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Musculoskeletal & Rheumatology > Children’s Orthopaedics > Flashcards

Children’s Orthopaedics Flashcards

1
Q

Physis

A

Growth plates
Areas from which long bone growth occurs post natally

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2
Q

Difference of children’s skeleton

A

Elasticity
Physis
Speed of healing
Remodelling

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3
Q

Physis of children’s bone

A

Varying growth speed at sites
Growth stops as physis closes (girls 15-16 boys 18-19)
Salter-Harris
Physeal injury - growth arrest - deformities

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4
Q

Speed and remodelling of children’s bone

A

Faster in children
Physis at knee grows more
Physis at extreme of upper limb grows more

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5
Q

Common children’s congenital conditions

A

Development Dysplasia of Hip
Club Foot
Achondroplasia
Osteogenesis Imperfecta

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6
Q

DDH

A

Group of disorder of neonatal hip where head of femur is unstable or incongruous in relation to the acetabulum

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7
Q

DDH Spectrum

A

Dysplasia - Subluxation - Dislocation

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8
Q

DDH stats

A

Dysplasia 2:100
Dislocation 2:1000

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9
Q

DDH Treatment

A

Reducible hip and <6 months
-Pavlik harness 92% effective

Failed Pavlik harness or 6-18 months
- secondary changes - capsule + soft tissue
- MUA + closed reduction and Spica

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10
Q

Clubfoot

A

Neonatal

CAVE deformity
Cavus - high arch: right intrinsic, FHL, FDL
Adductus
Varus
Equinous

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11
Q

Clubfoot treatment

A

Ponseti method
Series of casts to correct deformity
Many require operation
Foot orthosis brace
Some require further surgery

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12
Q

Rhizomelic dwarfism

A

Achondroplasia
Humerus shorter than forearm
Femur shorter than tibia
Normal trunk
Adult height at approx 125cm
Normal cognitive development significant spinal issues

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13
Q

Paediatric fractures

A

Pattern
Anatomy
Intra/extra-articular
Displacement

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14
Q

Paediatric fracture pattern

A

Transverse
Oblique
Spiral
Comminuted
Avulsion

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15
Q

Paediatric fracture anatomy

A

Proximal 1/3
Middle 1/3 diaphysis
Distal 1/3

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16
Q

Paediatric fracture intra/extra-articular

A

Primary bone healing
-direct union
-no callus formation
-preferred in intra as minimises risk of post traumatic arthritis

Secondary bone healing
-bone healing by callus

But remember physis

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17
Q

Paediatric fracture displacement

A

Displaced
Angulated
Shortened
Rotated

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18
Q

Classification of physeal injuries

A

Salter-Harris

1-physeal separation
2-fracture transverse physis and exits metaphysis
3-fracture transverse physis and exits epiphysis
4-fracture passes through epiphysis, physis, metaphysis
5-crush injury to physis

Risk of growth are at increased from 1-5

Type 2 injury most common

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19
Q

Growth arrest

A

Caused by injury to physis
Location and timing is key
Whole physis - limb length discrepancy
Partial - angulation as the non affected side keeps growing

20
Q

Growth arrest treatment

A

Limb length correction
-shorten long side
-lengthen short side

Angular deformity
-stop growth of unaffected side
-reform bone (osteotomy)

21
Q

Fracture management

A

Resuscitate
Reduce
Restrict
Rehabilitate

22
Q

Fracture management reduce

A

Correct deformity and displacement
Reduce secondary injury to soft tissue / NV structures

23
Q

Closed reduction

A

Gallows traction
Holding the skin, long bones of lower limb can be reduced
Correct deformities

24
Q

Fracture management restrict

A

Maintain fracture reduction
Provide stability for fracture to heal
Children rarely have issue with bone not healing

Plasters and splints commonly used
Remodelling and huge healing potential mean operative internal fixation often can be avoided

Operative intervention may be required
Consider ongoing growth at physis
Metalwork may need to be removed in the future

25
Q

Fracture management rehabilitate

A

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

26
Q

Limping child

A

Septic arthritis
Transient Synovitis
Perthes
SUFE

27
Q

Septic arthritis

A

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

28
Q

SUFE

A

Slipped upper femoral epiphysis

Proximal epiphysis slips in relation to metaphysis

29
Q

Intramembranous ossification

A

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

30
Q

Endochondral ossification sites

A

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)

31
Q

Endochondral primary ossification

A

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

32
Q

Endochondral secondary ossification

A

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

33
Q

Elasticity of children’s bone

A

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

34
Q

DDH risk factors

A

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

35
Q

DDH Examination

A

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

36
Q

DDH investigation

A

Ultrasound - birth to 4 months
X-ray - after 4 months
Age adjusted - prior to 6 weeks

Measure acetabula dysplasia and position of hip

37
Q

Clubfoot risk factor

A

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

38
Q

Achondroplasia

A

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

39
Q

Osteogenesis imperfecta

A

Brittle bone disease

Bones
-fragility fractures
-short stature
-scoliosis

Non-orthopaedic manifestations
-heart
-blue sclera
-dentinogenesis imperfecta - brown soft teeth
-wormian skull
-hypermetabolism

40
Q

Osteogenesis imperfecta genetic

A

Hereditary - autosomal dominant or recessive

Decreased type I collagen due to
-decreased secretion
-production of abnormal collagen

Insufficient osteoid production

41
Q

Septic arthritis classification

A

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

42
Q

Septic arthritis exclusion

A

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

43
Q

Perthes disease

A

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

44
Q

Perthes disease treatment

A

Supportive

45
Q

Perthes disease risk factor

A

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

46
Q

SUFE risk factor

A

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

47
Q

SUFE treatment

A

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

Musculoskeletal & Rheumatology (7 decks)

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