(9) Paeds Msk Flashcards by Peter Ford

What factors influences a child evolution?

genetics
physical trauma
nutrition
socioeconomic factors

How well did you know this?

Not at all

Perfectly

Where do greenstick fractures usually occur?

metaphysis

How well did you know this?

Not at all

Perfectly

Where do buckle fractures usually occur?

diaphysis

How well did you know this?

Not at all

Perfectly

How do bones fail first in children after trauma?

during rapid growth, bone lengthens before muscle and tendon can stretch sufficiently
ligaments are strong so bone fails first

How well did you know this?

Not at all

Perfectly

What is the weakest part in the growing bone?

Epiphysis (growth plate)

How well did you know this?

Not at all

Perfectly

What is the salter harris classification?

system to categorize fractures the physis, or growth plate in children

How well did you know this?

Not at all

Perfectly

What are avulsion fractures?

severe ligamentous injury unlikely to occur by itself in children

How well did you know this?

Not at all

Perfectly

Where do Apophyseal avulsion fractures occur?

at all main apophyses usually as a result of forceful eccentric/concentric contraction of the attached muscle

How well did you know this?

Not at all

Perfectly

What is osteochondrosis?

Group of conditions characterized by sclerosis and fragmentation of the epiphysis or apophysis in the immature skeleton
focal disturbance of endochondral ossification

How well did you know this?

Not at all

Perfectly

What can happen as a result of osteochondrosis?

interruption to the blood supply
necrosis of the ossification centre
Bony regrowth

How well did you know this?

Not at all

Perfectly

What is a Slipped Capital Femoral Epiphysis?

Displacement of the upper femoral epiphysis on the metaphysis

How well did you know this?

Not at all

Perfectly

What are the causes of a Slipped Capital Femoral Epiphysis?

increased stress across physis
possible hormonal contribution
underlying endocrine abnormality
renal failure

How well did you know this?

Not at all

Perfectly

What are the signs of a SCFE?

hip/groin pain
if chronic, may be thigh or knee pain
Limp
unable WB (acute slips)

How well did you know this?

Not at all

Perfectly

What is Perthes (aka Legg-Calve-Perthes disease)?

idiopathic juvenile avascular necrosis of femoral head

How well did you know this?

Not at all

Perfectly

What may cause an LCPD?

SCFE
trauma
steroid use
congenital dislocation of hip

How well did you know this?

Not at all

Perfectly

What is the pathophysiology of an LCPD?

fragmentation
revascularization
remodeling
whole process may take 3-4 years

How well did you know this?

Not at all

Perfectly

What are symptoms of LCPD?

painful limp
pain referred to groin, thigh or knee

How well did you know this?

Not at all

Perfectly

What are signs of LCPD?

Loss of medial rotation
Loss abduction
Flexion adduction contracture
Trendelenburg gait

How well did you know this?

Not at all

Perfectly

What is the management of LCPD?

maintaining femur abducted and IR
bracing no longer favoured over surgery
older with marked head involvement do not do well with surgery

What is Osgood Schlatter’s Disease?

stress related partial avulsion of the tibial tubercle apophysis

What are signs of Osgood Schlatter’s Disease?

Pain, swelling and tenderness at the tibial tubercle

What is Sinding-Larson and Johansson syndrome?

an overuse traction apophysitis
repetitive micro trauma at insertion point of proximal patellar tendon

What is seen on examination of Sinding-Larson Johansson syndrome?

proximal tibial swelling & tenderness
enlargement of prominence of tubercle
agg jumping or direct pressure
pain resisted knee extension
Full knee ROM
Hamstring tightness

What is PFJ Instability?

patellar recurrent subluxation / instability

What are signs of PFJ instability?

- joint laxity - ext tibial torsion - genu valgum - "J" sign - patellar apprehension

What is the treatment for PFJ instability?

- symptomatic management - quads regime - stretches: tight hamstrings and tight calf muscles - patellar tendon strap - activity modification - education

What is Sever's Disease?

painful inflammation of the calcaneal apophysis

How does Sever's Disease Occur?

microfractures occur due to shear stress

What are symptoms of Sever's Disease?

- pain at posterior heel made worse by sports - onset gradual - relived with rest - pain interferes with sport performance & ADL

What are signs of Sever's Disease on examination?

- 60% bilateral - pain on deep palpation of achilles tendon - pain toe raises - weak ankle dorsiflexors - mild swelling - may have calcaneal enlargement

What are red flags to look out for?

- fevers - night pain - weight loss - swelling - other sites pain - decreasing motor skills/ADLs

What are oncology red flags?

- malignant bone tumours - osteosarcoma (night pain) - Ewings sarcoma - mass present - abrupt onset pain with low trauma

What are signs of inflammatory conditions?

- Morning stiffness - Swelling post activity - chronic synovitis - rash - eye issues

What are the key Ax points?

- careful & thorough history taking - general well being child - Hx - development to date - function (school etc) - gait - symmetry - child protection

What is scoliosis?

- lateral curvature of the spine > 10 degrees - associated vertebral rotation

What causes adolescent idiopathic scoliosis?

- disproportionate rates of growth in different areas of the spine - develops and worsens during adolescent growth phase

What are the risks of progression?

- curves of >50 degrees - double curve pattern - Low Risser sign - Females - Location of curve - onset of pubertal growth spurt

What are key points of spinal Ax?

- pre or post menarche - nature of any pain - red flags/ special questions - yellow flags - observation & function - adams forward bend - special tests

What is spondylolysis?

- defect of pars interarticularis, most common at L5 - often described as stress fracture

What can cause spondylolysis?

- repetitive micro trauma - acute shearing forces - acute loading forces

What are symptoms of spondylolysis?

- back pain that eases with rest - activities include repetitive flexion and extension

What are signs of spondylolysis?

- pain reproducible with extension - stork test - forward bending painful - tight hamstrings - pain on palpation

What is spondylolisthesis?

slip of one vertebral body on the adjacent one

What are symptoms of spondylolisthesis?

- complains of NSLBP - activity related

What are the signs of spondylolisthesis?

- tenderness at L5/S1 - prominence may be detectable - para spinal muscle spasm - tightness hamstrings -