Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BRS Year 2 > orthopaediatrics > Flashcards

orthopaediatrics Flashcards

1
Q

child vs adult bones

A 
Child's has 270 bones - in continuous change
Physis (growth plates)
Elasticity greater
Speed of healing faster
Remodelling always
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

development of flat bones

A

intramembranous ossification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

development of long bones

A

endochondral ossification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

intramembranous ossification

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

ossificaiton centres

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what ossification centre is there pre-natally

A

primary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

endochondral primary ossification

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

endochondral secondary ossification

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What happens if the physis are faulty

A

Any congenital malfunction or acquired insult – traumatic/infective or otherwise will have impact on growth of the child

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

why are childrens bones more elastic

A

increased density of haversian canals (need blood supply for growing tissue)
dissipation of energy means it can bend more before breaking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

importance of childrens bone elasticity

A

plastic deformations - bends before breaking
buckle fractures - pushes outwards like roman column
greenstick fractures - one cortex fractures but other side doesnt break

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

when does bone growth stop

A

when physis closes - puberty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is physis closure dependent on

A

parental height
menarche
puberty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

when are boys and girls’ physis closed

A

boys - 18/19

girls - 15/16

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is a physeal injury

A

Categorised by salter harris

May lead to growth arrest -> deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What 2 factors impact remodelling potential of children?

A 
AGE:
greater the younger they are
LOCATION:
Physis at knee grows more
Pysis at extreme of upper limb grows more
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

common congenital ortho conditions

A

developmental dysplasia of the hip
club foot
achondroplasia
osteogenesis imperfecta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is developmental dysplasia of the hip (DDH)

A

Group of disorders where head of femur unstable or incongruous with acetabulum
A ‘packing disorder’- depending on how child sits in womb impacts how hip sits in acetabulum
Normal development relies of concentric reduction and balanced forces in hip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

risk factors for developmental dysplasia of hip

A

female 6:1
first born
breech
family history
oligohydramnios (lack of fluid in amniotic sac)
native american/ laplanders- swaddling of hip
Rare in african american/ asian

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

examination for DDH

A

baby check- screening usually picks it up
Hip RoM:
- usually limitation in hip abduction
- leg length (Galeazzi test)
In 3 months and older, Barlow and Ortolani test (to check for hip instability) are non-sensitive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

investigation for DDH

A

ultrasound (birth- 4 months) - measure acetabular dysplasia and hip position
If aster 4 months, X-Ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

treatment of DDH

A

If reducible hip and <6 months old - pavlik harness- holds femoral head in acetabulum
If failed/irreducible or 6-18 months old - MUA + closed reduction and spica

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is club foot?

Epidemiology?

A

congenital deformity of foot
Highest in hawaiians
M:F 2:1
50% are bilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what does CAVE mean in relation to club foot

A

Cavus - high foot arch: tight intrinsic muscles, FHL, FDL
Adductus of foot - tight tibialis post and ant
Varus - tight tendoachilles, tib post tib ant
Equinous - tight tendoachilles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

treatment of club foot

A

Ponseti method

  1. Series of casts to fix deformity
  2. Many require operative treatment
  3. Foot orthosis brace
  4. Some will require further operative intervention
26
Q

what is achondroplasia

A

Skeletal dysplasia - autosomal dominant
G380 mutation of FGFR3
inhibition of chondrocyte proliferation in proliferative zone of physis
results in defect in endochondral bone formation

27
Q

Symptoms of achondroplasia

A

Rhizomelic dwarfism:

  • Humerus shorter than forearm
  • Femur shorter than tibia
  • Normal trunk
  • Adult height of around 125cm
  • Significant spinal injuries
28
Q

what is osteogenesis imperfecta

A

hereditary autosomal D/R
decreased type I collagen - decreased secretion OR production of abnormal collagen
leads to insufficient osteoid production

29
Q

problems caused by osteogenesis imperfecta

A

Bone:
fragility fractures
short stature
scoliosis

Non-orthopaedic manifestations:
Heart
Blue sclera
Brown soft teeth
Wormian skull- abnormal fusion of cranial bones
Hypermetabolism
30
Q

classification of salter harris fractures

A

SALT:

  1. physeal Separation
  2. fracture transverse physics then exits metaphysis (Above)
  3. fracture transverse physics then exits epiphysis (Lower)
  4. Fracture passes Through epiphysis, physis, metaphysis
  5. crush injury
31
Q

what type of salter harris fracture has greatest risk of growth arrest?
What is the most common type?

