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Musculoskeletal > Children's Orthopaedics > Flashcards

Children's Orthopaedics Flashcards

1
Q

briefly outline bone development in children

A

intramembranous (mesenchymal cells > bone, for flat bones)

endochondral (mesenchymal > cartilage > bone, for long bones)

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2
Q

outline intramembranous ossification

A

condensation of mesenchymal cells > differentiate into osteoblasts > forms ossification centre > secreted osteoid trap osteoblasts > osteocytes > trabecular matrix + periosteum form > compact bone develops superficial to cancellous bone > blood vessels condense into red bone marrow

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3
Q

bones that undergo intramembranous ossification

A

clavicle

cranium

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4
Q

primary ossification centre

A

Sites of pre-natal bone growth through endochondral ossification from the central part of the bone

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5
Q

secondary ossification centres

A

Occurs post-natal after the primary ossification centre and long bones often have several (the physis)

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6
Q

outline endochondral ossification (pre natal bone growth through primary ossification centre)

A

mesenchymal differentiation at POC > cartilage model forms > capillaries penetrate cartilage > calcification at POC (forms spongy bone) > perichondrium transforms to periosteum > cartilage and chondrocytes continue to grow at ends > SOC develop

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7
Q

outline endochondral ossification (post bone growth through secondary ossification centre)

A 
long bone lengthening at physis, zone of elongation in long bone, contains cartilage
epiphyseal side (hyaline cartilage diving to form hyaline cartilage matrix)
diaphyseal side (cartilage calcifies, dies, replaced by bone
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8
Q

children’s skeleton differs from adult skeleton in terms of?

A

elasticity
physis
speed of healing
remodelling

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9
Q

what causes the increased elasticity in children’s bones?

A

increased density of Haversian canals

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10
Q

what pathologies can occur due to increased elasticity of the bone?

A 
plastic deformity (bend before break)
Buckle fracture (Tarus like the column)
Greenstick (one cortex fractures but doesn't break the other side)
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11
Q

when does growth stop?

A

as the physis closes

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12
Q

bone growth is complete at what age in girls and boys?

A

girls 15-16

boys 18-19

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13
Q

physeal injuries are categorised by?

A

Salter-Harris

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14
Q

physeal injuries can lead to?

A

growth arrest

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15
Q

growth arrest can lead to?

A

deformity

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16
Q

the speed of healing and remodelling potential is dependent on?

A

location

age of the patient (younger children heal faster)

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17
Q

which physis grows more?

A

at the knee

extreme of upper limb

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18
Q

common children’s orthopaedic congenital conditions

A

developmental dysplasia of the hip
club foot
achondroplasia
osteogenesis imperfecta

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19
Q

what is developmental dysplasia of the hip?

A

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

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20
Q

spectrum of developmental dysplasia of the hip

A

dysplasia
subluxation
dislocation

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21
Q

risk factors for developmental dysplasia of the hip

A 
female 6:1
first born
breech
family history
oligohydramnios
Native American/Laplanders - swaddling of hip
Rare in African American/Asian
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22
Q

examination for developmental dysplasia of the hip

A

usually picked up on the baby check - screening in UK (RoM of hip - leg length, limitation in hip abducation) 3 months or older Barlow and Ortalani are non-sensitive

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23
Q

investigation for development dysplasia of the hip

A

ultrasound 0-4 months (measures the acetabular dysplasia and the position of hip)
x-ray 4 months+

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24
Q

treatment for development dysplasia of the hip

A

reducible hip + <6 months > Pavlik harness

failed Pavlik harness or 6-18 months, secondary changes - capsule + soft tissue > MUA + closed reduction + spica

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25
Q

what is congenital talipes equinovarus?

A

congenital deformity of the foot

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26
Q

more likely for males or females to have congenital talipes equinovarus?

A

males to females

2:1

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27
Q

what % of congenital talipes equinovarus is bilateral?

A

50%

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28
Q

what is CAVE deformity?

A

Cavus
Adductus of foot
Varus
Equinous

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29
Q

cavus

A

high arch: tight intrinsic, FHL, FDL

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30
Q

adductus of foot

A

tight tib posterior and anterior

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31
Q

varus

A

tight tendoachilles, tib post, tib ant

32
Q

equinous

A

tight tendoachilles

33
Q

what gene causes congenital talipes equinovarus?

A

PITX1 gene

34
Q

treatment for congenital talipes equinovarus

A

ponseti method: series of casts > many require operative treatment > foot orthosis brace > some require further operative intervention to correct final deformity

35
Q

describe the genotype behind achondroplasia

A

autosomal dominant
G380 mutation ofFGFR3
inhibition of chondrocyte proliferation in theproliferative zoneof thephysis
results in defect in endochondral bone formation

36
Q

describe the phenotype of achondroplasia

A 
Rhizomelic dwarfism 
Humerus shorter than forearm
Femur shorter than tibia
Normal trunk
Adult height of approx. 125cm
Normal cognitive development
Significant spinal issues
37
Q

what causes osteogenesis imperfecta?

