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Y2 MSK > Children's fractures and disorders > Flashcards

Children's fractures and disorders Flashcards

1
Q

What is osteogenesis imperfect (Brittle bone disease)

A

Genetic disorder causing fragile bones and low trauma fractures

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2
Q

What genetic defect causes osteogenesis imperfecta

A

Defect of maturation and organization of type 1 collagen of bone

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3
Q

Why is type 1 collagen important

A

Because it accounts for most of the organic composition of bone

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4
Q

Inheritance pattern of osteogenesis imperfect a

A

Autosomal dominant
Autosomal recessive

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5
Q

Symptoms of autosomal dominant osteogenesis imperfecta

A

Multiple fragility fractures
Short stature
Blue sclerae
Dentinogenesis imperfecta (discoloured, translucent, weak teeth)
Loss of hearing
Easy bruising
Ligament laxity
Scoliosis

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6
Q

Symptoms of autosomal recessive osteogenesis imperfecta

A

Fatal in perinatal period
Spinal deformity

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7
Q

Investigations for osteogenesis imperfecta

A

Xray

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8
Q

What would xray show for osteogenesis imperfecta

A

Thin cortical layer
Osteopenic - loss of bone mineral
Mild cases may have normal xray with history of low energy fractures

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9
Q

Management for osteogenesis imperfecta

A

Fracture fixation - splints, surgery
Surgery to correct deformities
IV bisphosphonates

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10
Q

What is developmental dysplasia of the hip

A

Dislocation of femoral head during perinatal period causing the joint to be dislocated easily and develop abnormally

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11
Q

Risk factors for developmental dysplasia of the hip (5Fs)

A

Female
Firstborn
Family history
Fanny first (breech presentation)
Fluid - oligohydraminos

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12
Q

What is oligohydramino

A

Amniotic fluid volume less than expected for gestational age

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13
Q

Which hip is more commonly involved in DDOH

A

Left hip

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14
Q

Signs of DDOH

A

Asymmetry of legs
Loss of knee height
Less abduction in flexion
Positive Barlow’s test
Positive Ortolani’s test

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15
Q

Timing of presentation of DDOH

A

During neonatal baby checks - right after birth / 6-8 weeks during GP check
When the child starts to walk
<4 years old

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16
Q

Investigations for DDOH

A

US
Barlow’s test
Ortolani’s test
Xray only in 4-6 months old

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17
Q

Describe Barlow’s test

A
  1. infant supine
  2. Flex and adduct the hips while applying posterior force
    Positive = palpable dislocated hip
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18
Q

Describe Ortolani’s test

A
  1. Infant supine
  2. Flex and abduct the hips while applying an anterior force
    Positive = palpable and audible clunk as hip is reduced
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19
Q

Difference between Barlow’s and Ortolani’s test

A

Barlow’s is Bad = joint is dislocated
ORTolani - Orthopaedic doctors relocate joints = joint is reduced

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20
Q

Management of early DDOH

A

Pavlik harness 23-24hrs a day

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21
Q

Management of late DDOH

A

Closed / open reduction spica cast

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22
Q

What is transient synovitis

A

Inflammation of synovial lining of the hip joint

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23
Q

Transient synovitis most commonly affects

A

2-10 years old
Boys

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24
Q

Transient synovitis is often preceded by

A

Viral URTI

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25
Q

Symptoms of transient synovitis

A

Pain
Limp
Reluctant to weight bear
Reduced ROM
Low fever
Symptoms are generally milder than septic arthritis

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26
Q

Investigations for transient synovitis

A

Same day referral
Bloods - CRP, WCC
Xray
Joint aspiration if uncertainty between transient synovitis and septic arthritis
MRI

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27
Q

Management for transient synovitis

A

NSAID
Usually resolves within a few weeks

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28
Q

What is Perthe’s disease

A

avascular necrosis of femoral head in children

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29
Q

Perthe’s disease most commonly affects

A

4-9 years old
Boys
esp short stature / very active

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30
Q

Pathophysiology of Perthe’s disease

A
  1. The femoral head transiently loses its blood supply
  2. Causes necrosis and abnormal growth
  3. Remodelling occurs but the congruence of the joint is determined by age of onset and amount of collapse
  4. Older kids = more likely to be incongruent joint
  5. Incongruent joint causes early onset arthritis
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31
Q

