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Unit 2 > BIOMED 10/18c Changes to Pediatric Bone > Flashcards

BIOMED 10/18c Changes to Pediatric Bone Flashcards

1
Q

what is the issue about pediatric bone?

A
  1. patient is still growing
  2. there are periods of rapid change and variability in regards to
    - skeletal maturation
    - muscle growth
    - sexual maturation
    - skill acquisition
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2
Q

growth, size, volume, structure, and function of the skeleton are affected by

A
  1. hormones
  2. metabolic factors
  3. nutrition
  4. mechanical forces over time
  5. genetics
  6. disease or pathologic processes
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3
Q

hormones that contribute to longitudinal bone growth and mass after birth

A
  1. growth hormone - stimulates IGF-1

2. insulin like growth factor-1

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4
Q

importance of GH

A

deficiencies lead to decreased BMD during childhood

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5
Q

is IGF-1 important for just peds?

A

NO
it is important for skeletal maturaton and BM acquisition in peds

for adults, it is important for BMC maintenance

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6
Q

Importance of TH

A

thyroid hormone has a direct impact on bone metabolism

-children with hypothyroidism have decreased bone lengthening

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7
Q

sex hormone impact on pediatric bone growth

A
  1. at puberty, estrogens and androgens cause rapid longitudinal bone growth
  2. lead to fusion of physis and cessation of bone growth
  3. INCREASED LEAN BODY MASS
  4. Contribute to significant variability
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8
Q

Growth factors in the bone

A

Fibroblast Growth Factors

  • 23 different FGFs throughout skeletal system
  • continually interplay and constantly regulate skeletal muscle
  • Examples:
    1. periosteum
    2. perichhondrium
    3. chondrocytes
    4. osteoblasts
    5. differentiating osteoblasts
    6. mesanchyme of sutures of the cranial bone
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9
Q

Importance of Vitamin D**

A
  1. Vitamin D3 is produced in the skin following UV light exposure
    - metabolized in the liver to 25-hydroxyvitamin D (25D)
    - then metabolized in kidney to 1 alpha, dihydroxy vitamin D (125D)
  2. Vitamin 125D plays critical role in intestinal absorption of Ca and ionic phosphate
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10
Q

Significance of Calcium

A
  1. Calcium can only be absorbed at 500mg at a time

2. calcium supplementation should be separated out to get the proper amount of dosing

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11
Q

what makes it easier to change diet to absorb calcium than taking the pill?

A

it is easier because the pill can only be absorbed in doses of around 500mg per sitting. This requires the pt to continually supplement

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12
Q

how is skeletal maturity and bone age determined?

A
  • left hand and wrist were tested
  • the atlas technique of greulich and pyle
  • tanner whitehouse bone specific scoring
  • fels hand wrist method
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13
Q

what is the most common way to determine skeletal maturity/bone age?

A

Atlas technique of greulich and pyle

-modal maturity indicator

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14
Q

what is the tanner-whitehouse bone specific scoring scale

A

total bone maturity indicator score up to 1000

typically used in europe

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15
Q

what is the fels hand wrist method to determine skeletal maturity/bone age?

A

requires software to translate ratings into age

-typically used in North America

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16
Q

typically ____ y/o _____ had their first ____

A

12.5-13 y/o females had their first period

and this is important for surgery decision making

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17
Q

important aspects of bone growth

A
  1. stature
  2. growth velocity
  3. timing
  4. mass
  5. density
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18
Q

what is the difference between peak height age in males vs females?

A

females reached at around 15yo while males reached at around 18 yo

females have an early rapid growth velocity than males and they end before males

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19
Q

age comparison of male and female long bone physis closure: onset of closure to complete closure

A
  1. age at onset: F = 11-14.5; M = 12-16
  2. age at completion: F = 12.5-18; M=15->=18
  3. onset <=13.5: F = 4/6; M = 1/6
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20
Q

sexual maturity’s relationship to bone maturity

A

girls have around 2 yrs left after their first period for long bone growth

->shows why surgery can be delayed if growth plates aren’t fully developed yet

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21
Q

do you wait for growth plates to develop if pt has SCFE?

A

No

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22
Q

bone mineral content (mass)

A

total bone tissue in an area

measured in grams

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23
Q

bone mineral density

A

amount of bone tissue per volume

either g/cm2 or g/cm3

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24
Q

peak bone mass

A

maximal amount of bone tissue following skeletal maturation

25
Q

density and mass measurement

A
  1. dual energy x-ray absorptiometry (DXA) - g/cm2
  2. quantitative computed tomography
  3. peripheral QCT
  4. quantitative Ultrasound
  5. MRI
26
Q

what is the DXA scan?

A

areal bone mineral density

  • gold standard
  • gets the difference between 2 x-ray beams
27
Q

in peds use __score instead of __score and want to be in the ___ ___

A

z-score
t-score
standard dev

28
Q

how does one increase bone mass and density

A

increased activity at a younger age decreases fracture risk as you age

-greater bone mass and density are associated with decreased fragility fracture

continued increase of bone mass and density following end of height growth is still beneficial to bone healty

29
Q

in children __ to ___ of equivalent weight, ____ have greater ____ muscle mass than ___ b/c of ____

A 
3
13
females
quadriceps
males
onset of puberty
30
Q

it is suggested to use ___ related muscle reference data rather than ___ related because of ____ maturation

A

weight related
age related
sexual maturation

31
Q

were there differences noted amongst ethnically diverse subjects with tanner groups?

