Musculoskeletal Flashcards
What are the commonest neonatal Fractures and what are their progress?
1.** Clavicle fracture**: caused from shoulder Dystocia–> great prognosis no specific treatment in needed
2. Humerus or femur fracture: from breech delivery–> heals rapidly with immobilization
What is the appropriate management of a fracture in a child?
- Pain management depending on the age
- Manipulation and reduction (consider IV or local anasthetic)
Pain management
* <16old: ibuprofen paracetamol (IV if severe pain)
* >16old: paracetamol ± codeine± IV morphine
Manipulation:
* Radial Fractures: elbow plaster cast ot k-wire fixation
* Femoral Fracture:
1.Neonates <28 days: padded splints or Pavlik’s harness
2.<18months: Gallows traction
3.1-6 years: straight skin traction
4.>4 intramedullary nail
What is the appropriate sedation for the manipulation intervention?
1st line: intranasal/ ora midazolam or NO
2nd line: intranasal ketamine (severe)
How can we reduce the use of X-ray in anlke injuries?
Rules out clinically significant foot and ankle fractures to reduce use of x-ray imaging in patients ≥2 years.
What is the aetiology of Perthe’s disease?
**Avascular necrosis **of femoral epiphysis from an interruption of blood supply (osteochondritis)
This is followed by revascularisation and re-ossification
What are the common complications of Perthe’s Disease?
What is the epidemiology?
Premature Fusion of growth plates and osteoarthritis
5 times more common in boys
4-8 years old
How does Pethe’s Disease present and what are teh appropriate investigations?
Presentation:
- Insedious onset
- Pain in hip/ knee
- Limp
- limb shortening
Investigations:
- X-ray/MRI: MRI is needed because in early stages it is not as clear in X-ray
- Roll test: pt lying supine and roll affected hip internally and externally–> results in guarding or spasm
X-ray/MRI: shows increased density of femoral head which turns into a fragmented and irregular femoral head
What is the appropriate management of Perthe’s disease?
- Pain management: simple analgesia
- <6 years: observation (mobilisation and monitoring, potentially using non-surgical containment using splints)
- > 6years: Surgery
What happens in Osgood-Schlatter Disease (OSD)?
What is the most common age for its occurance?
It is a type of Osteochondritis of the patellar tendon insertion at the knee
Usually caused by multiple small avulsion fractures from contractions of guadricep muscle at their insertion
Commonly seen in physically active 10-15 yeat olds
What is the presentation of Oshoog-Schlatter Disease?
-
Knee pain after exercise (gradual onset ) that is relieved by stress
* Localised tenderness and swelling over tibial tuberosity - Hamstring tighness
What are the appropriate investigations and management for Osgood-Schlatter Diesease (ODS)?
Investigation:
1. Can be a clinical diagnosis
2. XR can show fregmentation of the tibial tubercle and overall soft tissue swelling
Management:
1. Analgesia (paracetamol or NSAD’s)
2. Ice packs (intermittent over tibial tuberosity 10-15 minutes)
3. Protective knww pads
4. Stretching
5. Reassure that it will resolve at the end of the growth spurt
6. Advise to stop/reduce physical activity (more swimming/ less running jumping)
What is the aetiology of Chondromalacia patellae?
Which group is it most commonly seen in?
Anterior knee pain from degeneration of articular cartilage on posterior surface of patella
Most commonly seen in yong adults who overuse in physical activity
How does chondromalacua pattalea present?
What is the appropriate management?
Symptoms:
- Anterior knee pain
- Pain worse when running, climbing stairs
- Painless passive movement but when repeated extension –> granting sensation
Management:
Physiotherapy: main aim is to strenghten the quadriceps
What is the pathophysiology of Osteochondritis Dissecans?
How does it usually presnt?
Osteochondritis Dissecans is caused by reduced blood flow which results in crack formation in the articular cartilage and subchondral bone –> avascular necrosis –> fregmentation of bone and cartilage with free movements of fregments.
Presents with activity.
