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MSK > Children's Orthopaedics > Flashcards

Children's Orthopaedics Flashcards

1
Q

Child skeleton vs adult skeleton bone no.

A

270 bones
subject to continuous change

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2
Q

What is the physis

A

Growth plates
Areas in which long bone growth occurs post-nataly
located at the proximal/distal ends

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3
Q

What are the two types of bones in the body?

A

Flat bones and Long bones

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4
Q

What is the process of forming flat bones called?

A

Intramembranous Ossification
e.g. clavicle + cranium

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5
Q

What is the process of forming long bones called?

A

Endochondral Ossification

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6
Q

Describe the process of intramembranous ossification

A

Mesenchymal (stem) cells condense and differentiate to osteoblasts.
Secreted osteoid (ECM) traps osteoblasts forming osteocytes. (calcify osteoid)
Trabecular matrix and periosteum forms
Compact bone forms superficial to cancellous bone
Angiogenesis - vessels form red bone marrow

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7
Q

Describe the process of endochondral ossification

A

Hyaline cartilage laid down
Bone forms w/in it at the centre -> 1º ossification centre
Pushes cartilage to the ends of the bone -> 2º

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8
Q

What are the primary ossification centres in endochondral ossification?

A

Pre-natal bone growth from the centre part of bone

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9
Q

What are the secondary ossification centres in endochondral ossification?

A

Post-natal - physis (physeal plate)
Lengthens long bones

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10
Q

Describe bone growth at 1º ossification centres
(endochondral)

A

Mesenchymal differentiation into chondrocytes
Cartilage model forms
capillaries penetrate cartilage, calcification occurs at the 1º causing the formation of spongey bone
perichondrium -> periosteum
cartilage and chondrocytes grow at end of bone

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11
Q

Describe bone growth at 2º ossification centres
(endochondral)

A

Zone of elongation containing cartilage
Epiphyseal side: Active cartilage division to form matrix
Diaphyseal side: Cartilage calcifies and is replaced by bone

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12
Q

What type of growth occurs at the physis?

A

Interstitial growth (long bone lengthening)

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13
Q

How does a child’s skeleton differ to that of an adult

A
  • More elastic
  • Active physis, constantly growing and developing
  • Increased speed of healing
  • Greater opportunity for bone remodelling
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14
Q

Why are children’s bones less dense than adults?

A

More haversian canals in children - more porous and decreased bone density
Allows for increased flexibility

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15
Q

What is a haversian canal

A

Tubes containing blood vessels, nerves and lymphatics

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16
Q

Why do children have more haversian canals

A

Their bone is more metabolically active as they are still growing

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17
Q

What three types of injuries can children’s bones get?

A

Plastic deformity,
buckle fracture,
greenstick fracture

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18
Q

Explain plastic deformity

A

Bones have elasticity .: bend before breaking. Unless an extreme bend, children with bent bones will usually straighten out without intervention

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19
Q

Explain how a buckle fracture works

A

Pressure on both sides of a bone, bone is not strong enough to hold pressure so buckles

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20
Q

Explain what a greenstick fracture is

A

Bones break like a tree branch - one sides tears but not all the way through

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21
Q

What happens to bones to stimulate growth arrest?

A

Physis closes

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22
Q

What affects when the physis closes

A

Puberty
Menarche
Parental height

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23
Q

At what age does the physis close

A

Girls 15-16 / Boys 18-19

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24
Q

What is the impact of trauma induced growth arrest

A

Physis injured
Lead to deformity, the uninjured area will continue ton grow

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25
Q

What is healing speed and remodelling potential dependent on?

A

The age of the child - younger child heals quicker
The location of injury

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26
Q

Which bony parts of the child’s body heals more quickly?

A

The more active areas - knees, extremes of upper limb (shoulder/wrist)

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27
Q

Common children’s congenital conditions

A

Developmental dysplasia of the hip
Club foot
Achondroplasia
Osteogenesis Imperfecta

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28
Q

What is developmental dysplasia of the hip

A

Congenital group of disorders where head of femur is unstable in relation to acetabulum (socket)

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29
Q

Why does hip dysplasia arise

A

The normal development relies on the concentric reduction and balanced forces through the hip. When this is absent it means the socket doesn’t form correctly due to lack of pressure.

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30
Q

What is the spectrum of symptoms of developmental dysplasia?

A

Dysplasia, - head of femur not placed correctly in socket
Subluxation - Hip pops in and out due to shallow socket
Dislocation - Hip develops outside of socket

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31
Q

What are risk factors for developmental dysplasia?

A

Female,
breech position
family history,
oligohydramnios - lack of amniotic fluid
some native american groups

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32
Q

What feature of examination can you identify developmental dysplasia?

A

Limited hip abduction, leg length

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33
Q

What treatment is there for developmental dysplasia?

A

Pavlik harness,
closed reduction if the harness fails

34
Q

Investigations for developmental dysplasia?

A

Ultrasound 0-4mths

35
Q

What is the technical name for club foot?

A

Congenital Talipes Equinovarus
congenital deformity of the foot

36
Q

What acronym describes the symptoms of club foot?

A

CAVE -
Cavus (high arch),
Adductus of foot,
Varus (tight tendoachillies),
Equinous (same as varus)

37
Q

Risk factors for club foot

A

Male
Hawaiian
PITX1 gene

38
Q

What is the treatment for clubfoot?

A

Ponseti Method - series of casts,
operative treatment for soft tissue release,
foot orthosis brace

39
Q

What is the most common skeletal dysplasia?

