infections
  • Septic Arthritis
  • Osteomyelitis
septic arthritis
Septic Arthritis
  • Inflammation of the joint
  • Pus-forming organisms
  • Newborn, infants and children

(2 - 3 years old)

Tachdjian Pediatric Orthopedics, 1990

septic arthritis42
Septic Arthritis
  • Involvement

1. Hip joint

2. Knee joint

3. Elbow joint

Tachdjian Pediatric Orthopedics, 1990

septic arthritis44
Septic Arthritis
  • Bacteria enter the joint via:

1. Blood stream

2. Direct extension

3. Direct injection

Tachdjian Pediatric Orthopedics, 1990

septic arthritis45
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 arthritis46
Septic Arthritis
  • Treatment
    • Antibiotics
    • Drainage and debridement
    • Splint - pain and prevent deformity
    • Function and congruency of joint

Tachdjian Pediatric Orthopedics, 1990

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

bones

Tachdjian Pediatric Orthopedics, 1990

osteomyelitis48
Osteomyelitis
  • Routes of infection
    • Bloodstream
    • Direct extension
    • Open fractures

Tachdjian Pediatric Orthopedics, 1990

osteomyelitis49
Osteomyelitis
  • Signs and Symptoms
    • Pain
    • High fever, chills,

vomiting and

dehydration

    • tenderness over bone

Tachdjian Pediatric Orthopedics, 1990

osteomyelitis51
Osteomyelitis
  • Treatment
    • Antibiotics
    • Splint or cast
    • Surgery

Tachdjian Pediatric Orthopedics, 2nd edition

slide56

father

Annual Report CPU 2005

common child abuse history risk factors
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 factors58
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
Physical Examination
  • Head and neck
  • Skin
  • Chest, abdomen, and genitalia
  • Skeletal trauma
head and neck
Head and Neck
  • swelling, abrasions, lacerations, bruises
  • uneven skull
  • bulging (skull)
  • bleeding in mouth
  • tooth decay
  • bleeding in eyes
  • deformed ears
slide61
Skin
  • Bruises, bites and burns
  • Pinch and ligature marks
  • “Object pattern” marks
  • “stocking” and “glove” immersion patterns
chest abdomen and genitalia
Chest, Abdomen, and Genitalia
  • Bruises
  • Unequal breathing
  • Pain
  • Deformities
  • Abrasion or

laceration on

private parts

what to do
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)

slide65
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

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