MSK Flashcards
What is ossification? How does it progress?
Conversion of cartilage into bone - hardening cartilage into bone
Progressed outward from diaphysis
When does ossification being? End?
Begins in embryo
Continues until 18-21 years old
What is bone made up of in infancy?
Cartilage
What are the pediatric differences in MSK system?
Weaker d/t cartilage
Presence of growth plate
Thicker periosteum (increase BF)
High osteogenic potential
What is another name for growth plate? Where is it? Can it be seen? When does it close?
Epiphyseal plate
Between diaphysis and epiphysis
Seen on an xray
Open until puberty –> can’t grow anymore
What does an increase blood flow do for the bone?
Helps with injury and growth
How does high osteogenic potential impact the bone?
Bone is produced and produced and produced during done growth
Goal is to increase length of bone
Damaged bone can be more successfully healed and can fill gaps
What is the impact when a childs bone is weaker d/t cartilage?
More breaks
Bones can bend instead of break (usually heal on own d/t osteogenic potential)
What is the healing period for a neonate? Early childhood? Later childhood? Adolescence? Adult?
Neonate: 2-3 weeks
Early childhood: 4 weeks
Later childhood: 6-8 weeks
Adolescent: 8-12 weeks
Adults: 10-16 weeks
What are the diagnostics for MSK?
Radiogrpahy (xray)
Arthrography
Bone scan
CT
MRI
Ultrasound
Joint aspiration
What lab values may be altered with a bone injury?
ESR
CRP
Alkaline phos
Creatinine kinase
What are the causes of fractures? (6)
Trauma
Falls
MVA
Sport injuries
Abuse
Bone tumor
What puts an adolescent at risk for stress fractures?
Decrease calories and calcium
NEED to make sure have enough of this
What are the s/s of a fracture? (9)
Pain or tenderness at site
Immobility or decreased ROM
Deformity of extremity
Edema
Crepitus
Ecchymosis
Erythema
Muscle spasm
Inability to bear weight
What is the weakest point of long bones? What does this cause?
Epiphyseal plate aka growth plate
Frequent site of injury
What is the injury goes all the way through degenerative cells of the epiphyseal plate? Treatment?
Most won’t but if they do it can cause serious damage to the epiphysis and plate and could result in shortening and deformity of limb
Treat with surgery and internal fixation to avoid shortening and deformity of limb
Why is X-ray not as useful in children?
Cartilage does not show up as easily so you might not be able to see a fracture –> missed fracture diagnosis
What are the reduction and fixation options?
Closed: manual alignment and immobilization
Open (ORIF): surgical insertion of internal fixation devices
What is retention? What does it do?
Application of cast or use of traction to immobilize
Keeps bone in place to realign it with ossification and healing
Where are casts placed? Types of cast?
Over joint above and below the fracture so completely immobilized like upper extremity, lower extremity and spica
Plaster or Paris or synthetic light weight cast that are more water resistant
What are the 5 Ps assessing for? What are they?
Assessing for vascular damage
- Pain
- Pallor
- Parathsia
- Paralysis
- Pulselessness
When do you assess the 5 Ps? Why?
Prior to and after casting and surgery
May not have initial vascular damage but if cast is too tight or something went wrong in surgery can develop
What is club foot? What are the different types of deformities?
Congenital malformation of the lower extremity that affects the lower leg, ankle, and foot
One or a combo of
1. Plantar flexion
2. Dorsiflexion
3. Varus deviation (foot turns in)
4. Valgus deviation (foot turns out)
What does club foot involve? Is it one or both feet? What are differences in the affected foot? At birth?
Involves bone deformity and malposition soft tissue
Can be unilateral or bilateral
Affected foot is smaller and short with empty heal pad and transverse plantar crease
Easily recognized at birth
What is the management of club foot?
Serial manipulation and casting
If sufficient correction not achieved in 3-6 months –> surgery
Long term follow-up
What is developmental dysplasia of the hip (congenital dislocation of hip)? Unilateral or bilateral?
Variety of condition when the femoral head and acetabulum are improperly aligned and overtime the acetabulum does not grow appropriately
Both unilateral or bilateral
What are risk factors for developing developmental dysplasia of the hip?
Twins (overcrowding in uterus)
Breech delivery
Maternal hormones
Large infant (overcrowding in uterus)
How do you assess for developmental dysplasia of the hip? When is this done?
Postive Ortolanis maneuver
Patient on back without diaper. One hand on hip and other on knee. Flex hip and knee to feel for a click
Done at birth and every well baby visit
What are the clinical manifestations of dysplasia of the hip in an infant? Child?
