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BRS Y2 > Children's Orthopaedics > Flashcards

Children's Orthopaedics Flashcards

1
Q

Is a child’s skeleton the same as an adults?

A

No, it is not just a mini skeleton it is structurally different

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2
Q

How many bones are there in a child’s skeleton?

A

270

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3
Q

What is the other name for physis?

A

Growth plates

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4
Q

What happens at the physis?

A

Bone growth, it is the zone of elongation

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5
Q

By what process do flat bones develop?

A

Intramembranous ossification

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6
Q

By what process do long bones develop?

A

Endochondral ossification

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7
Q

What is the difference between intramembranous and endochondral ossification and when is each used?

A

With endochondral ossification the mesenchymal cells become cartilage before they become bone but in intramembranous there is no cartilage involvement

Endochondral= long bone development
Intramembranous= flat bone development
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8
Q

Describe intramembranous ossification

A

Condensation of mesenchymal cells which differentiate into osteoblasts and an ossification centre forms
Secreted osteoid traps osteoblasts which become osteocytes
Trabecular matrix and periosteum form
Compact bone develops superficial to cancellous bone.
Crowded blood vessels condense into red bone marrow

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9
Q

Where does endochondral ossification occur

A

Occurs at both the primary and secondary ossification centres

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10
Q

What happens at primary ossification centres in endochondral ossification

A

Sites of pre-natal bone growth from the central part of the bone

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11
Q

What happens at secondary ossification centres in endochondral ossification

A

Post-natal growth after the primary ossification center and long bones often have several (the physis)

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12
Q

Describe the process of endochondral primary ossification

A

There is mesenchymal differentiation at the primary centre
The cartilage model of the future bony skeleton forms
Capillaries penetrate cartilage.
There is calcification at the primary ossification centre – spongy bone forms. Perichondrium transforms into periosteum
Cartilage and chondrocytes continue to grow at ends of the bone
Secondary ossification centres develop

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13
Q

Describe the process of endochondral secondary ossification

A

Long bone lengthening

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14
Q

Where does secondary endochondral ossification occur?

A

At the physis

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15
Q

What happens on the epihyseal side of the physis?

A

Hyaline cartilage is active and dividing to form hyaline cartilage matrix

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16
Q

What happens on the diaphyseal side of the physis?

A

Cartilage calcifies and dies and then replaced by bone

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17
Q

How does elasticity differ between children and adult bone?

A

Children’s bone can bend and are more elastic than adult

This is due to increased density of haversian canals

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18
Q

What is plastic deformity and why is it common in children?

A

When the bone bends before it breaks

It is common as children have more elastic bones

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19
Q

What is Buckle fracture and why is it common in children?

A

It is an incomplete fracture (aka torus fracture) where one side of the bone buckles in on itself but the other side is fine. It is more common in children as their bones are more elastic

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20
Q

What is greenstick fracture and why is it common in children?

A

When side of the bone bends and the other side snaps (like a twig), more common in children as they have more elastic bones

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21
Q

When does bone growth in children stop?

A

When the physis close

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22
Q

What factors affect when a child’s physes close?

A

Puberty
Menarche
Parental height

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23
Q

When does an average girl’s and boy’s physis close?

A

Girls=15-16

Boys=18-19

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24
Q

Why are physeal fractures more serious?

A

They can lead to growth arrest

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25
Q

How does speed and remodelling in children’s bones differ to adults?

A

It a lot faster and children can undergo a lot more deformity and angulation in comparison to adults

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26
Q

What is developmental dysplasia of the hip? When does it occur?

A

Group of disorders of the neonatal hip where the head of the femur is unstable or incongruous in relation to the acetabulum, occurs in utero.

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27
Q

What does normal hip development require that is disrupted in developmental dysplasia of the hip?

A

Concentric reduction and balanced forces through the hip

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28
Q

What are the types of developmental dysplasia of the hip? What kind is the most common?

A

Dysplasia (this is the most common)
Sublaxation
Dislocation

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29
Q

What are some risk factors for developmental dysplasia of the hip?

A 
Female
First born
FH
Breech
Native americans/laplanders (due to habit of swaddling hip)
Oligohydroamnios
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30
Q

How is developmental dysplasia of the hip usually picked up?

A

Baby check (there is screening in the UK)

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31
Q

How is developmental dysplasia of the hip treated?

A

Reducible hip and < 6months= pavlik harness

Failed harness or 6-18 months= MUA, closed hip reduction and spica

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32
Q

What is club foot? When does it occur?

A

Congenital deformity of the foot that occurs in utero

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33
Q

What population is club foot most common in?

A

Hawaiians

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34
Q

What gender is club foot more common in?

A

Twice as common in men as in women

35
Q

Is club foot genetic?

A

Yes, 50% genetic

36
Q

What gene is involved in risk for club foot?

A

PITX1

37
Q

What pneumonic is used to identify club foot?

A 
CAVE
Cavus foot with high arch
Adductus of foot
Varus
Eqinous
38
Q

How is club foot treated?

A

Ponseti method which is a primary series of casts to correct the deformity then surgery if needed later

39
Q

What is achondroplasia?

A

The most common skeletal dysplasia

40
Q

What is the pattern of inheritance for achondroplasia?