A

Achondroplasia (Rhizomelic dwarfism)

39
Q

What genetic inheritance pattern is achondroplasia?

A

Autosomal dom

39
Q

What is the technical name for brittle bone disease?

A

Osteogenesis Imperfecta

40
Q

What happens in achondroplasia?

A

Inhibited chondrocyte proliferation in physis, defect endochondral bone formation

40
Q

What molecule is decreased in OI and why?

A

Decreased Type 1 Collagen because of decreased secretion or abnormal production

40
Q

What are the symptoms of achondroplasia?

A

Humerus shorter than forearm,
femur shorter than tibia,
spinal issues,
normal trunk/skull,
normal cognition

40
Q

What is the relevance of the A in PAIDS?

A

Location of the fracture
proximal, middle (diaphysis) or distal third

40
Q

Levels of displacement in the bone

A

Displaced
Angulated
Shortened
Rotated - not tolerated well

41
Q

What structure does OI lead to an insufficiency of?

A

Osteoid (ECM)

41
Q

OI effect on the bone

A

Fragile bones, short stature, scoliosis

41
Q

What does it mean by intra/extra-articular?

A

Intra-articular fracture extends into the joints - 1º healing. Requires direct union and no callus

2º healing is by callus formation
Haematoma -> fibrocartilaginous callous -> bony callous -> remodelling

41
Q

Non-orthopaedic OI effects

A

Blue sclera,
dentinogenesis imperfecta (brown soft teeth), hypermetabolism - PTH
cardiac abnormalities

41
Q

What mneumonic do you use to assess paediatric fractures?

A

PAIDS -
Pattern,
Anatomy,
intra/Extra-articular,
Displacement,
Salter-Harris Classification

41
Q

What are the different types of fracture patterns?

A

TOSCA -
Transverse,
Oblique,
Spiral, - rotational torque pattern of injury
Comminuted (multi pieces), - high energy trauma
Avulsion - bone pulled off ligament

child specific - plastic deformity, greenstick, buckle

42
Q

What is the Salter Harris Staging?

A

Way of classifying physeal injury

43
Q

Stages in Salter Harris SALTS

A
  1. physeal Separation, through the physis
  2. Above physis into metaphysis fracture
  3. beLow physis into epiphysis
  4. Through all of physis, metaphysis and epiphysis
  5. physis cruShed (growth arrest)
44
Q

How does risk of growth arrest change with each salter harris stage

A

Risk of growth arrest increases
stage 2 is most common

45
Q

What can happen if partial injury occurs to physis?

A

Angulation of growth - non affected keeps growing whilst affected side has arrested

46
Q

What can happen if complete injury occurs to physis?

A

Limb length discrepancy

47
Q

What are the treatment aims with growth arrest?

A

Fix limb length discrepancy or minimise angular deformity

48
Q

How to correct limb length discrepancy

A

Shorten long side
Lengthen short side

49
Q

How to correct an angular deformity

A

Stop growth of unaffected side
Reform the bone via osteotomy

50
Q

What are the four Rs of fracture management?

A

Resuscitate,
Reduce,
Restrict,
Rehabilitate

51
Q

What system do you use for resuscitation?

A

ATLS - Advanced Trauma Life Support

52
Q

Meaning of fracture reduction

A

Correct deformity and displacement

53
Q

types of fracture reduction

A

Closed - w/o incision e.g. using traction/manipulation
Open - incision, realign fracture w/ surgery

54
Q

Why do we restrict fractures

A

provides stability for fracture to heal

55
Q

Types of fracture restriction

A

External - Splints, plaster (more commonly used)
Internal - plates, screws, intra-medullary device (may need to remove once healed)

56
Q

Why do children generally rehabilitate quicker?

A

Play is a good rehabilitator - testing weight bearing and movement
.: physiotherapy not usually rq

57
Q

What are the four most common diagnoses for a limping child?

A

Septic Arthritis,
Transient Synovitis,
Perthes,
SUFE

58
Q

Which of those four diagnoses is the most serious and should be investigated first?

A

Septic Arthritis

59
Q

What is septic arthritis

A

infection w/in intra-articular space
Medical emergency in children
Can cause irreversible long term jt problems due to necrosis and ^ pressure due to oedema

60
Q

management of septic arthritis

A

Surgical washout of the joint

61
Q

What classification can you use to identify if it is septic arthritis?

A

Kocher’s Classification:
Non-weight bearing,
ESR > 40,
WBC > 12,000,
Temp > 38

62
Q

Important points of history that help with classification of septic arthritis

A

duration - acute
recent illness
associated joint pain

63
Q

What is transient synovitis?

A

Inflamed joint due to a systemic condition
Diagnosed once septic arthritis is excluded

64
Q

How do you treat transient synovitis?

A

Supportive with antibiotics

65
Q

What is Perthes disease?

A

Idiopathic necrosis of proximal femoral epiphysis
diagnosed with plain film radiograph

66
Q

Who is perthes disease most common in?

A

Age 4-8, Male:Female 4:1

67
Q

What does SUFE stand for and what does it mean?

A

Slipped Upper Femoral Epiphysis - proximal epiphysis slips out of place
usually during a period of rapid growth

68
Q

Who is SUFE most common in?

A

obese adolescent (12-13) male, associated with hypothyroid/pituitary problems

69
Q

What is the treatment for SUFE?

A

Operative fixation with a screw inbetween bone and epiphysis. Minimise further growth problems

MSK (7 decks)

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