Growth and Development Flashcards
How is growth achieved?
- Hyperplasia (increase in cell number)
- Hypertrophy (increase in cel size)
- Accretion (increase in intercellular substances)
What skills are acquired during child development?
- Gross motor (movement & postural control)
- Fine motor & play
- Speech & language
- Cognition & learning
- Psychosocial & emotional
What are some of the factors affecting growth & development?
- Genes
- Hormones (growth hormone, puberty)
- Nutrition (failure to thrive)
- Mechanical factors (fractures, spasticity)
- Environmental factors
- Physical activity (development of skills, M/S growth)
- Illness
What do growth charts track?
- Height
- Weight
- Head circumference
- Ranked by percentiles (should generally remain on same percentile)
What are some of the reasons head circumference may be below the percentile line?
- Microcephaly (abnormal smallness of head usually associated with ID)
- Cranial stenosis (premature closure of cranial sutures)
What is one of the reasons why head circumference may be above the percentile line?
Hydrocephalus (increase CSF causing dilation of ventricles & raised ICP
What are the important features of musculoskeletal growth?
- Rapid growth from birth-2yrs
- At 2 years approx half adult height
- In childhood & adolescence occurs distal to proximal
- Hands/feet have accelerated growth spurt followed by limbs then trunk
When does peak height velocity (most rapid rate of growth) occur?
- Females: Starts 8-10yrs, peaks 11-12 yrs
- Males: Starts 10-12yrs, peaks 13-14yrs
What are the types of growth plates?
- Long bone epiphysis
- Ring epiphysis (e.g. carpals)
- Apophysis (iliac crest)
- Traction apophysis (muscle action on bone)
What are the approximate contributions of bone growth proximal/distal?
Proximal/distal
- Humerus: 80/20%
- Radius: 25/75%
- Ulna: 20/80%
- Femur: 30/70%
- Tibia: 55/45%
- Fibular: 60/40%
How is skeletal age determined?
- Using X-ray of hand & wrist
- Comparison of amount of cartilage to bone development of carpals relative to reference data for healthy children
What is a Risser sign?
- Measure of extent of ossification of iliac apophysis
- Commonly used to assess skeletal maturity in scoliosis
- Scale of 5
What are some of the implications of bone growth?
- Coordination difficulties
- Muscle contractures as muscles grow in response to bone growth
- Timing of orthopaedic surgery for children with CP
- Fractures through growth plates
- Bone remodelling in young children is possible for a maligned fracture
What is Osgood Schlatter’s disease?
- Inflammation of growth centre (apophysis) that forms the tibial tubercle
- Occurs during peak height velocity
How are growth plate fractures classified?
Salter-Harris Classification of Growth Plate Injuries (1-5)
What are the characteristics of an S-H1 fracture?
- Avulsion/shearing fracture of resting cartilage cells
- Good prognosis as growing cells are undisturbed
What are the characteristics of an S-H2 fracture?
- Fracture line passes through metaphysics into epiphyseal plate
- No fracture observed into epiphysis
- Produce minimal shortening, rarely result in functional limitations except at knee & ankle
What are the characteristics of an S-H3 fracture?
- Passes through epiphysis into articular surface
- Physis widened at lateral aspect, medial aspect is closed
- Prone to chronic disability as it typically involves the articular surface of the joint
- Deformities are rare
What are the characteristics of an S-H4 fracture?
- Two bone fragments at medial aspect of distal tibia
- Fracture through epiphysis, physics & metaphysis
- Can result in chronic disability
- Can produce joint deformity with angulation more likely at knee/ankle
What are the characteristics of an S-H5 fracture?
- Compression/crush injury of epiphyseal plate with no associated epiphyseal or metaphyseal fracture
- Poor prognosis as angulation & shortening 100%
How are ACL injuries in children managed?
Surgery delayed until growth plates have closed as surgical hardware needs to pass through growth plate
How is epiphyseodesis (fusion of growth plate) managed in children?
Growth plate is closed off either fully (in leg length discrepancies) or on one side of the bone (semi-epiphyseodesis) to correct angulation after an injury
