Ortho Flashcards
Are fractures in children more common than in adults? Why?
Yes - Different fracture patterns due to elasticity of pediatric bone
4 main types of pediatric fracture patterns
Buckle/torus
greenstick
plastic deformation
complete
which pediatric fracture pattern?
- most common in distal radius of wrist but can also seen in any long bone like ankle
- Stable fractures that heal well with a few weeks of mobilization
Buckle/torus
which pediatric fracture pattern?
- tension side of the bone starts to crack but concave side still intact (crack goes through one side of the bone but not the other)
- either careful manipulation or have to complete the fracture to put it back in position
Greenstick
which pediatric fracture pattern?
- no clear fracture line but it’s bent, so still needs to be fixed (can cause functional and cosmetic deformities)
- often need to complete the fracture
Plastic deformation
which pediatric fracture pattern?
- goes through all sides of the bone
- Different types: Transverse, Oblique, Spiral
complete
Which classification would this be on Salter-Harris physical injury classification?
goes through the growth plate - oftentimes x ray is completely negative, would be based on clinical assessment
I
What’s the most commonly seen classification of injury per the Salter-Harris physical injury classification?
II
Growth disturbance can happen in ___ type of physeal injury
any
If fracture goes through the growth plate, it can stop growth which can cause what 3 main problems?
joint incongruity, deformity, limb length discrepancy → can lead to long-term arthritis, joint pain
Which classification would this be on Salter-Harris physical injury classification?
complete crush injury - looks like it’s completely disappeared in the x-ray
V
The closer the break is to the growth plate, the ____ the healing
faster
True or false: Fractures that would require surgical correction in adults often don’t need surgery or reduction in kids
true
High alert for non-accidental trauma with fractures in ____ children
non-ambulatory
Femur fracture, healing fractures in different stages of healing
What fracture tx has strongest protection? When would you use?
Cast
for anything that’s unstable or has been reduced
Which is faster, splint or cast? What would you use splint for
splint
allow for swelling - good for acute injury that you know it’s going to swell, splint for 1st week to prevent compartment syndrome
What type of fracture would you use the Brace or Cam boot with?
buckle fracture or something more stable - can take off to shower/sleep
Sprain vs strain? What’s the immediate tx
Sprain: Injury to ligament that attaches bone to bone (ex. ACL)
Strain: Injury to muscle/tendon (ex. Patellar or achilles tendon)
Immediate treatment: PRICE (Protect, Ice, Rest, Compression, Elevation)
What’s the most common dislocation location in adolescents?
patellar dislocation (kneecap) - lateral dislocation that happens with twisting injury - also football helmet vs. knee injury
____ dislocation is uncommon under age 10, more common in age 10-20
What would this be in the under 10 population?
Shoulder
Under 10, this same injury would actually cause a humerus fracture
Osgood Schlatter, Jumper’s Knee (Sinding-Larsen-Johansson Syndrome), Severs Disease, and Little League Elbow are all types of
Apophysitis
inflammation of connection of secondary growth center to the bone
What type of Apophysitis?
- jumping sports, basketball - where patellar tendon attaches to tibia
- Might see bump on front of knee
Osgood Schlatter
Jumper’s Knee (Sinding-Larsen-Johansson Syndrome) is similar to Osgood Schlatter except at the ___ attachment
proximal
What type of Apophysitis when the area where achilles tendon attaches to heel bone is affected?
Severs Disease
Apophysitis and stress reaction/fractures are both types of ____ sports injuries
overuse
Curve < 10 degrees would be called
spinal asymmetry
Scoliosis definition
3-dimensional deformity (as spine bends, vertebrae curve and bring the ribs with them) measured by Cobb Angle, greater than 10 degree
What’s the most common type of scoliosis?
Idiopathic
Scoliosis not due to bony deformity but like tethered spinal cord or other malformation, or secondary to trauma (congenital heart disease+surgery, injury) would be classified as
secondary
Scoliosis seen with CP, Marfan’s etc would be classified as
Neuromuscular/syndromic
What populations have genetic predisposition with idiopathic scoliosis
identical twins and daughters of mom’s with scoliosis (10-20%)
Left or right thoracic curve most typical with idiopathic scoliosis?
right (90%)
___:___ female to male ratio for curves > 30 degrees
10:1
Imaging for scoliosis
PA/lateral standing scoliosis film
line from top endplate of most prominent vertebrae to bottom endplate of most prominent vertebrae
cobb angle
4 main types of scoliosis
idiopathic
secondary
congenital
NM/syndromic
Adam’s bend forward test
Hands together, knees straight, bend forward
- Rib rise secondary to elevated rib cage
- Loin rise from prominent unilateral lumbar paraspinal muscles
Younger age of onset of scoliosis has ___ likelihood of progression
increased
the bigger the curve the ____ the risk of progression
greater
4 ways to assess spine growth remaining
- Chronological age (girls grow until 14 approx)
- Menarche (Girls normally grow for about another 2 years after onset of menses
- Bone age (x-ray of hand to determine how old skeleton is)
- Riser sign which appears when puberty begins: I-V degree of ossification of illiac crest (once they’ve reached Riser IV then spine growth is pretty close to finished)
How to manage mild scoliosis (10-24 degrees) if skeletally mature and not skeletally mature
Skeletal mature: FU as needed.
Immature: FU Q4-6 months until maturity
How to manage moderate scoliosis (25-49 degrees) if skeletally mature and not skeletally mature
Skeletal mature: FU Q5 years to assess progression.
N: Consider bracing, FU Q 4-8 months
How to manage severe scoliosis (curve over 50)
consider surgery
100% chance of progression of curve over 50 degrees
Gold standard for bracing
Boston
Which is more effective, nighttime or daytime bracing
daytime/all the time (18 hours/day)
Goal of bracing? Best for what curvature?
Goal is to halt progression, NOT correction – can decrease risk of progression in patients listed below up to 80% when worn 16-18 hours/day
25-49 degrees in skeletally immature patients with idiopathic scoliosis
