Childrens Orthopaedics Flashcards
What are two methods of bone development?
Flat bones: intramembranous mesenchymal cells to bone
Long bones: endochondral mesenchymal to cartilage to bone
What happens during flat bone formation?
Condensation of mesenchymal cells which differentiate into osteoblasts at ossification centres
Osteoid is secreted to trap osteoblasts to make them osteocytes
These cells make the trabecular matrix and periosteum
Compact bone develops superficial to cancellous bone, the crowded blood vessels become bone marrow
Describe long bone formation prenatal and postnatal
Endochondral ossification
Pre-natal at primary ossification centres: mesenchymal cells differentiate to cartilage
Capillaries penetrate the cartilage and undergoes calcification to form spongy bones. Periosteum is formed
Cartilages continues to form at the ends of the bones
Secondary ossification centres form and capillaries keep making calcifying cartilage into spongy bone
Post natal: happens at physis containing cartilage which calcifies and dies creating bone (at secondary ossification centres)
How do children skeletons differ from an adult?
What can these 4 features give way to?
More elastic- greenstick (one side breaks but not other) and buckle fracture
Have physis- injuries here can lead to growth arrest and deformity
Speed of healing is quicker- knee and lower end of upper limb
More likely to remodel due to growth- larger injuries have better prognosis
What is developmental dysplasia of the hip?
Disorder of neonatal hip where head of femur is unstable in relation to acetabulum
What are the examinations and investigations for developmental dysplasia of the hip?
Baby check screening- RoM hip- reduced hip abduction
Ultrasounds if under 4 months, x ray after
What are the treatments for developmental dysplasia of the hip?
Pavlik Harness to reduce the hip if under 6 months
If over 6 months may need surgery
Condition may be progressive
What is club foot?
Deformity of the foot
Cavus- high arch
Adductus of foot
Varus: tight tendoachilles
Equinox’s
What is the treatment for club foot?
Ponseti method- foot placed in series of casts that gradually change
Sometimes require operative treatment
What is achondroplasia?
Most common dysplasia
Autosomal dominant
Inhibition of chondrocyte in physis resulting in endochondral bone formation- dwarfism. Humerus shorter than forearm, femur shorter than tibia and fibula
What is osteogenesis imperfecta?
Brittle bone disease
Autosomal dominant or recessive
Abnormality in T1 collagen = insufficient osteoid production
Bones are fragile and short stature
Blue sclera
Heart conditions
What must we also include when describing a child fracture?
Salter-Harris- damage to physis
S physeal Separation
A fracture traverses physis and exits metaphysis (Above)- most common
L fracture traverses physis and exits epiphysis (Low)
T fracture passes Through epiphysis, physis, metaphysis
5. Crush injury to physis
What is growth arrest and how do we treat it?
Damage to physis- causing uneven limb lengths or angulated limbs
Limb length correction- shorten long side or lengthen short side
Angular deformity- stop growth of unaffected side or reform bone
What are the fracture management 4rs?
What is preferred from the second two due to remodelling ability?
Resuscitate- if trauma is acute
Reduce- closed (preferred due to remodelling ability) or open (incision or no incision)
Restrict- external (preferred due to remodelling ability) or internal (splints, plaster, plate and screws, intramedullary)
Rehabilitate- children play so its a lot easier and quicker
What is the clinical term known as the limping child?
4 emergency cases which cause a limping child
Septic arthritis- always exclude first
Transient synovitis-
Perthes- necrosis of proximal femoral epiphysis
SUFE- slipped upper femoral epiphysis- usually teens
