MS - Pediatric Skeletal Disorders

Question 1

fracture classifications

Answer 1

greenstick/buckle
simple
comminuted
complex

Question 2

physeal fractures: Salter-Harris Type 1

Answer 2

• transversely through physis
• separates epiphysis from metaphysis
• treatment: reduction and casting
• heals quickly

Question 3

physeal fractures: Salter-Harris Type 2

Answer 3

• most common type of physeal injuries
• fractures passes transversely through physis
• exits through metaphysis
• triangular fragment
• sometimes needs opens reduction

Question 4

physeal fractures: Salter-Harris Type 3

Answer 4

• crosses physis and exits through epiphysis of joint space
• older children
• open reduction and internal fixation (ORIF)

Question 5

physeal fractures: Salter-Harris Type 4

Answer 5

• vertical fracture through all three components
• metaphysis
• physis
• epiphysis
• accurate reduction to avoid physeal bar
• ORIF
• follow up to detect growth disturbance

Question 6

physeal fractures: Salter-Harris type 5

Answer 6

• crushing injury to physeal
• rare and difficult to see on x-ray
• diagnosed retrospectively > growth arrest

Question 7

toddler fractures

Answer 7

• spiral or oblique nondisplaced fracture distal shaft of tibia with intact fibula
• less than 2 years of age
• no notable injury, child learning to walk
• no notable injury, child learning to walk
• child refuses to bear weight on leg
• all injuries are ruled out including child abuse
• treatment: above the knee/long cast 3-4 weeks

Question 8

femur fractures

Answer 8

• most commonly fractured long bone in peds
• trauma: falls, sports, car accidents
• toddler: rule out child abuse
• treatment: traction, spica cast, ORIF, external fixation

Question 9

spica cast

Answer 9

• assessment of extremities
• small peritoneum opening
• caregiver care; tuck diaper in opening, avoid plastic sheets, HOB elevated during elimination, s/s of infection report to HCP, t&p q2hr, support extremities
• feedings: high fluid and fiber-avoid constipation; calcium and protein-promote healing; upright after feeds

Question 10

hip dysplasia

Answer 10

• congenital
• developmental: in utero positioning-breech, petite mother, born in water
• easily missed until 6 weeks of age with pelvic x-ray
• 80% female
• neurological conditions (CP or specific)
• treatment: pavlik harness-assess neurovascular, Bryant’s traction, spica cast, surgery
• untreated: pain r/t arthritis