Accidents and Injuries in School School Environment Injuries

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Accidents and Injuries in School

Accidents and Injuries in School

School Environment • Injuries - 3 % - 9 % annually • Fractures -

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

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 Injuries Cause • Fall 78% • Traffic accidents 11% De la Calzada,

Incidence of Injuries Cause • Fall 78% • Traffic accidents 11% De la Calzada, Caballes and Javier, 1998

Incidence of Injuries Place • Home 41% • Streets 22. 7% • School 20.

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

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

Overall Frequency of Fractures • % children with fractures (0 to 16 years of

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

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

Common Childhood Fractures and Dislocations

Common Childhood Fractures and Dislocations

Fractures and Dislocations • What is a fracture? Injury caused by a break in

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

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

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

Wrist Fractures • Signs and Symptoms - swelling over wrist - tenderness - painful

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

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

Forearm Fractures • Caused by landing on an outstretched upper extremity

Forearm Fractures • Caused by landing on an outstretched upper extremity

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

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

Forearm Fractures • What to do? - Splint - Elevate hand - Seek medical

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

Elbow Fractures • 5 – 7 years old • Caused by falls

Elbow Fractures • 5 – 7 years old • Caused by falls

Elbow Fractures • Signs and Symptoms - swelling of elbow - tenderness - limitation

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

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

Clavicular Fractures • fall on the shoulder

Clavicular Fractures • fall on the shoulder

Clavicular Fractures • Signs and Symptoms - swelling of shoulder - tenderness - limitation

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

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

Femoral Shaft Fractures • Older children – high-energy injuries • Children younger than walking

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 -

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

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

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

Common Dislocations • Elbow • Shoulder

Common Dislocations • Elbow • Shoulder

Elbow Dislocations • Uncommon in children • 13 – 14 years old • Sports

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

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

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

Shoulder Dislocations • Signs and Symptoms - swelling of shoulder - tenderness - limitation

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

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

Sports Injuries in Children

Sports Injuries in Children

Sports Injuries • Repetitive stress • Adolescence Data from Sports Clinic, UP-PGH, 2006

Sports Injuries • Repetitive stress • Adolescence Data from Sports Clinic, UP-PGH, 2006

Sports Injuries • Most common type of sports associated with injuries - basketball -

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

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

Infections • Septic Arthritis • Osteomyelitis

Infections • Septic Arthritis • Osteomyelitis

Septic Arthritis • Inflammation of the joint • Pus-forming organisms • Newborn, infants and

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

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

Septic Arthritis

Septic Arthritis

Septic Arthritis • Bacteria enter the joint via: 1. Blood stream 2. Direct extension

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

Septic Arthritis • Signs and Symptoms – Acute – Pain – Limitation of motion

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

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

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

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

Osteomyelitis • Signs and Symptoms – Pain – High fever, chills, vomiting and dehydration

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

Osteomyelitis

Osteomyelitis

Osteomyelitis • Treatment – Antibiotics – Splint or cast – Surgery Tachdjian Pediatric Orthopedics,

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

Battered Child Syndrome

Battered Child Syndrome

Annual Report CPU 2005

Annual Report CPU 2005

Annual Report CPU 2005

Annual Report CPU 2005

Annual Report CPU 2005

Annual Report CPU 2005

er th fa Annual Report CPU 2005

er th fa Annual Report CPU 2005

Common Child Abuse History Risk Factors • • • Unexplained injury Absent, changing, or

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

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 •

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

Head and Neck • swelling, abrasions, lacerations, bruises • uneven skull • bulging (skull)

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”

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

Chest, Abdomen, and Genitalia • • • Bruises Unequal breathing Pain Deformities Abrasion or laceration on private parts

Specificity of Fractures for Physical Abuse

Specificity of Fractures for Physical Abuse

What to do? • If you suspect physical abuse to children: - Department of

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

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