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%)• 6 – 9 year old (27%)• 1 – 5 year old (23%)

• M : F 3 : 1

De la Calzada, Caballes and Javier, 1998

Incidence of InjuriesCause

• Fall 78%

• Traffic accidents 11%

De la Calzada, Caballes and Javier, 1998

Incidence of Injuries

Place

• Home 41%

• Streets 22.7%

• School 20.7%

De la Calzada, Caballes and Javier, 1998

Incidence of Fractures in Children

Rockwood and Wilkins Fractures in Children, 2001

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

• Common Childhood Fractures and Dislocations

• Sports Injuries• Infections• Battered Child

Syndrome

Common Childhood Fractures and Dislocations

Fractures and Dislocations

• What is a fracture?

Injury caused by a break in the

bone

Common Fractures

• Wrist (distal radius)

• Forearm (radio-ulna)

• Elbow (supracondylar)

• Collar bone (clavicle)

• Thigh (femur)

Wrist Fractures

• Common site of forearm fracture

• Adolescence • Fall on an

extended wrist

Wrist Fractures

• Signs and Symptoms

- swelling over

wrist

- tenderness

- painful motion

of wrist

- gross deformity

of wrist

Wrist Fractures

• What to do?

- Splint

- Elevate hand

- Seek medical

consult

Forearm Fractures

• Caused by landing on an outstretched upper extremity

Forearm Fractures

• Signs and Symptoms

- swelling of

forearm

- tenderness

- deformity of

forearm

Forearm Fractures

• What to do?

- Splint

- Elevate hand

- Seek medical

consult

Elbow Fractures

• 5 – 7 years old• Caused by falls

Elbow Fractures

• Signs and Symptoms

- swelling of elbow

- tenderness

- limitation of

elbow motion

- deformity of

elbow

Elbow Fractures

• What to do?

- Splint

- Elevate arm

- Seek medical

consult

Clavicular Fractures

• fall on the shoulder

Clavicular Fractures

• Signs and Symptoms

- swelling of

shoulder

- tenderness

- limitation of

shoulder motion

- gross deformity

of shoulder

Clavicular Fractures

• What to do?

- Sling

- Seek medical

consult

Femoral Shaft Fractures

• Older children – high-energy injuries

• Children younger than walking age

( <1 yo) – 80% caused by child abuse

Femoral Shaft Fractures

• Signs and Symptoms

- swelling of thigh

- tenderness

- limitation of

motion of lower

extremity

- deformity of

thigh

Femoral Shaft Fractures

• What to do?

- Splint

- Keep patient

lying down

- Seek medical

consult

Fractures and Dislocations

• What is a dislocation?

Injury affecting the congruity of

a joint

Common Dislocations

• Elbow

• Shoulder

Elbow Dislocations

• Uncommon in children

• 13 – 14 years old• Sports injuries• Fall on an

outstretched

arm

Elbow Dislocations

• Signs and Symptoms

- swelling of elbow

- tenderness

- limitation of

elbow motion

- deformity of

elbow

Elbow Dislocations

• What to do?

- Splint

- Elevate upper

extremity

- Seek medical

consult

Shoulder Dislocations

• Adolescence• Contact sports,

falls, fights, and motor vehicle accidents

Shoulder Dislocations

• Signs and Symptoms

- swelling of

shoulder

- tenderness

- limitation of

shoulder motion

- gross deformity

of shoulder

Shoulder Dislocations

• What to do?

- Sling

- Seek medical

consult

Sports Injuries in Children

Sports Injuries

• Repetitive stress

• Adolescence

Data from Sports Clinic, UP-PGH, 2006

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

Data from Sports Clinic, UP-PGH, 2006

Infections

Infections

• Septic Arthritis

• Osteomyelitis

Septic Arthritis

• Inflammation of the joint

• Pus-forming organisms

• Newborn, infants and children

(2 - 3 years old)

Tachdjian Pediatric Orthopedics, 1990

Septic Arthritis

• Involvement

1. Hip joint

2. Knee joint

3. Elbow joint

Tachdjian Pediatric Orthopedics, 1990

Septic Arthritis

Septic Arthritis

• Bacteria enter the joint via:1. Blood stream2. Direct extension3. Direct injection

Tachdjian Pediatric Orthopedics, 1990

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 Arthritis

• Treatment– Antibiotics– Drainage and debridement– Splint - pain and prevent deformity – Function and congruency of joint

Tachdjian Pediatric Orthopedics, 1990

Osteomyelitis

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

bones

Tachdjian Pediatric Orthopedics, 1990

Osteomyelitis

• Routes of infection– Bloodstream– Direct extension– Open fractures

Tachdjian Pediatric Orthopedics, 1990

Osteomyelitis

• Signs and Symptoms– Pain – High fever, chills, vomiting and dehydration– tenderness over bone

Tachdjian Pediatric Orthopedics, 1990

Osteomyelitis

Osteomyelitis

• Treatment– Antibiotics– Splint or cast– Surgery

Tachdjian Pediatric Orthopedics, 2nd edition

Battered Child Syndrome

Annual Report CPU 2005

Annual Report CPU 2005

Annual Report CPU 2005

Annual Report CPU 2005

fath

er

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 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

• Head and neck• Skin• Chest,

abdomen, and genitalia

• Skeletal trauma

Head and Neck

• swelling, abrasions, lacerations, bruises

• uneven skull• bulging (skull)• bleeding in mouth• tooth decay• bleeding in eyes• deformed ears

Skin

• Bruises, bites and burns

• Pinch and ligature marks

• “Object pattern” marks

• “stocking” and “glove” immersion patterns

Chest, Abdomen, and Genitalia

• Bruises • Unequal breathing• Pain• Deformities• Abrasion or laceration on private parts

Specificity of Fractures for Physical Abuse

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)

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