Childrens Orthopeadics 2 Flashcards
What are the stages of paediatric fractures?
- Pattern
- Anatomy
- Intra/extra-articular
- Displacement
- Salter-harris
What are the patterns of paediatric fractures?
- Transverse
- Oblique
- Spiral
- Comminuted
- Avulsion
Where do transverse, oblique, spiral and comminuted paediatric fractures happen?
middle 1/3 diaphysis
Where do avulsion paediatric fractures happen?
distal 1/3
What happens in primary bone healing?
- Heals by direct union
- No Callus formation
- The preferred healing pathway in intra-articular fracture as minimises risk of post traumatic arthritis
What are the stages of secondary bone healing?
- Bone healing by callus
1. Haematoma formation
2. Fibrocartilagenous callus formation
3. Bony callus formation
4. Bone remodelling - but remember physis
What are the types of displacement?
- Displaced
- Angulated
- Shortened
- Rotated
What does salter harris do?
Classification of physeal injuries (SALT)
What are the stages of Salter Harris?
- Physeal Separation
- Fracture traverses physis and exits metaphysis (Above)
- Fracture traverses physis and exits epiphysis (Lower)
- Fracture passes Through epiphysis, physis, metaphysis
- Crush injury to physis
What type of injury is most common and how does the risk of growth arrest increase?
- Risk of growth arrest increases from 1 -5
- Type 2 injuries most common
What is growth arrest?
- Injuries to the physis can cause growth arrest
- The location and timing is key
What happens in whole physis growth arrest?
limb length discrepancy
What happens in partial physis growth arrest?
angulation as the non affected side keeps growing
What is the treatment of growth arrest?
Aim is to correct the deformity
•Minimise angular deformity
•Minimise limb length difference
What are the options for limb length correction in growth arrest?
- Shorten the long side
2. Lengthen the short side
What are the options for angular deformity in growth arrest?
- Stop the growth of the unaffected side
2. Reform the bone (osteotomy)
What are the stages of fracture management?
- Resuscitate
- Reduce
- Restrict
- Rehabilitate
What does reducing involve?
- Correct the deformity and displacement
* Reduce secondary injury to soft tissue / NV structures
What happens in a closed reduction?
- Reducing a fracture without making an incision
* Such as traction and manipulation in A&E
What happens in an open reduction?
- Making an incision
* The realignment of the fracture under direct visualisation
What are the options in a closed reduction?
- Gallows traction
- Holding the skin, the long bones of the lower limb can be reduced
- Closed reduction to correct deformity
What is restricting?
- Maintain the fracture reduction
- Provides the stability for the fracture to heal
- Children rarely have issues with bone not healing
- Can have issues with too much healing!
- But remember the child’s quicker fracture healing times and remodeling potential
What is an external restriction?
- splints
- plaster
What is an internal restriction?
- plate and screws
- intra-medullary device
What restriction is mostly used in paediatric fractures?
- Plasters and splints commonly used in paediatric fracture
* Remodeling and huge healing potential means that operative internal fixation often can be avoided
What is internal restriction used?
- Operative intervention may be required
- Consider the ongoing growth at the physis
- Metalwork may need to be removed in the future
What is involved in the rehabilitation of paediatric fractures?
- Children generally rehabilitate very quickly
- Play is a great rehabilitator
- Stiffness not as major issue as in adults
- Use it, Move it and Strengthen!
What can be the reasons for the limping child?
- Septic arthritis
- Transient synovitis
- Perthes
- SUFE
What is septic arthritis?
in a child is a orthopaedic emergency
What can septic arthritis cause?
- Can cause irreversible long term problems in the joint
* Therefore needs surgical washout of the joint to clear the infection
What is Kocher’s classification in septic arthritis?
-can help score probability •Non weight bearing •ESR >40 •WBC >12,000 •Temperature >38
Why is history key for septic arthritis?
- Duration
- Other recent illness
- Associated joint pain
What is transient synovitis?
- Transient synovitis is a diagnosis once septic arthritis has been excluded
- Is a inflamed joint in response to a systemic illness
What is the treatment of transient synovitis?
supportive treatment with antibiotics
What is perthes disease?
Idiopathic necrosis of the proximal femoral epiphysis
When does perthes disease happen?
- Usually in those 4-8 years old
* Male 4:1 Female
What is the treatment of perthes disease?
•Septic arthritis needs to be excluded first (its more chronic and unlikely to see temp and inflammatory markers)
•Treatment is usually supportive in the first instance
-plain radiograph
What is SUFE?
- Slipped upper femoral epiphysis
* The proximal epiphysis slips in relation to the metaphysis
When does SUFE happen?
- Usually obese adolescent male
- 12-13 years old during rapid growth
- Associated with hypothyroidism/hypopituitrism
What is the treatment for SUFE?
•Septic arthritis needs to be excluded first
•Treatment is operative fixation with screw to prevent further slip and minimise long term growth problems
-acute/chronic but no temp/inflam markers
What is important to consider in children orthopaedics?
If physis involved!!!
What are different type of MSK conditions in children due to?
Packaging disorders or due to conditions that not only affect biochemistry that affects bone itself (osteogensis imperfecta) but also of physis itself e.g. achondroplasia
