orthopaediatrics Flashcards
child vs adult bones
Child's has 270 bones - in continuous change Physis (growth plates) Elasticity greater Speed of healing faster Remodelling always
development of flat bones
intramembranous ossification
development of long bones
endochondral ossification
intramembranous ossification
formation of ossification centre - condensation of mesenchymal cells to osteoblasts
secreted osteoid traps osteoblasts – osteocytes
trabecular matrix and periosteum form
compact bone develops superficially, crowded blood vessels become red bone marrow
ossificaiton centres
primary ossification centres - pre-natal bone growth through endochondral oss from central part of bone
secondary ossification centres - post-natal after primary ossification centres, forms the physis
what ossification centre is there pre-natally
primary
endochondral primary ossification
mesenchymal differentiation creates a cartilage model in diaphysis
angiogenesis penetrates, primary centre forms and spongy bone
continues up the shaft, cartilage and chondrocytes form bone ends.
secondary ossification centres form at bone ends now
endochondral secondary ossification
centre calcifies and dies to immature spongy bone
epiphyseal side contains active hyaline cartilage which continues dividing to form hyaline cartilage matrix (epiphyseal growth plate)
What happens if the physis are faulty
Any congenital malfunction or acquired insult – traumatic/infective or otherwise will have impact on growth of the child
why are childrens bones more elastic
increased density of haversian canals (need blood supply for growing tissue)
dissipation of energy means it can bend more before breaking
importance of childrens bone elasticity
plastic deformations - bends before breaking
buckle fractures - pushes outwards like roman column
greenstick fractures - one cortex fractures but other side doesnt break
when does bone growth stop
when physis closes - puberty
what is physis closure dependent on
parental height
menarche
puberty
when are boys and girls’ physis closed
boys - 18/19
girls - 15/16
what is a physeal injury
salter harris
may lead to growth arrest
remodelling potential of children
greater the younger they are
common congenital ortho conditions
developmental dysplasia of the hip
club foot
achondroplasia
osteogenesis imperfecta
what is developmental dysplasia of the hip
head of femur unstable or incongruous with acetabulum
may result in subluxation - hip popping in and out
risk factors for developmental dysplasia of hip
female
first born
breech
family history
examination for DDH
baby check - hip RoM
investigation for DDH
ultrasound - measure acetabular dysplasia and hip position
treatment of DDH
if reducible - pavlik harness
if failed/irreducible - MUA+closed reduction and spica
what is club foot
congenital deformity of foot
CAVE - cavus, adductus foot, varus, equinous
familial disorder
what does CAVE mean in relation to club foot
Cavus - high foot arch
Adductus of foot - tight tib post and ant
Varus - tight tendoachilles, tib post tib ant
Equinous - tight tendoachilles
treatment of club foot
ponseti method - casts, operation (soft tissue release), brace, may need additional operations
what is achondroplasia
skeletal dysplasia - normal trunk, femur smaller than tibia and humerus smaller than forearm
G380 mutation of FGFR3
pathophysiology of achondroplasia
inhibition of chrondrocyte proliferation in proliferative zone of physis
results in defect in endochondral bone formation
what is osteogenesis imperfecta
hereditary autosomal D/R
decreased type I collagen - decreased secretion and production of abnormal
leads to insufficient osteoid production
problems caused by osteogenesis imperfecta
fragility fractures short stature scoliosis blue sclera brown, soft teeth
classification of salter harris fractures
SALT Separation through then up Above physis through then goes Lower physis Through epiphysis (vertically) crush injury
what type of salter harris fracture has greatest risk of growth arrest
type 5 - crush injury
how is growth arrest affected by the fracture
whole physis - complete arrest
partial physis - angulation
principles of treatment of salter harris fractures
correct deformity - minimise angular deformity and limb length difference
limb length corretcing
shorten long side
lengthen short side - plates
angular deformity correction
stop growth of affected side
reform bone - osteotomy
closed reduction for paediatric fracture
gallows traction for long bones
correction for deformity
4 rs of paediatric fractures
resuscitate
reduce
restrict
rehabilitate
restriction for paediatric fractures
plasters and splints most common
operative internal avoided but titanium nails more elastic so best for growing bones
rehabilitation techniques for children
play
use it move it strengthen it
differential Dx for limping child
septic arthritis
transient synovitis
perthes
slipped upper femoral epiphysis
septic arthritis in children kochers classification
non-weight bearing
ESR over 40
WBC over 12,000
temp over 38
when can transient synovitis be diagnosed in children
after exclusion of septic arthritis
perthes disease
idiopathic necrosis of proximal femoral epiphysis
boys 4-8 more likely
SUFE usual presentation
obese adolescent males
12-13 yo
associated with hypothyroid/pituitarism
treatment for SUFE
operative fixation with screw to prevent further slip and minimise long term growth problems
what is transient synovitis
inflamed joint in repsonse to a systemic illness
treated by antibiotics
