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Unit 2 > 10-18c Changes to Pediatric Bone & Muscle > Flashcards

10-18c Changes to Pediatric Bone & Muscle Flashcards

1
Q

What factors affect skeletal growth, size, volume, structure, and function of the skeleton?

A 
Growth, size, vol., structure, and function depend upon:
Hormones
Metabolic factors
Nutrition
Mechanical Forces over time
Genetics
Disease or Pathologic processes

growth: m. activation and activity

development and function: bone growth

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2
Q

What are the biochemical components of bone growth? What do they contribute to?

A

Growth Hormone, Insulin-like growth factor: longitudinal bone growth and mass

GH deficiencies: ^BMD

IGF also important for maitenance of BMC in adulthood

puberty and sex hormones: bone growth and development

TH: direct impact on bone metabolism (hypothyroidism = decreased bone lengthening

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3
Q

What do sex hormones (estrogens and androgens) lead to at puberty?

A

rapid longitudinal bone growth, fusion of physis, increased lean body mass, and contribute to significant variability

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4
Q

What are the growth factors in the bone? What do they do?

A

FGF: continually regulate skeletal patterning and bone growth throughout the skeletal growth period

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5
Q

What do vitamin D and calcium do?

A

Vitamin D becomes 125D, which is critical for intestinal absorption of Ca and ionic phosphate

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6
Q

What is limiting about Ca?

A

only 500 mg can be absorbed at one time

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7
Q

What measurements are key factors in age, growth, and development?

A

height, weight, BMI, skeletal maturity and sexual maturity

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8
Q

What are the typical growth scales based on?

A

height, weight, BMI

growth timing and velocity

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9
Q

What technique determines skeletal maturity/bone age?

A

All use left hand and wrist

Atlas technique of Greulich and Pyle: modal maturity indicators described for a specific age

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10
Q

What determines bone growth?

A

stature, growth velocity, timing, mass, and density

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11
Q

When do females reach peak height?

A

15 YO

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12
Q

When do females see an increase in growth velocity (height)?

A

from 9.5 to 10 YO

velocity is ~3.5 in/yr

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13
Q

When do males reach peak growth height?

A

18 YO

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14
Q

When do males increase in growth velocity (height)?

A

11.5 to 13 YO

velocity is ~3.7 in/year

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15
Q

When do females see closure of physis?

A

12.5 to 18 YO

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16
Q

When do males see closure of physis?

A

15-=> 18 YO

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17
Q

When do females reach peak bone growth velocity and completion of fusion?

A

11.5 YO

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18
Q

When do males reach peak bone growth velocity?

A

13.5 YO

19
Q

How does age impact differential diagnosis?

A

fracture around growth plate differs depending on age due to fusion

onset for fusion is earlier in females

20
Q

How many years after longitudinal growth do females have after first period?

A

two years

21
Q

What is bone mineral content (mass)?

A

total bone tissue in an area

measured in grams

22
Q

what is bone mineral density?

A

amount of bone tissue per volume

measured as g/cm squared or cubed

23
Q

Peak bone mass?

A

maximal amount of bone tissue following skeletal maturation

24
Q

What measures areal bone mineral density? Units?

A

DXA (g/cm squared)

25
Q

What measures volumetric density of axial bone?

A

QCT (g/cm cubed)

26
Q

What measures the bone density and mass for peripheral extremeties?

A

Peripheral QC

27
Q

What does greater bone mass and density affect?

A

less likely for fragility fracture

28
Q

What does a Z score act as?

A

percentile/standard deviation

29
Q

In children 3 to 13 of equivalent weight, what is the diff b/w females and males?

A

females have greater quad muscles than males

30
Q

What do males have more of at Tanner stage 5?

A

greater extremity lean soft tissue and total body skeleton m. mass

31
Q

How does muscle strength correlate to factors in males and females aged 4-16? What does this suggest?

A

males: weight
females: weight and age
weight related m. reference data

32
Q

at what phase ar females heavier, taller, and stronger?

A

11-13 yo

33
Q

What ethnicity factors relate to bone density/longitudinal growth?

A

black children have longer legs and greater cross sectional area

34
Q

What is true about US born children?

A

heavier and taller

35
Q

How many SD are african american children than caucasian children in bone age? What may this represent?

A

0.5 SD
delayed bone age for african american children
advanced bone age for caucasian child

36
Q

What is unique about pediatric skeletons?

A

preosseus cartilage, growth plates, periosteum (thicker, stronger), more shock absorption (lower BMC)

37
Q

What are pediatric orthopedic concerns?

A

growth plate injuries (apophysitis), LE deformities, growing pains, pediatric fracture remodeling (better than adults)

38
Q

Why are kids more likely to injure a growth plate than a ligament?

A

ligaments are attached to the epiphysis and hold on tight, so the force translates down towards the growth plates (less continuous fiber type: multi-segmental)

39
Q

What are the four apophysitis diseases?

A

Osgood-Schlatter Syndrome:Traction injury due to tendon pulling periostenum away from bone at tibial tuberosity

Sinding-larsen-johansonn is the pull on the inferior patella

Sever’s Disease: Traction apophysitis of the posterior calcaneus

Iliac Apophysitis: Traction apophysitis along the iliac crest and/or spine

40
Q

What are growing pains associated with? treatment?

A

hormonal factors that cause muscle strain during growth; instability at growing junctions

massage, hot or cold pack, analgesics

41
Q

What are the major factors for bone remodeling following fracture?

A

age (younger the better they do), proximity to a joint (physis) the better it remodels, joint axis (deformity in the plane of primary osteokinematic motion)

problems: overgrowth, boyonet apposition to compensate

42
Q

What are the requirements for youth resistance training programs?

A

specifically designed program, supervised setting, proper technique, safety guidelines

43
Q

What are the results to youth training?

A

significant strength gains, decrease in skinfold measurements, changes in strength likely due to neural components

44
Q

What factors contribute to injury in youth resistance training?

A

poorly designed programs, poorly supervised programs, excessive load, unqualified supervision, poorly designed equipment, free access to equipment

Unit 2 (29 decks)

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