Trauma Tuesday POD- BOWING FRACTURE

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BOWING FRACTURES  

What is it?

  • Incomplete fracture of tubular long bones pediatric patients.

    • Commonly radius and ulna

Presentation:

  • Fall on outstretched hand. Child presenting with pain and swelling of forearm

How does it happen?

  • Pediatric bones bend because the cortex is thinner than adult bones.

Management

  • Depends on degree of angulation

    • <20degrees= splint

    • >20 degrees= reduction of bowing (call orthopedics)

      • during the reduction they are very prone to fracturing

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POD- Lyme Disease Prophylaxis

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LYME DISEASE: When to give prophylaxis for a tick bite? Patient must meet ALL of the following criteria:

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  1. I. scapularis tick

  2. Tick attached >36 hours

  3. Prophylaxis begins within 72 hours of tick removal

  4. Bite occurred in area with high rate of infection

  5. Doxycycline not contraindicated

    1. Patient > 8 years of age

    2. Not pregnant or lactating

Prophylaxis=Doxycycline 4mg/kg max 200mg one-time dose

*** If patient does not meet the criteria for antibiotic prophylaxis recommendation is that they be observed and only treated if signs of symptoms of Lyme Disease develop

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WILMS TUMOR

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WILMS TUMORMost common renal malignancy in children <15yomedian age at diagnosis: 43 months in girls and 37 months in boys

ASSOCIATED WITH- Aniridia- Genitourinary abnormalities- Loss of function mutations of tumor suppressor and transcription genes

CLINICAL PRESENTATIONMost common: Asymptomatic abdominal mass or swelling (typically found by parents while bathing child)- Abdominal pain (30-40%)- Hematuria (12-25%)- Hypertension (25%)

PHYSICAL EXAMCareful!!! Vigorous palpation may rupture the renal capsule, resulting in tumor spillage, increasing the tumor stage and the need for more intensive therapy- firm, non-tender, smooth mass- eccentrically located - rarely crosses the midline

DIAGNOSIS1.      Abdominal ultrasound with evaluation of mass (assess flow)2.      CT/MRI abdomen can be used to further evaluate the lesion3.      Routine CT chest - Lung is the most common metastatic site4.      Definitive: biopsy with histologic confirmation

STAGINGBased on anatomic extent of tumor

MANAGEMENTRefer to a pediatric cancer centerTypically multimodal therapy involving chemotherapy, radiation therapy and surgery    -Surgical excision for respectable tumors    -Chemotherapy for all patients except extremely low risk    -Radiation therapy indicated by stage and histology

Overall five-year survival for Wilms tumor is 90%

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