Bone Dev and Ped injuries

Question 1

EO

Answer 1

Hyaline cartilage is model
Perichonrium surrounds, OB infilatrate and convert to P
Cartilage in center of D disintegrates- OB forms 1OC towards ends of bone
HC in epiphyses inc length, OB form 2OC, E converted to spongy bone

requires contact between joints

Question 2

Developmental Dysplasia of the Hip (DDH) patho

Answer 2

Abnormal contact of femoral head w acetabulum
Fem head grows faster than acetabulum
Hip flexion inc eccentric contact

Question 3

DDH RF

Answer 3

Female
Breech presentation (head down)
Genetics/FH
Swaddling

Question 4

Treat DDH

Answer 4

Maintain contact w femoral head/acetabulum

After 2 years, prob cant treat

Question 5

Bone age

Answer 5

use ossification centers

Question 6

Areas of weakness

Answer 6

Physis- growth plate, 1OC

Epiphysis- 2OC, lengthening

Apophysis- attachment site of tendons, 2OC, contour

Highest risk of injury during rapid growth (Puberty(

Question 7

Pediatric Bone

Answer 7

Ligament>bone (much more bone injuries)
P is osteogenic & met active
thicker/stronger

Question 8

Greenstick frac

Plastic deform

Answer 8

Intact periosteum, only one side fracture

Bend prior to fracture
Buckle (torus)- compression via longitudinal force
Bowing- microscopic fractures dissipate impact

Question 9

Physis areas

Answer 9

Germinal- resting state, abundant ECM
Proliferative- active growth center for length, abundant ECM
Hypertrophic- center of chondrocyte diff, little ECM, weakest area
Endochondral cal- chondro death and matrix calcification
Strongest area

Question 10

Salter harris classification of physis injuries

Answer 10

1S- straight across (physis)
2A- above (physis/meta)
3L- lower (physis/epi)
4T- through (Phy/epi/meta)
5ER- Erasure- crush injury

Question 11

Slipped Capital Femoral Epiphysis (SCFE)

Answer 11

Type 1- inf/post slippage of proximal femoral epi
Obese, around 11-14

Chronic most common
Acute can occur w fall/trauma
Dull, nonradiating groin/thigh/knee pain
Dec internal rotation

Question 12

SH Type 2

Answer 12

Most common- meta/phy

Rarely causes bone growth arrest

Question 13

SH Type 3

Answer 13

Intraarticualr frac- phys/epi
Possible bone growth arrest
Emergent surgical reduction bc of fragment

Question 14

SH Type 4

Answer 14

Intraarticular frac- E/P/M
Possible bone growth arrest
Emergent surgical correction

Question 15

SH Type 5

Answer 15

Diff to dx
Bone growth arrest
Dx made after growth arrest

Question 16

Osteochondritis dissecans (OCD)

Answer 16

Osteonecrosis of epiphyseal subchondral bone
separation of articular cartilage and subchondral bone

Rep microtrauma
Ischemia, necrosis, bony collapse
Failed revasc w ingrowth of capillaries
Demineralization w detached bone/articualr cart

Question 17

OCD Clinically

Answer 17

School age kids/adolescent
Localized pain worse w activity
Intermittent swelling/tenderness
Mostly lat med femoral condyle

Question 18

Legg-Calve-Perthes Dz

Answer 18

Idiopathic avascular necrosis of femoral epiphysis (children 4-8)
Persistent hip/knee pain
Limp

Question 19

Apophysitis

Answer 19

Overuse injury
Forceful contraction of muscle, separates/fragments apophysis

Pain @ apophysis worse with movement
Swelling, normal ROM

Question 20

Apophysitis usual areas

Answer 20

Tibial Tubercle (11-15) Osgood Schlatter (quads)

Medial Epicondyle (8-14) LLE Forearm flexors

Question 21

Apophysitis Management

Answer 21

Self limited- resolves with ossification of apophysis

OS- ice/NSAIDs/quad strengthening

LLE- no throwing 6-8 wks, ice/NSAIDs/limit pitch count