Symptoms of Perthe’s disease

A

Intermittent hip pain
Referred knee/groin pain exacerbated by internal hip rotation
Limp

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32
Q

Signs of Perthe’s disease

A

Loss of internal rotation of the hip
Then progresses into loss of abduction
Then progresses into Trendelenburg’s gait

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33
Q

Pain in transient synovitis may be similar to Perthe’s disease. What is the key difference?

A

Pain in transient synovitis resolves within 2 weeks whereas pain in Perthe’s can persist for >4 weeks.

Raise suspicion if pain persist >4 weeks

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34
Q

Most cases of Perthe’s disease are unilateral / bilateral

A

Unilateral
10% bilateral

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35
Q

Investigations for Perthe’s disease

A

Xray - may be normal at first so should be repeated if suspicion persists
MRI

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36
Q

What can be shown on xray for Perthe’s disease

A

Sclerosis
Fragmentation of epiphysis

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37
Q

Management for Perthe’s disease

A

For less than 50% involvement of femoral head
- rest
- avoid physical activity
- traction
For more than 50% involvement of femoral head
- plaster cast
- osteotomy

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38
Q

When is osteotomy indicated in Perthe’s disease

A

If femoral head partially dislocates due to femoral head becoming flatter, wider, aspherical (incongruent)

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39
Q

What is slipped upper femoral epiphysis

A

Weakness in the proximal femoral growth plate allows displacement of the capital femoral epiphysis

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40
Q

In which direction does the femoral head epiphysis slip in relation to the femoral neck in SUFE

A

Inferiorly

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41
Q

Risk factors for SUFE

A

Adolescents 8-18
Overweight
Male
Hypothyroidism
Hypogonadism
Afro-Carribean / Hispanic ethnicity

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42
Q

Symptoms of SUFE

A

Hip pain
Limp
Referred pain to knee; Can present as JUST knee pain
Antalgic gait
Trendelenburg’s gait

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43
Q

Difference between antalgic gait and Trendelenburg’s gait

A

Antalgic gait is due to pain whereas Trendelenburg’s gait is due to weakness in gluteus medius/minimus

Hip does not dip to one side in antalgic gait

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44
Q

Signs of SUFE

A

Antalgic gait
Loss of internal rotation of hip

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45
Q

Investigations for SUFE

A

Xray - AP and Lateral
Frog leg xray - provides visualisation of femoral head

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46
Q

Management for SUFE

A

Internal fixation

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47
Q

Complications of SUFE

A

AVN
Deformity
Chondrolysis

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48
Q

What is femoroacetabular impingement syndrome

A

Bones of the hip joint are not shaped properly during childhood which causes them to rub against one and another

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49
Q

When does femoroacetabular impingement syndrome usually present

A

20-45 years olds as groin pain

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50
Q

Types of femoroacetabular impingement syndrome

A

CAM
Pincer
Mixed

51
Q

What is CAM type femoroacetabular impingement

A

Femoral head is not completely round so it cannot rotate smoothly inside the acetabulum

52
Q

CAM type femoroacetabular impingement is associated with

A

Previous SUFE

53
Q

What is Pincer type femoroacetabular impingement

A

Extra bone extends over the normal rim of acetabulum, can crush acetabular labrum

54
Q

CAM type femoroacetabular impingement is more commonly seen in males / females

A

Males

55
Q

Pincer type femoroacetabular impingement is more commonly seen in males / females

A

Females

56
Q

femoroacetabular impingement syndrome can result in

A

Damage to labrum
Damage to cartilage
OA

57
Q

Symptoms of femoroacetabular impingement syndrome

A

Pain in groin during flexion and rotation of hip
Difficulty sitting

58
Q

Signs of femoroacetabular impingement syndrome

A

Positive C sign
Positive FADIR test (flexion/adduction/internal rotation)

59
Q

What is C sign

A

When patients indicate the location of pain by gripping the lateral hip just above the greater trochanter

