Locomotor: Young MSK

Question 1

Describe the age distribution of the common diseases resulting in a limping child

Hint: Alphabetical except for transient synovitis because this is flipped around in itself

Answer 1

Question 2

What is transient synovitis?

Answer 2

It is a benign condition where the synovial membrane around the hip is inflamed, often in children 2-5yo

Question 3

What is DDH?

Answer 3

Developmental dysplasia of the hip, the hip joint of the baby is either dislocated or prone to dislocation

Question 4

DDH risk factors

Answer 4

• Hereditary
• Born in breach
• First born
• Female:Male 5:1

Question 5

DDH examinations

Answer 5

• Barlows/Ortolani - passive dislocation of hip by practitioner with relocation, only useful for babies
• When slightly older you are looking for leg length discrepancy, assymetry of leg creases is a good sign
• When older can also look for reduce abduction in one side

Question 6

DDH Treament

Answer 6

Stirrups/Strap

Question 7

What is Perthes disease?

Answer 7

It is where blood supply to the femoral head is cut off resulting in osteonecrosis of the femoral head

Question 8

Perthes disease treatment

Answer 8

Because the loss of blood supply is only tempory the femoral head can actually heal

Treatment is therefore focussed around ensuring this heals well

This is mainly done by keeping the femoral head within the acetabulum and treating symptoms. Sometimes with surgury.

Question 9

Perthes causes and risk factors

Answer 9

• Causes not really know but it is non genetic
• Male:Female 4:1
• 4-8 years
• Lower social class increases risk, maybe due to smoking

Question 10

What does SUFE stand for?

Answer 10

Slipped Upper Femoral Epiphysis

Question 11

What is actually happening in SUFE?

Answer 11

The femoral head (epiphysis when growing) slipped downward at the growth plate

Question 12

SUFE causes and risk factors

Answer 12

• Males:Females 3:1
• Happens during rapid growth at puberty
• Happens slightly earlier in females and not after menarche (first menstrual period)
• Obesity or Lanky are both risk factors
• Small 7% risk if a family member is involved

Question 13

SUFE signs, symptoms and presentation

Answer 13

• Limp
• Pain at groin/thigh/knee
• Externally rotated and adducted limb
• Roughly bilateral 50% of the time

Question 14

SUFE surgical treatment

Answer 14

Screw throught he growth plate in order to stop it slipping further

Question 15

Red flag: back pain but can be non specific

Answer 15

Discitis

Question 16

Red flag: warm swelling

Answer 16

Infection

• Septic arthrisits
• Osteomyelitis
• Cellulitis

Question 17

Red flag: atraumatic painless swelling

Answer 17

Tumour!

Need to get a CT done

Question 18

Red flag:

• Inconsistent history
• Injury not consistent with history
• Multiple bruises at different times

Answer 18

Child abuse

Question 19

How does a peadiatric fracture tend to present compared to an adult and why?

Greenstick

Answer 19

Peadiatric bones are more supple and hence tend to bend a little bit more before breaking incompletely

This is know as greenstick. You get a partial break on the tension side and a buckle on the compression side

Question 20

What is different about a child’s periosteum and what does this mean for fractures?

Answer 20

Child’s periosteum is thicker hence this acts as a stabiliser and sort of hinge that helps with bone to be held in position during healing

Question 21

Are children’s bones better at remodelling?

Answer 21

Yes

Question 22

What is Wolf’s law?

Answer 22

During remodelling bone is deposited on the compression side and apsorbed on the tension side

Question 23

What does the Salter-Harris classification of fractures describe?

Answer 23

Fractures based around the physis

Question 24

The memomic to remeber the Salter-Harris classifications is SALTR

Describe these 5 classiciations

Hint: You have to orient the bone with the physis above the epiphysis

Answer 24

• Type I - Straight
• Type II - Above
• Type III - Lower
• Type IV - Through
• Type V - Ruined

Question 25

Type I Salter Harris Fracture diagnosis, treatment and prognosis

Answer 25

Straight * Difficult to diagnose * Can usually reduce closed (without surgury) * Immobilise with cast/wires * Good prognosis, unlikely to cause growth abnormalities

Question 26

Type II Salter Harris Fracture diagnosis, treatment and prognosis

Answer 26

Above * Most common * Immobilise with cast/wires * Can usually reduce closed * Good prognosis, unlikely to cause growth abnormalities

Question 27

Type III Salter Harris Fracture diagnosis, treatment and prognosis

Answer 27

Lower * Chance of growth deformity * Monitor growth deformity * Anatomic reduction

Question 28

Type IV Salter Harris Fracture diagnosis, treatment and prognosis

Answer 28

Through * Chance of growth deformity * Monitor growth deformity * Anatomic reduction

Question 29

Type V Salter Harris Fracture diagnosis, treatment and prognosis

Answer 29

Ruined * Caused by a crush injury * Worst prognosis * Growth arrest * Monitor growth arrest * Perform an epiphysiodesis (surgically destroy other physis) on the other limb in order to prevent growth deformity

Question 30

NAI (non accidental injury) of soft tissue giveaways

Answer 30

* In children < 18 months soft tissue injuries to head/face extremely rare, but these are common in NAIs * In children < 5 lumbar injuries extremely rare, these common in NAIs * Human bite marks * Burns * Bruises in line with hand prints

Question 31

NAI fracture to long bones

Answer 31

Metaphysis corner fracture Indicative of shaking Ocurrs in NAIs of children < 2years

Question 32

NAI fractures to ribs?

Answer 32

This is a sign of an NAI and can be due to crushing during shaking

Question 33

Femoral fractues < 4yo?

Answer 33

Can be a sign of NAI About 30% due to NAI and child isn't walking much femoral fracture uncommon

Question 34

Where do physis occur?

Answer 34

Physis (growth plates) occur on the ends of long bones and at the base of boney structures serving as attachments for tendons. They are called proximal/distal physis or if on a boney structure apophysis.