Children’s Orthopaedics Flashcards

Question

Fracture management rehabilitate

Answer 1

Children rehabilitate quickly Play is great rehabilitation Stiffness not as major issue as in adults

Answer 2

Septic arthritis Transient Synovitis Perthes SUFE

Answer 3

Medical emergency Can cause irreversible long term problem in joint - need surgical washout of joint to clear infection History is key -duration -other recent illness -associated joint pain

Answer 4

Slipped upper femoral epiphysis Proximal epiphysis slips in relation to metaphysis

Answer 5

Condensation of mesenchymal cells which differentiate into pre-osteoblasts and then osteoblasts - ossification centre forms Secreted osteoid traps osteoblasts which become osteocytes Cells collectively create immature woven trabecular matrix and immature periosteum form Angiogenesis occurs Blood vessels incorporated between woven bone and trabecular bone will form future bone marrow Immature woven bone remodelled and progressively replaced by mature lamellar bone

Answer 6

Primary - sites of pre-natal bone growth through endochondral ossification from the central part of bone Secondary - occurs post-natally after primary ossification centre and long bones often have several (physis)

Answer 7

Mesenchymal differentiation at primary centre at centre of bone Cartilage model of future bony skeleton forms Capillaries penetrate cartilage Calcification at primary ossification centre - spongy bone forms Perichondrium transforms into periosteum Cartilage and chondrocytes continue to grow at ends of bone Secondary ossification centres develop

Answer 8

Long bone lengthening At physis (physeal plate) Zone of elongation in long bone Contains cartilage Epiphyseal side - hyaline cartilage active and dividing to home hyaline cartilage matrix Diaphyseal side - cartilage calcifies and dies and then replaced by bone

Answer 9

Plasticity deformity - bends before break Buckle feature - tarus like the column Greenstick - like the tree, one cortex fractures but does not break the other side Increased density of haversian canals

Answer 10

Female 6:1 First born Breech Family history Oligohydramnios (not enough fluid in amniotic sac) Native American/Laplanders - swaddling of hip Rare in African American/Asian

Answer 11

Usually picked up on baby check Range of motion of hip -usually limited in hip abduction -leg length In those 3 months or older Barlow and Ortalani are non sensitive

Answer 12

Ultrasound - birth to 4 months X-ray - after 4 months Age adjusted - prior to 6 weeks Measure acetabula dysplasia and position of hip

Answer 13

1:1000 Highest in Hawaiians M2:F1 50% bilateral 5% likely of siblings Familial in 25%

Answer 14

Most common skeletal dysplasia Autosomal dominant - G380 mutation of FGFR3 - inhibition of chondrocyte proliferation in proliferation zone of physis - results in defect in Endochondral bone formation

Answer 15

Brittle bone disease Bones -fragility fractures -short stature -scoliosis Non-orthopaedic manifestations -heart -blue sclera -dentinogenesis imperfecta - brown soft teeth -wormian skull -hypermetabolism

Answer 16

Hereditary - autosomal dominant or recessive Decreased type I collagen due to -decreased secretion -production of abnormal collagen Insufficient osteoid production

Answer 17

Kocher’s classification can score probability -non weight bearing -ESR>40 -WBC>12,000 Temperature>38

Answer 18

Transient synovitis Inflamed joint in response to systemic illness Supportive treatment with antibiotics is treatment

Answer 19

Idiopathic necrosis of proximal femoral epiphysis Last longer and no fever Diagnostic is radiograph

Answer 20

Supportive

Answer 21

Usually in those 4-8 years old Male 4:1 Female

Answer 22

Usually obese adolescent male -12-13 years old during rapid growth -associated with hypothyroidism/hypopituitrism

Answer 23

Operative fixation with screw to prevent further slip and minimise long term growth probler