Asymmetry in gluteal folds, leg folds, and length of leg
Limited ROM in affected hip
Asymmetric abduction
Femur on affected side appears shorter
Everything above plus minimal to prona=ouced variations in gait including lurching toward affected side, limp
What is the therapeutic management of dysplasia of the hip in newborn? After newborn?
Splinting the hip w/ pavlik harness to maintain flexion, abduction and external rotation - aligns hip into acetabulum and keeps it there
After - traction or surgery to release muscles and tendons
Does the harness for dysplasia of the hip need to be worn at all times?
24/7 even when eating and sleeping
What is osteogenesis imperfecta? What does this cause? Are there different forms? Most common?
Bones are brittle and extremely brittle and fragile d/t deficit in synthesis of collagen
Causes many fractures to occur easily
Several forms that vary in severity
Autosomal-dominant inheritance pattern most common
What are the s/s of osteogenesis imperfecta? (10)
Osteoporosis
Excessive bone fragility
Increase joint flexibility
Blue sclera
Discolored teeth
Conductive hearing loss by 20-30
Skin can appear translucent
Easily bruised
Short stature
Multiple fractures –> limb and spinal deformities
How do you diagnose osteogenesis imperfecta?
History of frequent fractures and clinical evaluation
Xray
Genetic testing
What is the therapeutic management of osteogenesis imperfecta?
Prevention of fractures by being cautious, braces, heel chair
Medication: calcitonin and bi[hosphonates
Orthopedic stabilizing procedures like traction, casting and fixation
How do you diagnose congenital dysplasia of hip?
Screening at birth with ortolani and barlow maneuvers
Ultrasound between ages 4-6 weeks
Xray for older infants and children
What is slipped capital femoral epiphysis (SCFY)? When does it occur? What increases the risk?
Femoral head separates/slip along growth plate –> affects upper femoral growth plate
Occurs at time of rapid growth
Increase body weight and height are at increased risk d/t increased stress on epiphysis so obese adolescent males
What is the patho of slipped capital femoral epiphysis (SCFY)?
Normally epiphyseal plate thins in d/t hormonal influences during adolescence and plate eventually permanently close in adolescence
When there is increase body weight and height –> increase stress of epiphyses –> relative displacement/slip of femoral neck from the femoral head –> pain
What are the clinical manifestations of slipped capital femoral epiphysis (SCFY)?
Hip pain that is aching or mild along with limp and decreased ROM
Aggravated by activity and relieved with rest
Pain in groin, thigh, or knee
Walk with leg turned outward (externally rotated) to relieve stress and pain in hip joint
What is the treatment for slipped capital femoral epiphysis (SCFY)?
Emergency
Admitted to hospital and place on bed rest to prevent further slipping
Traction to relieve muscle spasms and keep hip in alignment preoperatively
Surgical internal fixation to secure to femoral head and prevent further slippage
What is scoliosis? What other disorders can it be seen in?
Lateral curvature of spine - compensatory or structural
Seen in osteogenesis imperfacta, juvenile arthritis, and spinal cord tumors
What is mild scoliosis? Moderate? Severe? What test to confirm?
Mild: 20 degrees
Moderate: 25-40/50 degrees
Severe: over 50 degrees
X-ray to determine curvature
What are the s/s of scoliosis? (6)
Rib hump when bending forward
Asymmetric rib cage
Uneven shoulder or pelvic heights
Prominence of scapula (makes wing) or hip
Differences in space between arms and trunk when child is standing
Apparent leg-length discrepancy
How should you have a child stand when assessing for symmetry in scoliosis?
Arms at side, feet shoulder width apart
How is scoliosis diagnosed?
Physical exam
X-ray
What is the therapeutic management of scoliosis? What does it depend on?
Depends on extent of curse, child’s age and projected growth, and prescience of associated complications
Regular and periodic observation for progression (mild)
Bracing - not a cure but will delay/slow progression
Spinal fusion surgery (severe)
What is some education about a spinal brace that should be discussed? (6)
Brace slows progression but does not protect
Brace is worn 23 hours/day and is only off to shower or swim
T-shirt worn under brace to protect skin
Exercises done several times/day while in brace to correct thoracic lordosis
Slight muscle ache common when first wearing brace
Encourage teens to be as active as possible when in brace
What occurs in spinal fusion surgery? What is post care?
Remove spinous process and can crush to make a paste –> fuse spine
Pain management (start with epidural –> IV meds –> PO meds)
Foley cath - remove ASAP
Mobility - usually up on day 1
