bone xrays

Question 1

describe the 5 grades of salter (SALTR) harris classification of #

Answer 1

Slip grade 1 - # thru growth place alone (not M/E)
Above grade 2 - # thru the grwth place + above into M
beLow grade 3- # thru growth plate and below into E
Through grd 4 - # thru growth plate and M and E
Rammed Grd5 Compression of growth plate

Question 2

Complication of salter Harris fractures

Answer 2

Premature closure of growth plate 27% angle deformity

38% grade 3/4 SH fractures

Question 3

Order of bone fusion of elbow

Answer 3

CRITOE
Capitellium
Radial head
Internal epicondyle
Trochlea
Olecraneom
Ext epicondyle
1,3,5,7,9,11years
I,T order important in elbow Fractures

Question 4

Fat pads in elbow fractures

Answer 4

Posterior fat pad should not be seen if see = #

Anterior fat pad. Sail like projection =#

Question 5

Slipped femoral epiphysis

Answer 5

Presentation hip pain 50% knee pain 25% limp groin pain
Boys 12-15
Girls before first period
Obesity
Bilateral 10% at presentation 
20-80% other times
Need 2 views AP and FROG view
Slip anterior or post

Question 6

Signs of slipped femoral epiphysis on X-ray

Answer 6

Decreased ht of the epiphysis
No epiphysis lateral to Kliens line
Metaphysics increased radiolucency
Klein’s line not thru the femoral head

Question 7

What is kliens line

Answer 7

Line drawn from the superior femoral neck and it should bisect the femoral head epiphysis (if the head below it’s slipped)

Question 8

Child abuse signs on X-ray. High specificity

Answer 8

Classical metaphysial fracture CML
Rib fractures post med
Scapular
Sternum
Spinous processes

Question 9

What fractures are moderate specificity of child abuse (6 things)

Answer 9

Multiple fractures esp bilaterally
Fractures of different ages
Vertebral fractures
Digital fractures (babies don’t #digits stomped on)
Complex skull fractures
Epiphyseal separation (birth trauma >4kg or child abuse)

Question 10

What signs on X-ray are low specificity for child abuse

Answer 10

Sub periosteal fractures
Clavicle fractures
Fractures of long bones shaft
Linear skull fractures

Question 11

When are Classical metaphysesl fractures seen

Where is it seen. What bones

Answer 11

In child abuse
<18 months of age usually <2years (small enough to be shaken twisted)
Seen in the long bones of the legs and in the humerus
Bucket handle tear / Conner fracture

Question 12

What is the DD of CML classic metaphyseal lesion (3)

Answer 12

1 physiological see sub periosteial changes related to rapid growth 1-5 months of age (6/12) usually bilateral <2mm

2 Ricketts frayed splayed metaphysis / R Rosary/ osteopenia -pathological fractures
3 osteogenesis imperfecta. Rare ( CML and post rib #rare in OI)

Question 13

Physiological differences children’s fractures to adults

Answer 13

Remodeling 
Overgrowth
Progressive deformity
Non union 
Speed of healing. Quicker

Question 14

Remodeling in childhood fractures

Answer 14

1 tolerate treated degrees of deformity esp close to the growth plate there is better remodeling
2 you need >2years of remodeling to go eg <12 yrs female >14year males
3 if the fracture is in the plane of the bone
Remodeling WONT happen if
1 intra articular fracture
2 fracture 90 degrees to the plane of the bone

Question 15

What is overgrowth in relation to childhood fractures

Answer 15

Overgrowth can happen in fractures that get a bit blood flow eg femur and can get a difference in the leg length

Question 16

What is non union in fracture

Answer 16

Rare in children
1Happens if there is a displaced intra articular fracture eg lateral humural fracture
2 Fracture has soft tissue interposition

Question 17

Age of child is important in fractures

Answer 17

Remodeling need 2 years more of growth for it to work 12 girls 14 boys
<3 years 25 % of Fractures non accidental injury

Question 18

Pulled elbow in toddlers mechanism and what is it

Answer 18

Pulled elbow
Subluxation of the radial head
Will resolve on its own

Question 19

X-rays what things should you get in a ? Fracture

Answer 19

2 views and need to involve both joints above and below

Question 20

Elbow fractures

Answer 20

Radio calielium line should be straight on lat view
Fat pads should not be seen ? Arthrosis effusion fracture
Comparison with the other side if uncertain

Question 21

If a child has a fracture what things do you look for on examination

Answer 21

1 swelling deformity
2 neurovascular
3 point tenderness = characteristic of #
4 move ?tendon injury

Question 22

If fracture has neurovascular involvement what should you do

Answer 22

Requires URGENT. Treatment with reduction don’t need analgesia
EMERGENCY

Question 23

Toddler fracture = spiral fracture common happen when they trip

Answer 23

True not NAI

Question 24

Open fractures are orthopedic emergency

Answer 24

True 
Photo 
Clean big bits out 
Sterile dressing don’t disturb till child in OT
Antibiotics
X-ray 
Surgery within 6 hours

Question 25

Neonatal Fractures humerus clavicle femur common sites in birth trauma

Answer 25

> 4-4.5kg normal

Osteogenesis imperfect

Question 26

Supracondylar fractures are common in childhood

Answer 26

True 
3-10 year of age 
Fall on an outstretched hand
15% have nerve palsy ant intraossus nerve 
Brachial artery entrapment /injury

Question 27

Fracture pattern

Answer 27

Spiral fracture (twisting force ) bowing fracture
Oblique
Transverse direct blow
Butterfly >2 elements to the # lots of energy involved in #

Question 28

Growth plate injury

Answer 28

Progressive angular deformity
Limb length discrepancy
Joint incongruity