Accidents and Injuries in School

1
Accidents and Injuries in School
2
School Environment

• Injuries
• - 3 - 9 annually
• Fractures
• - 5 - 10 of all school related
• injuries
• Rockwood and Wilkins Fractures in
  Children, 2001

3
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

4
Incidence of Injuries

• Cause
• Fall 78
• Traffic accidents 11
• De la Calzada, Caballes and Javier, 1998

5
Incidence of Injuries

• Place
• Home 41
• Streets 22.7
• School 20.7
• De la
  Calzada, Caballes and Javier, 1998

6
Incidence of Fractures in Children
Rockwood and Wilkins Fractures in Children, 2001
7
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

8

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

9
Common Childhood Fractures and Dislocations
10
Fractures and Dislocations

• What is a fracture?
• Injury caused by a break in the bone

11
Common Fractures

• Wrist (distal radius)
• Forearm (radio-ulna)
• Elbow (supracondylar)
• Collar bone (clavicle)
• Thigh (femur)

12
Wrist Fractures

• Common site of forearm fracture
• Adolescence
• Fall on an extended wrist

13
Wrist Fractures

• Signs and Symptoms
• - swelling over
• wrist
• - tenderness
• - painful motion
• of wrist
• - gross deformity
• of wrist

14
Wrist Fractures

• What to do?
• - Splint
• - Elevate hand
• - Seek medical
• consult

15
Forearm Fractures

• Caused by landing on an outstretched upper
  extremity

16
Forearm Fractures

• Signs and Symptoms
• - swelling of
• forearm
• - tenderness
• - deformity of
• forearm

17
Forearm Fractures

• What to do?
• - Splint
• - Elevate hand
• - Seek medical
• consult

18
Elbow Fractures

• 5 7 years old
• Caused by falls

19
Elbow Fractures

• Signs and Symptoms
• - swelling of elbow
• - tenderness
• - limitation of
• elbow motion
• - deformity of
• elbow

20
Elbow Fractures

• What to do?
• - Splint
• - Elevate arm
• - Seek medical
• consult

21
Clavicular Fractures

• fall on the shoulder

22
Clavicular Fractures

• Signs and Symptoms
• - swelling of
• shoulder
• - tenderness
• - limitation of
• shoulder motion
• - gross deformity
• of shoulder

23
Clavicular Fractures

• What to do?
• - Sling
• - Seek medical
• consult

24
Femoral Shaft Fractures

• Older children high-energy injuries
• Children younger than walking age
• ( lt1 yo) 80 caused by child abuse

25
Femoral Shaft Fractures

• Signs and Symptoms
• - swelling of thigh
• - tenderness
• - limitation of
• motion of lower
• extremity
• - deformity of
• thigh

26
Femoral Shaft Fractures

• What to do?
• - Splint
• - Keep patient
• lying down
• - Seek medical
• consult

27
Fractures and Dislocations

• What is a dislocation?
• Injury affecting the congruity of a joint

28
Common Dislocations

• Elbow
• Shoulder

29
Elbow Dislocations

• Uncommon in children
• 13 14 years old
• Sports injuries
• Fall on an
• outstretched
• arm

30
Elbow Dislocations

• Signs and Symptoms
• - swelling of elbow
• - tenderness
• - limitation of
• elbow motion
• - deformity of
• elbow

31
Elbow Dislocations

• What to do?
• - Splint
• - Elevate upper
• extremity
• - Seek medical
• consult

32
Shoulder Dislocations

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

33
Shoulder Dislocations

• Signs and Symptoms
• - swelling of
• shoulder
• - tenderness
• - limitation of
• shoulder motion
• - gross deformity
• of shoulder

34
Shoulder Dislocations

• What to do?
• - Sling
• - Seek medical
• consult

35
Sports Injuries in Children
36
Sports Injuries

• Repetitive stress
• Adolescence

Data from Sports Clinic, UP-PGH, 2006
37
Sports Injuries

• Most common type of sports associated with
  injuries
• - basketball
• - volleyball
• - badminton

Data from Sports Clinic, UP-PGH, 2006
38
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
39
Infections
40
Infections

• Septic Arthritis
• Osteomyelitis

41
Septic Arthritis

• Inflammation of the joint
• Pus-forming organisms
• Newborn, infants and children
• (2 - 3 years old)
• Tachdjian Pediatric Orthopedics, 1990

42
Septic Arthritis

• Involvement
• 1. Hip joint
• 2. Knee joint
• 3. Elbow joint
• Tachdjian Pediatric Orthopedics, 1990

43
Septic Arthritis
44
Septic Arthritis

• Bacteria enter the joint via
• 1. Blood stream
• 2. Direct extension
• 3. Direct injection
• Tachdjian Pediatric Orthopedics, 1990

45
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

46
Septic Arthritis

• Treatment
• Antibiotics
• Drainage and debridement
• Splint - pain and prevent deformity
• Function and congruency of joint
• Tachdjian Pediatric Orthopedics, 1990

47
Osteomyelitis

• Infection of bone
• Infants and children
• Metaphysis of long
• bones
• Tachdjian Pediatric Orthopedics, 1990

48
Osteomyelitis

• Routes of infection
• Bloodstream
• Direct extension
• Open fractures
• Tachdjian Pediatric Orthopedics, 1990

49
Osteomyelitis

• Signs and Symptoms
• Pain
• High fever, chills,
• vomiting and
• dehydration
• tenderness over bone
• Tachdjian Pediatric Orthopedics, 1990

50
Osteomyelitis
51
Osteomyelitis

• Treatment
• Antibiotics
• Splint or cast
• Surgery
• Tachdjian Pediatric Orthopedics, 2nd edition

52
Battered Child Syndrome
53
Annual Report CPU 2005
54
Annual Report CPU 2005
55
Annual Report CPU 2005
56
father
Annual Report CPU 2005
57
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

58
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

59
Physical Examination

• Head and neck
• Skin
• Chest, abdomen, and genitalia
• Skeletal trauma

60
Head and Neck

• swelling, abrasions, lacerations, bruises
• uneven skull
• bulging (skull)
• bleeding in mouth
• tooth decay
• bleeding in eyes
• deformed ears

61
Skin

• Bruises, bites and burns
• Pinch and ligature marks
• Object pattern marks
• stocking and glove immersion patterns

62
Chest, Abdomen, and Genitalia

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

63
Specificity of Fractures for Physical Abuse
64
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)

65
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