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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 l.jpg
School Environment

  • Injuries

    - 3 % - 9 % annually

  • Fractures

    - 5% - 10% of all school related

    injuries

    Rockwood and Wilkins Fractures in Children, 2001


Incidence of injuries l.jpg
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


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Incidence of Injuries

Cause

  • Fall 78%

  • Traffic accidents 11%

    De la Calzada, Caballes and Javier, 1998


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Incidence of Injuries

Place

  • Home 41%

  • Streets 22.7%

  • School 20.7%

    De la Calzada, Caballes and Javier, 1998


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Incidence of Fractures in Children

Rockwood and Wilkins Fractures in Children, 2001


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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


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Fractures and dislocations l.jpg
Fractures and Dislocations

  • What is a fracture?

    Injury caused by a break in the bone


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Common Fractures

  • Wrist (distal radius)

  • Forearm (radio-ulna)

  • Elbow (supracondylar)

  • Collar bone (clavicle)

  • Thigh (femur)


Wrist fractures l.jpg
Wrist Fractures

  • Common site of forearm fracture

  • Adolescence

  • Fall on an extended wrist


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Wrist Fractures

  • Signs and Symptoms

    - swelling over

    wrist

    - tenderness

    - painful motion

    of wrist

    - gross deformity

    of wrist


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Wrist Fractures

  • What to do?

    - Splint

    - Elevate hand

    - Seek medical

    consult


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Forearm Fractures

  • Caused by landing on an outstretched upper extremity


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Forearm Fractures

  • Signs and Symptoms

    - swelling of

    forearm

    - tenderness

    - deformity of

    forearm


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Forearm Fractures

  • What to do?

    - Splint

    - Elevate hand

    - Seek medical

    consult


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Elbow Fractures

  • 5 – 7 years old

  • Caused by falls


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Signs and Symptoms

- swelling of elbow

- tenderness

- limitation of

elbow motion

- deformity of

elbow

Elbow Fractures


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Elbow Fractures

  • What to do?

    - Splint

    - Elevate arm

    - Seek medical

    consult


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Clavicular Fractures

  • fall on the shoulder


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Clavicular Fractures

  • Signs and Symptoms

    - swelling of

    shoulder

    - tenderness

    - limitation of

    shoulder motion

    - gross deformity

    of shoulder


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Clavicular Fractures

  • What to do?

    - Sling

    - Seek medical

    consult


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Femoral Shaft Fractures

  • Older children – high-energy injuries

  • Children younger than walking age

    ( <1 yo) – 80% caused by child abuse


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Signs and Symptoms

- swelling of thigh

- tenderness

- limitation of

motion of lower

extremity

- deformity of

thigh

Femoral Shaft Fractures


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Femoral Shaft Fractures

  • What to do?

    - Splint

    - Keep patient

    lying down

    - Seek medical

    consult


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Fractures and Dislocations

  • What is a dislocation?

    Injury affecting the congruity of a joint


Common dislocations l.jpg
Common Dislocations

  • Elbow

  • Shoulder


Elbow dislocations l.jpg
Elbow Dislocations

  • Uncommon in children

  • 13 – 14 years old

  • Sports injuries

  • Fall on an

    outstretched

    arm


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Elbow Dislocations

  • Signs and Symptoms

    - swelling of elbow

    - tenderness

    - limitation of

    elbow motion

    - deformity of

    elbow


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Elbow Dislocations

  • What to do?

    - Splint

    - Elevate upper

    extremity

    - Seek medical

    consult


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Shoulder Dislocations

  • Adolescence

  • Contact sports, falls, fights, and motor vehicle accidents


Shoulder dislocations33 l.jpg
Shoulder Dislocations

  • Signs and Symptoms

    - swelling of

    shoulder

    - tenderness

    - limitation of

    shoulder motion

    - gross deformity

    of shoulder


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Shoulder Dislocations

  • What to do?

    - Sling

    - Seek medical

    consult



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Sports Injuries

  • Repetitive stress

  • Adolescence

Data from Sports Clinic, UP-PGH, 2006


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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 l.jpg

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



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Infections

  • Septic Arthritis

  • Osteomyelitis


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Septic Arthritis

  • Inflammation of the joint

  • Pus-forming organisms

  • Newborn, infants and children

    (2 - 3 years old)

    Tachdjian Pediatric Orthopedics, 1990


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Septic Arthritis

  • Involvement

    1. Hip joint

    2. Knee joint

    3. Elbow joint

    Tachdjian Pediatric Orthopedics, 1990



Septic arthritis44 l.jpg
Septic Arthritis

  • Bacteria enter the joint via:

    1. Blood stream

    2. Direct extension

    3. Direct injection

    Tachdjian Pediatric Orthopedics, 1990


Septic arthritis45 l.jpg
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


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Septic Arthritis

  • Treatment

    • Antibiotics

    • Drainage and debridement

    • Splint - pain and prevent deformity

    • Function and congruency of joint

      Tachdjian Pediatric Orthopedics, 1990


Osteomyelitis l.jpg
Osteomyelitis

  • Infection of bone

  • Infants and children

  • Metaphysis of long

    bones

    Tachdjian Pediatric Orthopedics, 1990


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Osteomyelitis

  • Routes of infection

    • Bloodstream

    • Direct extension

    • Open fractures

      Tachdjian Pediatric Orthopedics, 1990


Osteomyelitis49 l.jpg
Osteomyelitis

  • Signs and Symptoms

    • Pain

    • High fever, chills,

      vomiting and

      dehydration

    • tenderness over bone

      Tachdjian Pediatric Orthopedics, 1990



Osteomyelitis51 l.jpg
Osteomyelitis

  • Treatment

    • Antibiotics

    • Splint or cast

    • Surgery

      Tachdjian Pediatric Orthopedics, 2nd edition






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father

Annual Report CPU 2005


Common child abuse history risk factors l.jpg
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 l.jpg
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


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Physical Examination

  • Head and neck

  • Skin

  • Chest, abdomen, and genitalia

  • Skeletal trauma


Head and neck l.jpg
Head and Neck

  • swelling, abrasions, lacerations, bruises

  • uneven skull

  • bulging (skull)

  • bleeding in mouth

  • tooth decay

  • bleeding in eyes

  • deformed ears


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Skin

  • Bruises, bites and burns

  • Pinch and ligature marks

  • “Object pattern” marks

  • “stocking” and “glove” immersion patterns


Chest abdomen and genitalia l.jpg
Chest, Abdomen, and Genitalia

  • Bruises

  • Unequal breathing

  • Pain

  • Deformities

  • Abrasion or

    laceration on

    private parts



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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)


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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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