(9) Paeds Msk Flashcards
What factors influences a child evolution?
- genetics
- physical trauma
- nutrition
- socioeconomic factors
Where do greenstick fractures usually occur?
metaphysis
Where do buckle fractures usually occur?
diaphysis
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
What is the weakest part in the growing bone?
Epiphysis (growth plate)
What is the salter harris classification?
system to categorize fractures the physis, or growth plate in children
What are avulsion fractures?
severe ligamentous injury unlikely to occur by itself in children
Where do Apophyseal avulsion fractures occur?
at all main apophyses usually as a result of forceful eccentric/concentric contraction of the attached muscle
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
What can happen as a result of osteochondrosis?
- interruption to the blood supply
- necrosis of the ossification centre
- Bony regrowth
What is a Slipped Capital Femoral Epiphysis?
Displacement of the upper femoral epiphysis on the metaphysis
What are the causes of a Slipped Capital Femoral Epiphysis?
- increased stress across physis
- possible hormonal contribution
- underlying endocrine abnormality
- renal failure
What are the signs of a SCFE?
- hip/groin pain
- if chronic, may be thigh or knee pain
- Limp
- unable WB (acute slips)
What is Perthes (aka Legg-Calve-Perthes disease)?
idiopathic juvenile avascular necrosis of femoral head
What may cause an LCPD?
- SCFE
- trauma
- steroid use
- congenital dislocation of hip
What is the pathophysiology of an LCPD?
- fragmentation
- revascularization
- remodeling
- whole process may take 3-4 years
What are symptoms of LCPD?
- painful limp
- pain referred to groin, thigh or knee
What are signs of LCPD?
- Loss of medial rotation
- Loss abduction
- Flexion adduction contracture
- Trendelenburg gait
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
