MSK - paeds ortho/trauma Flashcards
What is the most common traumatic injury in children?
Broken forearm
What are the principles of childrens’ fractures?
Often simple, incomplete and heal quickly
They remodel well in plane of joint movement
A thick periosteal hinge helps recovery (usually)
Fractures involving physes can result in progressive deformity
What are the different types of facture?
Transverse oblique spiral Buckle Impacted Communicated Greenstick Intra/extra articular Butterfly Burst Crash
What are the low energy fractures that occur in the forearm?
Buckle
Greenstick (buckle on ine side, snap on other)
What are the high energy fractures that occur in the forearm?
Open
Displaced
Often with soft tissue injury
What is the important consideration in forearm injuries?
Maintaining the supination/pronation range of movement
How do you assess a fracture?
History - ask for mechanism of injury Deformity Look at soft tissue - whole limb Wounds Sensation, motor function Vascular status
Document
Repeat post-intervention
What radiological investigations are needed into fractures?
X-rays in 2 planes
Must see above and below joint in both
PA, true lateral
What is the primary symptom of comparmtnet syndrome?
Pain ou of proportion
What are the complications of forearm fractures?
Compartment syndrome (volkman's) Non-union Refracture Radioulnar synstosis (abnormal fusion of bone) Radial nerve injury Radiocapitellat problems
What is radioulnar synstosis?
Abnormal fusion of radial and ulna bones
Happens more proximally
High energy, same level
How do you prevent radioulnar synstosis?
Single incicsion between two bones
How do you manage a buckle fracture of the forearm?
cast for 3-4 weeks
How do you manage a greenstick fracture of the forearm?
Cast for 4-6 weeks
How do you manage a complete fracture of the forearm?
Cast for 6 weeks
Sometimes K wires
What are the risks for remanipulation?
Complete fractures
Failed anatomic reduction
What are the differentials for knee trauma?
Infection Inflammatory arthropathy Neoplasm Apophysitis Sickle cell, haemophilia "Anterior knee pain"
What bony injuries occur in knee injuries?
Physeal/metaphyseal Tibial spine Patellar fracture Sleeve fracture Patellar dislocation
What are the complications of a physeal injury?
Hyperextension - vascular injury
Varus - CPN injury
How do you treat a physeal injury?
Cast immbolise
Percutaneous fix
Earlly loss of range of movement
How do you monitor a physeal frature?
Look for Harus lines
Angulation
Length (growth arrest - resect if occurs)
What is a tibial spine injury?
ACL injury pulls off tibial spine
Only occurs in children as bone is weaker than tendon
What is a tibial spine injury?
Patella tendon rips off tibial spine
How do you treat a patellar fracture?
Undisplaced = cylinder cast Displaced = ORIF (open reduction internal fixation)
What are the risk factors for patella dislocation?
Laxity of ligaments (collagen disorders) Poor Vastus Medialis Obliqus Q angle (angle between long line of tibia and that of femur) Femoral anteversion Tibial external rotation Patella alta
Who commonly gets osteochondral lesions?
Adolesccant population
If there is a knee injury what other joint should you look at?
Hip
What is the most common plane of fracture in the ankle?
The physis as it is weaker than ligaments
What views should the film be taken in to prevent missed fractures?
Mortise
Oblique
What are the different Slater-Harris classifications of fractures?
Type 1 - Fracture Line is within the Physis
Type 2 - Extends from the Physis into the Metaphysis
Type 3 - Fracture enters the Epiphysis from the Physis
Type 4 - Fracture extends across the Physis, from the Articular Surface to the Epiphysis
Type 5 - Fractures are Crush Injuries of the Physis
What is the most common ankle fracture?
Slater-harris 2
Extending from physis into metaphysis
Often displaced
What are the worries with a transitional fracture?
That the growth plate with close
What are the types of transitional fracture?
Triplane
Tillaux
What are the two types of overuse injuries you see in children?
Osgood-schlatter’s disease
Sever’s disease (football)
What are the warnings for non-accidental injuries?
Incongruent history (doesn’t quite add up)
Bruising patterns
Burns
Multiple fractures at multiple stages of healing
Metapyseal fracture
Humeral shaft fracturesRib fractures
Non-ambulant fractures
Who is most likely to get developmental dysplasia of the hip?
Easten Europe neonates (up to 3%)
Not just based on genetics, but also way they carry children
Girls 6:1
First born
Breech presentation
Oligohydramnios
What are the clinical features of developmental dysplacia of hip?
Ortolani’s sign (will the hip dislocated)
Barlow’s sign (will joint relocated)
Piston motion sign (motion)
How do you treat developmental dysplasia of the hip?
An abductive brace
Who does Legg-calve-Perthes disease affect?
Mainly primary school children
Males 5:1
What are the clinical features of Legg-Calve-Pertes (LCP)?
Short stature Limp Knee-pain on exercise Stiff hip joint Systemically well
What are the phases of LCP?
Avascular necrosis (femoral head)
Fragmentation - revascularisation - painful phrase
Reossification - bony healing
Residual deformity
When do patients with LCP usually present?
Fragmentation phase
At which point it is too late to help
What are the differentials of LCP (unilateral)?
Septic hip
JIA
SCFE
Lymphoma
What are the differentials for bilateral LCP?
Hypothyroid
Sickle
Epiphyseal dysplasia
How do you treat LCP?
Maintain hip motion
Analgesia
Restrict painful activities
Nothing active
What is valgus?
Deviation away from midline
What is varus?
Deviation toward midline
What is SCFE?
Slipped capital femoral epiphysis
Who is affected by SCFE?
Tenage boys more than girls
9-14yrs
What is stable vs unstable SFE?
Stable is if you cna weight bear
How does SCFE present?
Pain in hip OR knee!
Externally rotated posture and gait
Reduced internal rotation, especially in flexion
What determines mild/moderate/severe SCFE?
Mild is less than 1/3 of femoral head slipping
Moderate up to half
Severe is more than half
Relative on AP film
What is the pathology of SCFE?
Displasment through hypertrophic zone
Metaphysis moves anterior and proximally
How do you treat SCFE?
Screw across the physis (surgery)
What are teh complications of SCFE (surgery)?
AVN - avascular necrosis
Chondrolysis (screw too far)
Deformity
Early osteoarthritis
