MSK Flashcards
List differences b/w adult and pediatric MSK systems
Physis: proliferating cartilage b/w metaphysis and epiphysis. weakes part of bon. 15-30% of all bony injuries
Periosteum: thick strong. usually tears only on one side, attachment of muscles
Porous bone: more pliable and less dense therefore more susceptible to fractures but less likely to be comminuted
what is the mgmt of a buckle fracture
- Splint, backslab, or Velcro splint if distal radius involved.
- Children treated with splints have fewer ED visits, less pain, and improved function compared to casting.
Can follow up with GP, remove splint or slab in 3-4 weeks.
Describe the salter-harris classification system
Salter 1: Straight through physis
Salter II: through physis and Above proximally to metaphysis
Salter III: through physis and beLow distally to epiphysis
salter IV: Through physis and below and above
salter V: cRush injury of physis
When should orthopedics be involved in the management of clavicle fractures?
- For follow up: displaced lateral and medial third fractures, high level athletes
- For emergent consultation in ED:
o Displaced medial third fractures
o Skin at risk over fracture
o Displaced lateral third fractures
o Pathologic fractures - For emergent open reduction:
o Open
o Severely displaced with skin at risk
o Neurovascular injuries
o Severely comminuted or shortened middle third (>2cm if >12 yo)
Congenital pseudoarthritis of clavicle – multiple previous fractures in same location.
List the secondary ossification centres of elbow and age of appearance
Capitellum (10
Radial head (3)
Medial (Internal) epicondyle (5)
Trochlea (7)
Olecranon (9)
Lateral (External) epicondyle (11)
Describe Gartland classification of extension type supracondylar fractures and mgmt
Type I:
- Undisplaced fracture
- Anterior humeral line does pass through middle of capitellum.
- Can be very subtle
- Suspect when anterior / posterior fat pads are present
Rx:
- Backslab with elbow at 90° for 3 weeks.
- NO cast – risk of compartment
If occult (only fat pads), splint, and f/up Xray.
Type II:
- Angulated fracture with intact posterior cortex
- Anterior humeral line anterior to middle of capitellum.
Rx:
- Reduction for neurovascular compromise
- Ortho referral in ED
Type III: - Displaced distal fragment posteriorly - No cortical contact. - IIa: posteromedial rotation of distal fragment - IIIb: posterolateral rotation of distal fragment. Rx: - Reduction for neurovascular compromise - Ortho referral in ED
What is the mnemonic for Monteggia and Galieazzi fractures?
- MUGR – Monteggia is ulnar #, Galleazzi is radius #
- If see proximal ulna fracture MUST look for radial head dislocation
- If see distal radius fracture, MUST look for distal ulna dislocation.
What is a Monteggia fracture dislocation?
- Fracture of the proximal 1/3 of the ulna with dislocation of the radial head
- Can be subtle, with only a minor greenstick or bowing of ulna BOWING COUNTS
MUST be vigilant and assess radial head position.
What are acceptable amounts of displacement for midshaft radius fractures?
Mid and distal third shaft fractures
age LT 10y.o: LT 15 degress
age GT 10y.o: LT 10degrees
Proximal third shaft fractures
age LT 10y.o: LT 10 degress
age GT 10y.o: anatomic reduction recommended
What is the Management of physeal wrist fractures?
Non displaced SH type I-II: below arm cast x 4 wks
Displaced SH I-II: closed reduction w/below elbow cast x 6 wks
SH III-IV: referral to ortho
How are tibial spine fractures treated in the ED?
- Evacuation of joint hemarthrosis
- Closed reduction by knee extension
- Post reduction, splint in zimmer, non-weight bearing, cast clinic follow up
- If displaced, irreducible post hemarthrosis evacuation, call ortho.
What is a tillaux fracture
- Foreceful external rotation force – inversion with externally rotated and supinated foot
- SH III involving anterolateral corner of the distal tibia (last portion to close)
- Ottawa ankle rules miss this injury!!
Rx:
- All need ortho referral in ED
- May need CT to prove not displaced
What is a triplane fracture
- Forced external rotation force
- SH IV along 3 planes:
- Transverse: through physis
- Coronal: through posterior metaphysis
- Sagittal: within epiphysis, extending into joint
Rx:
- All need ortho in ED
When is a skeletal survey indicated?
- All physically abused children 5 yo
Case by case basis for 3-5 yo.
List 4 complications of a hip fracture in children
- AVN
- Premature closure of physis
- Malunion, non-union
- Leg length discrepancy