A

hereditary (autosomal dominant/recessive)
decreased type I collagen: decreased secretion/production of abnormal collagen
insufficient osteoid production

38
Q

effects of osteogenesis imperfecta on bones

A

fragility fractures
short stature
scoliosis

39
Q

non-orthopaedic manifestations of osteogenesis imperfecta

A 
heart
blue sclera
dentinogenesis imperfecta – brown soft teeth
Wormian skull
hypermetabolism
40
Q

classification of paediatric fractures

A 
pattern
anatomy
intra/extra-articular
displacement
(acronym PAID)
41
Q

pattern of paediatric fractures

A 
transverse
oblique
spiral
comminuted
avulsion
42
Q

anatomy of paediatric fractures

A

proximal, middle, distal 1/3 of the bone

diaphysis, metaphysis, epiphysis

43
Q

intra/extra-articular of paediatric fractures

A

intra > primary bone healing by direct union, no callus formation
extra > secondary? healing by callus

44
Q

displacement of paediatric fractures

A

displaced
angulated
shortened
rotated

45
Q

what type of injuries are classified by salter-harris?

A

physeal

46
Q

salter-harris classification

A

I physeal separation
II Fracture traverses physis and exits metaphysis (Above)
III Fracture traverses physis and exits epiphysis (Lower)
IV Fracture passes Through epiphysis, physis, metaphysis
V Crush injury to physis

47
Q

how does risk of growth arrest change from type I to type V salter harris fractures?

A

increases

48
Q

what salter-harris fracture type is most common?

A

type II

49
Q

injury to the whole physis that causes growth arrest has what effect?

A

limb length discrepancy

50
Q

injury to partial physis that causes growth arrest has what effect?

A

angulation as the non affected side continues to grow

51
Q

aim of treatment of growth arrest

A

minimise angle of the deformity

minimise limb length difference

52
Q

ways to address limb length discrepancy

A

shorten long side

lengthen short side

53
Q

ways to address angular deformity

A

stop growth of unaffected side

reform the bone (osteotomy)

54
Q

treatment of growth arrest is dependent on

A

location of the injury

when injury occurred/ how much growth is left

55
Q

what are the 4 R’s of fracture management?

A

resuscitate
reduce
restrict
rehabilitate

56
Q

what is the ‘reduce’ part of fracture management?

A

Correct the deformity and displacement

Reduce secondary injury to soft tissue / NV structures

57
Q

closed reduction of a fracture, define and give an example

A

Reducing a fracture without making an incision

Such as gallows traction and manipulation in A&E

58
Q

open reduction of a fracture

A

Making an incision

The realignment of the fracture under direct visualisation

59
Q

what is the ‘restrict’ part of fracture management?

A

maintain fracture reduction

provides stability for fracture to heal

60
Q

outline types of restriction in fracture management

A

external: splints, plaster
internal: plate + screws, intramedullary device

61
Q

are external or internal methods of restriction commonly used in paediatric fracture?

A

external

62
Q

what should be considered for operative intervention during fracture management

A

ongoing growth at the physis

metalwork may need to be removed

63
Q

what is the ‘rehabilitate’ part of fracture management?

A

using, moving, strengthening affected limb
children generally rehab quickly
stiffness not as major issue as in adults

64
Q

differential diagnoses for limping child

A

septic arthritis
transient synovitis
perthes
SUFE

65
Q

septic arthritis in a child is a orthopaedic emergency because?

A

Can cause irreversible long term problems in the joint

> needs surgical washout of the joint to clear the infection

66
Q

what part of the history is key for septic arthritis?

A

duration
other recent illness
associated joint pain

67
Q

Kocher’s classification can help you score probability

A

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

68
Q

what is transient synovitis?

A

inflamed joint in response to a systemic illness

69
Q

treatment for transient synovitis

A

supportive treatment with antibiotics

70
Q

what is Perthes disease?

A

Idiopathic necrosis of the proximal femoral epiphysis

71
Q

Perthes disease usually presents at what age?

A

4-8

72
Q

ratio male to female of those affected by Perthes disease

A

4:1

73
Q

what do you exclude first before coming to a diagnosis of transient synovitis, Perthes disease or SUFE?

A

septic arthritis

74
Q

what is SUFE?

A

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

75
Q

SUFE typically presents in what patient?

A

usually obese adolescent male 12-13 years old during rapid growth

76
Q

SUFE is associated with what disorders?

A

hypothyroidism/hypopituitrism

77
Q

treatment for SUFE is?

A

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

Musculoskeletal (7 decks)

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