60
Q

Investigations for femoroacetabular impingement syndrome

A

Xray
CT
MRI - visualize labrum damage

61
Q

Management for femoroacetabular impingement syndrome

A

Observation in asymptomatic patinets
Arthroscopic / open surgery for CAM
Osteotomy for Pincer
Arthroplasty / THR for older patients with secondary OA

62
Q

What is skeletal dysplasia

A

Short stature (dwarfism) due to genetic error causing abnormal development of bone and connective tissue

63
Q

Most common type of skeletal dysplasia

A

Achondroplasia

64
Q

What does achondroplasia cause

A

Disproportionately short limbs
Prominent forehead
Wide nose
Lax joints
Bowing of legs

65
Q

Does achondroplasia disturb mental development

A

No

66
Q

Inheritance pattern of achondroplasia

A

Mostly sporadic
Can be autosomal dominant

67
Q

What can other types of skeletal dysplasia cause

A

Learning difficulties
Spine deformity
Haemangiomas
Spinal cord compression
Atlanto-axial subluxation

68
Q

Examples of connective tissue disorders

A

Familial joint laxity
Marfan’s syndrome
Ehlers-Danlos syndrome
Down syndrome

69
Q

What causes the genetic connective tissue disorders

A

Due to genetic disorders of type 1 collagen synthesis

70
Q

Connective tissue disorders cause

A

Joint hyper mobility

71
Q

Osteogenesis imperfecta is also caused by disorder of type 1 collagen. What is the difference between it and connective tissue disorders

A

Connective tissue disorders affects soft tissues more than bone whereas osteogenesis imperfecta affects type 1 collagen of bone

72
Q

Inheritance pattern of familial joint laxity

A

Autosomal dominant

73
Q

Signs of familial joint laxity

A

“double jointed”
Able to perform tricks such as voluntary dislocation of shoulder
Frequent ankle sprains
Recurrent dislocations of joints

74
Q

Inheritance pattern of Marfan’s syndrome

A

Autosomal dominant
Sporadic

75
Q

Signs of Marfan’s syndrome

A

Disproportionately long limbs
High arched palate
Tall stature
Pectus excavatum
Aortic problems - aortic dissection / aneurysm
Mitral valve prolapse

76
Q

What is Ehlers-Danlos syndrome

A

Abnormal elastin and collagen formation

77
Q

Signs of Ehlers-Danlos syndrome

A

Joint hyper mobility
Highly elastic skin
Easy bruising
Scoliosis

78
Q

Disorders causing joint hyper mobility all causes

A

Frequent soft tissue injuries - ankle sprains
Recurrent dislocations

79
Q

What is Duchenne muscular dystrophy

A

Genetic disorder leading to progressive muscle wasting

80
Q

Inheritance pattern of Duchenne muscular dystrophy

A

X linked recessive

81
Q

Duchenne muscular dystrophy only affects

A

Males

82
Q

Cause of Duchenne muscular dystrophy

A

Defect in dystrophin gene. Dystrophin is required to maintain the integrity of muscle cells

83
Q

Signs of Duchenne muscular dystrophy

A

Progressive muscle weakness
Unable to walk by the age of 10
Progressive cardiac and resp failure
Death at 20

84
Q

Investigations for Duchenne muscular dystrophy

A

Raised CK
Muscle biopsy

85
Q

Difference between the bones of children and adults

A

In children:
Presence of growth plate
Thicker periosteum
More elastic
Can remodel themselves and correct angulation

86
Q

Why do children’s fractures heal more easily than adults

A

Thicker periosteum
Growth plates

87
Q

How does thicker periosteum allow better healing of the bone

A

Often stays intact in fractures -> can stabilise fracture
Rich supply of osteoblasts

88
Q

When should we consider children’s bones as adult bones

A

12-14 ; once they hit puberty

Because after they hit puberty, there is less chance of remodeling / correcting angulation by themselves

89
Q

What is special about children’s fractures? Why does this occur?

