Injuries and Medical Problems in Children and Adolescents Flashcards
Why are the differences in MSK anatomy in children/adolescents
- epiphysial plates (and its junction) where growth occurs
- growth spurts
- bone malleability
- apophysites present
- articular cartilage is different
- muscle developement
- variety in sports play when younger
what are the 3 anatomical subsections that compromise a long bone?
- epiphysis
- metaphysis
- diaphysis
What is present in the developing skeleton
- epiphyseal plates
- to allow for bone growth
- site of weakness
- can be susceptible to fractures and sheer forces
What occurs during a growth spurt?
- bone length changes and then soft tissue length adapts to that
- leads to changes in coordination and biomechanics
- effects energy levels
what part of the bone is softer in developing bone? what is the impact of this
metaphysis
absorbs greater energy
suscpetable to different forms of fracture
generaly, developing bones are less dense/more porous
What is an apophysis?
Bony attachment site of a tendon (where muscle attaches to bone via tendon)
eg ASIS for rectus femoris muscle
What is the site of development and remodelling of adolescent bone?
The articular cartilage
- thicker and greater ability to remodel than in adults
What can happens if articular cartilage is damaged?
osteochondritis dessicans- disruption to blood supply to cartilage –> ischaemia and necrosis
Why are joints less stable in children and adolescents?
- muscle development not optimal/fully maturated, reducing core stability
- reduced cross bridges in ligaments leading to increased laxity
- joint stability relies less on muscle stability than in adults
Principles of managing injuries in children/adolescents
- Remember they are not mini adults
- manage physiological processes
- identify causes
- rehabilitate with emphasis on casual factors- more scope to address than in adults
- important to address biomechanics
Factors to take into account when addressing sporting injuries
- holistic approach
- CVS changes
nutritional - psychosocial
- enivornmental
- ethical considerations
- player development
Factors to take into account when addressing sporting injuries
- holistic approach
- CVS changes
nutritional - psychosocial
- enivornmental
- ethical considerations
- player development
CVS changes in children/adolescents
- lower SBP
- lower SV
- increased MHR
- lower CO
increased RR - less anaerobic power
- screening for any congenital issues
children/adolescents environmental consideratinos
- greater body surface area to mass- more susceptable to extreme conditions
- lower sweating rate
- more SA:VR
- lower rate of heat acclimatisation
- issues in hot and cold environments
children/adolescents environmental consideratinos
- greater body surface area to mass- more susceptable to extreme conditions
- lower sweating rate
- more SA:VR
- lower rate of heat acclimatisation
- issues in hot and cold environments
Common injury complaints in children/adolescents
- fractures
- hip and groin complaints
back pathology
traction apophysitis - joint instability
These relate to the physiological differences between adults and children/adolescents
Why are fractures managed differently in children/adolescents?
- greater capacity to heal
- bones contain growth plates
Why are fractures managed differently in children/adolescents?
- greater capacity to heal
- bones contain growth plates
How are growth plate fractures classified?
Salter Harris classification:
- type 1: epiphysis completely separated from end of bone, vital portion of growth plate remain intact. require cast but will be normal bone growth once healed
- type 2: most common. epiphysis and growth plate partially separate from metaphysis which is cracked. Typically have to be surgically put in place and immobilised.
- type 3: rare. Usually distal tibia. fracture runs through epiphysis and separates part of epiphysis and growth plate from metaphysis. surgery may be necessary. good prognosis if blood supply to separated portion is intact, no displacement, and bone regrows
- type 4: requires surgery to align growth plate. If this isnt achieved then prognosis for future growth is poor
- type 5: end of bone is crushed and growth plate is comrpessed. prognosis is poor, growth likely to be stunted
damage to growth plate will reduce future growth at that portion leading to biomechanical imbalances
Factors affecting severity of growth plate fractures
- severity
- age
- type of growth plate involved
Greenstick fracture
- one side broken and the other is bent
- reduced and cast over 6 weeks
occur in metaphysis
Buckle fracture
- incoplete fracture when bone buckles without distrupting one side of the bone
- common due to soft skeleton
- persistent pain more than a few hours, usually from falling onto wrist
- 5-11yr
- Quicker healing time
- 3 week cast
Causes of hip and groin pain in children/adolescents
- traumatic
- apophyseal injuries
- avascular necrosis of hip
- Perthe’s disease
- slipped upper femoral epiphysis
Groin pain in children/adolescents prognosis
80% heal in 3 weeks