Ankle Pediatric Fractures Osteochondrities Flashcards
What is chronic recurrent multifocal osteomyelitis (CRMO)
Autoinflammatory disorder of children and young adults that is characterized by nonbacterial osteomyelitis
Is CRMO bacterial or nonbacterial osteomyelitis
Nonbacterial osteomyelitis
What are the typical imaging findings of CRMO
Lyric and sclerotic lesions in the metaphyses of long bones
What is Diaz Disease
Aseptic Necrosis of the Taurus
- Rare and associated with trauma
- Self limiting
- Walking cast to protect the talus, returns to shape
What are symptoms of Juvenile RA (Still’s Disease)
- antalgic gait
- skin rash - salmon pink macuole increasing in size
- Rheumatologist referral due to long term treatment
Describe Rheumatic Fever
- starts as upper respiratory tract infection
- Transient swelling with pain of the joints
- successive pattern
- subsides in one appears in another
- early treatment to avoid valvular damage (group A beta-hemolytic strep)
What is Osteomyelitis
- pyogenic
- hematogenous or inoculation by puncture wound
- symptoms: swelling, erythema, tenderness, calor of joint with throbbing pain
Which bone is most commonly affected by hematogenous osteomyelitis
Calcaneus
Describe osteomyelitis in infants and children
- in infants: epiphyseal
- in children - metaphysis
What are the radiographic findings of osteomyelitis
- early: swelling
- lytic areas, periosteal changes
- Brodie’s abscess
What medical condition can result from osteomyelitis
Tuberculosis: due to hematogenous spread in metaphyseal of long bones
What is one common differential diagnosis for osteomyelitis
Ewing’s sarcoma
What are the problems associated with ball and socket joint of the ankle
- allows for sagittal plane motion but also transverse and frontal
- results in instability
How do you treat ball and socket joint of the ankle
- if chronic ankle problems occur, fusion is the surgical procedure
Describe ankle valgus and how it is acquired
- congenitally short fibula
- acquired from fibular fracture, unequal growth with tibia
What to the treatment for ankle valgus
Tib-fib fusion or bone graft to produce stability
Describe epiphyseal fractures
- can occur from significantly different consequences from adult fractures
- unique fracture patterns
- premature epiphyseal arrest
When does the primary centers of ossification in long bones start forming
7th week intrauterine
When does the femur ossify
Early 7th week
When does the tibia ossify
Later in 7th week
When does the fibula ossify
8th week
What are pressure epiphyses
Articular, end of long bone, transmit pressure through joints, provide longitudinal growth of bone
What are traction epiphysis
Sites of muscle attachments, tremendous pressure, provide shape and contour of bone
Describe the anatomy of the physis
Radiolucent cartilaginous plate between meta and epiphysis
In epiphyseal fractures, where does injury actually occur
In the physis, not the epiphysis
What occurs in the in the cartilaginous zone of the epiphyseal
Growth due to dividing cells
Maturation —> calcification
Transformation —> ossification
What happens in the metaphysis of the epiphyseal region
- assist in bone formation and remodeling
What happens in Ranvier and LaCroix of the epiphyseal region
Fibrous components
What is Type 1 Salter Harris
Epiphysis separated from the metaphysis without boney fracture
What is Type II Salter Harris
Thurston Holland fracture though the epiphysis transversely going through metaphysis (triangle)
What is Type III Salter Harris
Intra articular fracture from joint surface through the epiphysis, then extending along the plate to its periphery
What is Type IV Salter Harris
Intra articular from the joint surface through the epiphysis across the physeal plate and through a portion of the metaphysis (oblique fracture)
What is Type V Salter Harris
Severe crushing injury and compression force of the physeal plate
What is the treatment and prognosis for Type I Salter Harris
NWB Cast 3-4 weeks
Peds heal in 1/2 the time it would take an adult
Prognosis - excellent
Hat is the most common physeal plate injury
Salter Harris Type II
What is the treat for nondisplaced salter Harris Type II
WB cast 4 weeks
What is the treatment for displaced Salter Harris Type II
Reduce —> NWB 4 weeks above knee —> 2 weeks in BK walking cast
What is the prognosis for Salter Harris Type II
Excellent - growing cells stay within the cartilage
What is the treatment for nondisplaced Type III Salter Harris
BK cast 4-6 weeks with 3-4 weeks NWB
What is the treatment for displaced Type III Salter Harris
if ORIF, okay to use smooth k wires prependicular to growth plate,
Remove k wires in four weeks
DO NOT COMPRESS - NO SCREWS
What is he prognosis for Type III Salter Harris
Good - if blood supply intact
Treatment for Nondisplaced Type IV Salter Harris
AK Cast for 4 weeks —> BK cast for 2 weeks
WB for both
Treatment for displaced Type IV Salter Harris
ORIF
What is the prognosis for Type IV Salter Harris
Poor
High incidence of premature closure with angulation deformity
What is the treatment for Type V Salter Harris injury
NWB cast for 3 weeks
- uncommon crushing force injury
- no physeal fracture or displacement
What id the prognosis for Type V Salter Harris
Poor
What is osteochondrosis
- non inflammatory disturbance affecting the epiphysis
- unknown etiology
What are the stages seen on x ray findings of osteochondrosis
- necrotic sage - sclerotic appearance of bone
- regenerative - increased fragmentation
- remodeling - boney replacement of necrotic cortex and marrow
What is osteochondrosis of the talus
Diaz disease
What is oseochondrosis of the cuneiforms
Bushke’s disease
What is osteochondrosis of the 5th MT base
Iselin’s disase
What is osteochondrosis of the sesamoids
Treve’s disease
What is osteochondrosis of the accessory tarsal navicular
Haglund disease
What is osteochondrosis of the navicular
Kohler’s disease
What is osteochondrosis of the 2nd MT head
Frieberg’s disease
What is osteochondrosis of the calcaneal apophysis
Sever’s disease