A

Bones bend or bow rather than snap and splinter
Because bones are soft and the periosteum is thick

Growth plates is the weakest part of the bone so it is prone to injury

90
Q

What classification is used for fractures at growth plate

A

Salter Harris

91
Q

Most common type of growth plate fracture

A

Salter Harris II

92
Q

What is salter Harris I fracture

A

Pure growth plate separation

93
Q

Prognosis of salter Harris I fracture

A

best prognosis, unlikely to complicate into growth arrest

94
Q

What is salter Harris II fracture

A

Small metaphysical fragment attached

95
Q

Prognosis of salter Harris II fracture

A

Good, unlikely to complicate into growth arrest

96
Q

Salter Harris II fracture commonly occurs at

A

Distal radial physis

97
Q

What are salter Harris III and IV fractures

A

fracture spitting the growth plate + Intraarticular fractures

98
Q

Prognosis of salter Harris III and IV fractures

A

Greater potential for growth disturbances

99
Q

What is salter Harris V fracture

A

Compression injury to growth plate causing growth arrest

100
Q

When can salter Harris V fracture be seen

A

CANNOT be seen on xray
Only seen when angular deformity has occurred

101
Q

What are the common children’s distal radius fractures

A

Buckle fractures
Greenstick fractures
Salter Harris II fractures

102
Q

What is a buckle fracture

A

When the bone is pressed to the point of bulging out of space

103
Q

Management of buckle fracture

A

Splint 3-4 weeks

104
Q

What is greenstick fracture

A

Partial thickness fracture - only cortex and periosteum disrupted on one side but undisrupted on the other

105
Q

What are the common forearm fractures in children

A

Monteggia
Galeazzi
Both bones of forearm

106
Q

Management of monteggia and galeazzi fractures in children

A

Reduction + fixation with plates and screws

107
Q

Usually for children’s fractures reduction and rigid fixation is not needed since they heal well. Why is it used in monteggia and galeazzi fractures ?

A

Because there is high rate of re-dislocation of radial head / distal radio-ulnar joint if only manipulation and casting is used

108
Q

Injury mechanism of supracondylar fracture

A

Fall on outstretched hand

109
Q

management of supracondylar fracture in children

A

If undisplaced - splint
If displaced - closed reduction + wires

110
Q

Which structures may be damaged by a severely displaced supracondylar fractures in children

A

Brachialis muscle
Median nerve
Brachial artery

111
Q

Managment of severe displaced supracondylar fracture with damage to brachialis

A

Open reduction

112
Q

Sign of median nerve damage at elbow

A

cannot make OK sign
hand of benediction - no flexion at 1-3rd fingers

113
Q

Why does median nerve damage cause hand of benediction sign

A

Because median nerve innervates all anterior compartment muscles except MEDIAL half of flexor digitorum and flexor carpi ulnaris
This means that the little and ring fingers will still be able to flex.

114
Q

Sign of median nerve damage at wrist

A

Parasthesiae at palmar thumb, index, middle and half of ring fingers
thumb weakness
muscle wasting of thenar eminence

115
Q

What would indicate an emergency surgery for supracondylar fractures

A

Absent radial pulse
Nerve injury

116
Q

Injury mechanism of femoral shaft fracture in children

A

Fall onto flexed knee
Bending/rotational force

117
Q

Femoral shaft fractures in children less than 2 can indicate

A

NAI

118
Q

Management of femoral shaft fracture in children less than 2

A

inform senior if suspect NAI
Admit child for safeguarding, ensure other children at home are also safe
Manage fracture
- Gallows traction
- Hip spica cast

119
Q

Management of femoral shaft fracture in children 2-6

A

Thomas splint / hip spica cast

120
Q

Management of femoral shaft fracture in children above 6

A

Flexible IM nail in 6-12
Adult IM nail in above 12

121
Q

What should you suspect when you see a femoral shaft fracture in a child

A

NAI
Malignant bone tumours

122
Q

What fracture does “toddler’s fracture” describe

A

Undisplaced spiral tibial shaft fracture - common in toddlers

123
Q

Management of toddler’s fracture

A

Cast
flexible IM nail / plates and screws / external fixation of severe

Y2 MSK (19 decks)

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