Difference between temporal bone fracture types: Longitudinal Vs Transverse: Made Easy

The temporal bone fracture are common with head injury accounting for 30 % of all head trauma and 75 % of all motor vehicle accident. 31% of temporal bone fracture are associated with Motor vehicle accident. 

Longitudinal fracture are common fracture caused by lateral forces over the mastoid and temporal squamosa and fracture line parallels petrous pyramid axis. It is generally anterior and extra-labyrinthine.

NEURAL SYMPTOMS WITH TRANSVERSE #

PHYSICAL SYMPTOMS WITH LONGITUDINAL #

Difference between temporal bone fracture types: Longitudinal Vs Transverse

Nerve Injury or neural component more common with transverse # Facial nerve injury(VII), vertigo(VIII: Vestibular Nerve), Sensorineural hearing loss(VIII: Auditory Nerve) and Nystagmus (vestibular Nerve/ CNS component) are more common and intense with transverse fracture.

Physical damage like bleeding demonstrated as  Hemotympanum and otorraghia , fractures seen as  CSF otorrhea, Conductive hearing loss due o disruption of ossicles and Tympanic membrane perforation, are common with longitudinal fracture. Neural component less common or less intense than it’s contrary.

Differential diagnoses of various otological symptoms

Parameter		Longitudinal Fracture	Transverse Fracture
Direction Of  Fracture		Along The Axis Of Petrous Pyramid	Perpendicular To Petrous Pyramid
Incidence		More Common (80%)	20%
Mechanism		Parieto Temporal Trauma	Fronto Occipital Trauma
Otoraghia	PHYSICAL DAMAGE	Common	Rare
Hemotympanum		Common	Possible
TM Perforation		Common	Rare
CSF Otorrhoea		Common	Occasional
Hearing Loss		Conductive	Sensorineural	NEURAL DAMAGE
Facial Nerve Injury		Less Common (20%) Often Temporary Delayed Onset	More Common (50%) Often Permanent Acute Onset
Vertigo		Common (Less Intense)	More Intense
Nystagmus		Common (Less Intense)	Common Third Degree

All Anthropometry Formulas and values in Paediatrics: Height, Weight, Head circumference

Normal Anthropometric values at birth 

Anthropometry formula for expected parameters in pediatrics

Normal Anthropometric Values at Birth

Parameter	Range	Normal for easy memory
Weight	2.5-3.5kg	3 kg
Length	45-55 cm	50cm
Head circumference	33-37cm	35cm

Calculate body surface area from the weight (kg)

Body Surface area = (4w+7)/(w+90) m²

Ideal weight gain

Age	Expected weight	Rate of weight gain  g/day
Up to 4 months	3-6kg	30g/day
4-8 months	6-8kg	20g/day
8-12 months	8-10 kg	15g/day

Age	Rate of weight gain  g/week
3 months	200 g/week
4 – 6 months	150 g/week
7 – 9 months	100 g/week
10 – 12 months	50 – 75 g/week
1 – 2 years	40 g/week
2 - puberty	30 g/week

All you need to remember for baby weight 

Age	Rate of weight gain
Up to 3 months	30  g/day
3 months to 1 year	400 g/month
3-7 years	2 kg/year
7 years to adolescence	3kg/year

The weight of any baby should multiply in the following rate ideally

Birth Weight (x)	Time	Examples (2.5kg )
2x (Doubles)	5 months	5kg
3x (Triples)	1 year	7.5kg
4x (Four Times)	2 years	10kg
5x (Five times)	3 years	12.5kg
6x (Six times)	5 years	15kg
7x (Seven times)	7 years	17.5kg
10x (Ten times)	10 years	25kg

Formula to calculate expected weight at certain age

Age	Weech Formula
3-12 months	(Age in months + 9) / 2
1-6 years	Age(years)x2 + 8
7-12 years	(Age in years X 7- 5)/2

Inability to gain adequate weight, may be undernutrition. Learn about marasmus and kwashiorkor 

Measurement and calculation of Height

Age	Length at birth
Birth	50cm
3 months	60cm
1 year	75cm
2 years	90cm
4-5 years	100cm
5 years to 10 years	5cm/years
Adolescence	8 cm/year for girls during 12-16 years 10cm/year for boys during 14-18 years

Expected length gain in pediatric

Weech Formula for expected height from 2 years to 12 years

Expected height = age in years x 2 + 77 cm

Rate of gain of length/ height

Age	Gain in length/height
Up to 3 months	3.5cm/month
6-9 months	1.5cm/month
9-12 months	1.3cm/month
2-5 years	6-8cm/year
5 years to 10 years	5cm/years
Adolescence	8 cm/year for girls during 12-16 years 10cm/year for boys during 14-18 years

Head Circumference

Birth	35 cm
3 Months	40 cm
1 years	45 cm
2 years	48cm
5 years	52cm

Rate of growth of Head circumference

Up to  3 months	2 cm/month
3 months – 1 year	2cm/ 3 months
1-3 years	1cm/ 6 month
3-5 year	1cm/ year

Dines formula to estimate HC at 1 years

(HC at birth(cm) + 9.5 ± 2.59)/2 

Learn about abnormality in Head circumference and their causes (Microcephaly, macrocephaly). 

Normal Values of Head circumference and Chest circumference

Chest Circumference 

HC > CC @ Birth by 3cm

HC = CC @ 9-12 months

HC< CC after 1 years

Mid Arm Circumference (MUAC)

Increase in first year       11cm - 16cm

1-5 years                         16cm - 17cm 

Sources: http://www.adsa.org.za/Portals/14/Documents/Clinical20Guideline20Anthropometry.pdf

Essential pediatrics OP Ghai 

Meherban singh Clinical Methods

Paediatrics: Head Examination: Differential Diagnoses

Delayed Dentition

Causes of Delayed Dentition 

>>Various Anthrometric values at various ages and methods to calculate them.

Delayed Closure of Sutures

Causes of Delayed Closure of suture

Bossing of Skull

Causes Of  Bossing Of Skull

Bulging Anterior Fontanelles

Causes of Bulging Anterior Fontanelle

Craniotabe (Ping Pong Ball)

Causes Of Craniotabes

Microcephaly (<-3SD for Age, Sex, Height and Weight)

Causes of Microcephaly

>>Know the normal head circumference and its rate of growth.

Macrocephaly (> 2 SD or > 2.5cm of mean for age)

Causes of Macrocephaly

Macroglossia

Causes of Macroglossia

Hyperplasia of Gums

Causes of Gum Hyperplasia