A

no

32
Q

significance of growth and isometric strength

A
  1. height favors boys at 4
  2. 10 yo boys are significantly heavier and taller than girls
  3. 11-13 yo girls are heavier and taller than boys
  4. 15 yo boys are significantly heavier and taller than girls
33
Q

black vs white femoral density

A

black children have longer legs and a significantly greater cross sectional area at midshaft

–greater bone strength in children

–no difference in skeletal age when matched for skeletal maturation

34
Q

growth variation for US born children vs foreign

A

US are heavier and taller than foreign born children

35
Q

what happens to bone age as we age?

A

it starts to increase more than our actual age!

tw2-tw3 goes into a negative number because of environmental factors, hereditary, dietary, etc

36
Q

pediatric skeletal difference

A

Kids bounce after a fall because of more ELASTICITY/SPRINGYNESS of the bone

  • preosseous cartialge
  • physis: growth plate
  • periosteum: thicker, stronger, more osteogenic – faster, bigger callous
  • more shock absorption: lower BMC and greater porosity
37
Q

pediatric orthopedic concerns

A
  1. growth plate injuries and conditions
  2. lower extremity deformities
    - growing pains
    - pediatric fracture remodelling
38
Q

structural contributions to physis injury

A
  1. occurs prior to ligament injury
    - phenomenon decreases with progression toward skeletal maturity/physis closure
    - ligaments attach to epiphyses therefore transferring force to the physis
    - ligamets are shorter and continuous tissue type (greater tensile strength)
39
Q

the ____ you are, the ___ likely you are to a joint injury at growth plates

the ___ you are, the ___likely you are to have a ligamentous injury

A

younger
more

older
more

40
Q

how do forces typically travel in the body?

A

horizontally, that leads to growth plate rupture

41
Q

___are stronger than ____ in children

A

ligaments

bone

42
Q

apophysitis dieases in children?

A
  1. osgood schlatter
  2. sinding-larsen-johansonn syndrome
  3. sever’s disease
  4. iliac apophysitis
43
Q

do the apophysitis diseases in children all have the same underlying mechanism?

A

yes! They are just presented in different parts of the body

they are all because of traction!

44
Q

osgood schlatter syndrome

A

traction apophysitis of the tibial tuberosity

  • prominent tibial tube
  • significant tenderness of the tibial tube
  • tendon is pulling the periosteum away from the bone
45
Q

sindig-larsen-johansson syndrome

A

traction apophysitis of the inferior pole of the patella

-significant point tenderness to the inferior patella tubercule and proximal patella tendon

46
Q

Sever’s disease

A

traction apophysitis of the posterior calcaneus

  • pain with shoes, toe walking, running
  • outgrowth of bone on lateral order of calcaneus
  • posterior calcaneous tenderness
  • gastroc/soleus tightness
47
Q

iliac apophysitis

A

traction of apophysitis along the iliac crest and/or spine

  • TFL
  • REctis Femoris
  • Sartorius
  • Glute Med
  • Abdominal Obliques
  • track and field athelets and dancers
48
Q

signs of apophysitis of any of the joints?

A
  1. location
  2. pt will jump when you palpate
  3. muscle shuts down to compensate (activity decreases)
49
Q

what is the treatment for apophysitis

A

stretch the muscle and start to strengthen it

50
Q

is there evidence confirming growing pains

A

no conclusive evidence regarding cause

  • anecdotally related to:
    1. biochemica/hormonal factors
    2. muscle strain during growth
    3. instability at growing junctions
51
Q

treatment for growing pains

A

more for pt comfort

  1. massage
  2. hot/cold packs
  3. analgesics
52
Q

bone remodeling following fracture

A
  1. the younger the child, the better
  2. the more proximal to the joint/physis the better
  3. if the fracture is in the same line as the primary axis of motion, the better
53
Q

what can happen to bone after remodeling when pt is younger than 10 yo

A

frequently find 1-3 cm overgrowth in long bone due to physeal stimlation during fracture healing

54
Q

requirements for youth resistance training programs

A

(pre-pubscent)

  • general muscle strengthening ( no targeted body parts)
  • supervised settings (less pts to PT)
  • proper technique
  • SAFETY
55
Q

pediatric patients must have the following when practicing resistance training

A
  1. proper supervision and technique

2. avoid maximum lifint until at least tanner stage 5 (usually 16-17yo)

56
Q

body composition changes in pediatrics after resistance training

A

small, if any changes in lean body mass

  1. minimal muscle hypertrophy
  2. changes in strength likely due to neural components because of strength gains
    - motor unit recruitment
    - frequency of motor unit firing
    - changes in muscle activation
    - changes in contractile properties
57
Q

Exercise ___ cause growth to be stunted

A

DOES NOT

58
Q

what are main factors contributing to pediatric injury during strength training

A
  1. poorly designed programs
  2. poorly supervised programs
  3. excessive load
  4. unqualified supervision
  5. poorly designed equipment
  6. free access to equipment

Unit 2 (31 decks)

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