A

Autosomal dominant

41
Q

What gene is involved in achondroplasia?

A

G380 mutation of FGFR3

42
Q

Briefly describe the pathophysiology of achondroplasia

A

There is inhibition of chondrocyte proliferation in the proliferative zone of the physis
This results in defects in endochondral bone formation

43
Q

What results from achondroplasia?

A

Rhizomelic dwarfism

44
Q

What are the characteristics of rhizomelic dwarfism in those with achondroplasia?

A 
Humerus shorter than forearm
Femur shorter than tibia
Normal trunk
Adult height of approx. 125cm
Significant spinal issues
45
Q

What is osteogenesis imperfecta?

A

Brittle bone disease

46
Q

How is osteogenesis imperfecta inherited?

A

Autosomal dominant or recessive

47
Q

What type of collagen is reduced in osteogenesis imperfecta? Why?

A

Type 1 because there is decreased secretion and production of abnormal collagen

48
Q

What happens to osteoid production in osteogenesis imperfecta?

A

It is insufficient

49
Q

What are the effects on bone of osteogenesis imperfecta?

A

Fragility fractures
Short stature
Scoliosis

50
Q

What are non orthopaedic manifestations of osteogenesis imperfecta?

A 
Heart problems
Blue sclera
Dentinogenesis imperfecta – brown soft teeth
Wormian skull
Hypermetabolism
51
Q

What pneumonic is used to describe fractures?

A 
PAID
Pattern
Anatomy
Intra/extra articular
Displacement
52
Q

What are the different fracture patterns?

A 
Transverse
Oblique
Spiral
Comminuted
Avulsion
Torus
Greenstick
53
Q

What are the different anatomy catagories when describing fractures?

A

Proximal, middle or distal 1/3rd of the bone

54
Q

What are the different fracture displacements?

A

Displaced
Angular
Shortened
Rotated

55
Q

What classification method is used for physeal fracture?

A

Salter Harris

56
Q

What pneumonic is associated with the Salter Harris classfication and what does it stand for?

A

SALT
Physeal Separation
Fracture traverses physis and exits metaphysis (Above)= most common
Fracture traverses physis and exits epiphysis (Lower)
Fracture passes Through epiphysis, physis, metaphysis
Crush injury to physis

57
Q

Going down the SALT pneumonic for Salter Harris classification what happens to risk of growth arrest?

A

Risk of growth arrest

58
Q

What happens if the whole physis is affected in a fracture?

A

There is limb length discrepancy

59
Q

What happens if only part of the physis is affected in a fracture?

A

Angulation as the non-affected side keeps growing

60
Q

What are the 2 aims in treating fracture affecting the physis?

A

Minimise angular deformity

Minimise limb length difference

61
Q

How can limb length be corrected in physeal fracture?

A

Shorten the long side

Lengthen the short side

62
Q

How can angular deformity be corrected in physeal fracture?

A

Stop growth on the unaffected side

Reform the bone (osteotomy)

63
Q

What pneumonic/phrase is used in fracture management?

A

Resuscitate
Reduce
Restrict
Rehabilitate

64
Q

What common method of closed reduction is used for children?

A

Gallows traction which involves holding the skin so long bones of the lower limb can be reduced

65
Q

What is restriction in fracture management?

A

Maintainence of the fracture reduction

66
Q

What are external methods of fracture restriction?

A

Splints

Plaster

67
Q

What are internal methods of fracture restriction?

A

Plate and screws

Intra medullary device

68
Q

When operating on fracture in children what should be considered?

A

Ongoing growth at the physis

Metalwork that may need to be removed in the future

69
Q

What is a good rehabilitator for kids in relation to fractures?

A

Play

70
Q

What is the main differential in a limping child?

A

Septic arthritis

71
Q

How do children with septic arthritis usually present?

A

Previously well
Gone off food in past 24 hrs
Doesn’t want to put weight on their knee and hip

72
Q

Why must you exclude septic arthritis in a limping child?

A

Because its a medical emergency and can cause irreversible long-term problems in the joint

73
Q

What classification can be used to help score the probability of a child have septic arthritis?

A

Kocher’s classification

74
Q

What does Kocher’s classification for scoring probability of septic arthritis include?

A

Non-weight bearing
ESR >40
WBC >12,000
Temperature >38

75
Q

What is transient synovitis?

A

An inflamed joint in response to a systemic illness

76
Q

How is transient synovitis treated?

A

Supportive treatment with antibiotics is the treatment

77
Q

What is Perthe’s disease?

A

Idiopathic necrosis of the proximal femoral epiphysis

78
Q

How is Perthe’s disease treated?

A

Supportive treatment

79
Q

What is SUFE?

A

Slipped upper femoral epiphysis where the proximal epiphysis slips in relation to the metaphysis

80
Q

Who does SUFE mainly affect?

A

Usually obese adolescent male

81
Q

What conditions is SUFE associated with?

A

Hypothyroidism and hypopituitrism

82
Q

How is SUFE treated?

A

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

83
Q

What are the differentials in a limping child?

A

Septic arthritis
Transient synovitis
SUFE
Perthe’s disease

BRS Y2 (85 decks)

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