A

Risk of growth arrest increases from 1-5
Type 2 most common
Type 5 have greatest risk

32
Q

How can the location of growth arrest affect the limbs?

A

whole physis - complete arrest- limb length discrepancy

partial physis - angulation as non affected side keeps growing

33
Q

principles of treatment of salter harris fractures

A

correct deformity - minimise angular deformity and limb length difference

34
Q

limb length correcting

A

shorten long side (prematurely fuse physis)
OR
lengthen short side - plates

35
Q

angular deformity correction

A

stop growth of affected side

reform bone - osteotomy

36
Q

closed reduction for paediatric fracture

A

gallows traction for long bone fractures

Closed reduction to correct for deformity

37
Q

4 rs of paediatric fractures

A

resuscitate
reduce
restrict
rehabilitate

38
Q

restriction for paediatric fractures

A

Plasters and splints most common (External)
Remodelling and huge healing potential means operative internal fixation can usually be avoided

Sometimes operation is needed:
Internal- plates and screws or intramedullary device
Titanium nails more used due to being flexible so can help tension and hold fractures

39
Q

rehabilitation techniques for children

A

play

use it move it strengthen it

40
Q

differential Dx for limping child

A

septic arthritis
transient synovitis
perthes
slipped upper femoral epiphysis

41
Q

What classification is used to diagnose probability of septic arthritis in children?

A 
Kochers classification:
non-weight bearing
ESR over 40
WBC over 12,000
temp over 38
42
Q

when can transient synovitis be diagnosed in children

A

after exclusion of septic arthritis

43
Q

perthes disease

A

idiopathic necrosis of proximal femoral epiphysis

Affects boys 4-8 more likely

44
Q

SUFE usual presentation

A

obese adolescent males
12-13 yo
associated with hypothyroid/pituitarism

45
Q

treatment for SUFE

A

operative fixation with screw to prevent further slip and minimise long term growth problems

46
Q

what is transient synovitis

A

inflamed joint in repsonse to a systemic illness

treated by antibiotics

47
Q

What does SUFE stand for and what is it?

A

Slipped upper femoral epiphysis

Proximal epiphysis slips in relation to metaphysis

48
Q

What do you need to exclude first before diagnosing SUFE?

A

Septic Arthritis

49
Q

What is treatment for Perthes disease?

A

Supportive

50
Q

What is important about septic arthritis?

A

Orthopaedic emergency- can cause irreversible joint problems

51
Q

What is typical presentation of septic arthritis?

A

Prev. fit and well
Over last 24hrs off food and drink
Last 12hrs- fever, don’t move hip or knee

52
Q

What’s the treatment for septic arthritis?

A

Surgical washout

53
Q

What is transient arthritis?

How is it treated?

A

Inflamed joint in response to systemic illness

Supportive treatment with ABs

54
Q

What are the aims for reducing a fracture?

A

Correct deformity and displacement

Reduce secondary injury to soft tissues and neurovascular structures

55
Q

What are 2 ways a fracture can reduced?

A

Closed- without incision such as traction and manipulation

Open- make incision and realign fracture

56
Q

What are the different ways a bone can be displaced?

A

Angulated
Displaced
Shortened
Rotated (can’t be remodelled)

57
Q

When looking at a paediatric fracture, what are the 5 things we need to consider?

A 
Pattern
Anatomy
Intra/Extra-articular
Displacement
Salter-Harris
58
Q

What are the different patterns of fracture?

A 
Transverse
Oblique
Spiral
Comminuted
Avulsion (pulled of ligament)
Torus (thiscker at one bit)
Greenstick
59
Q

What are the different anatomical location we have to consider for a fractured bone?

A

Proximal 1/3
Middle 1/3 / diaphysis
Distal 1/3

60
Q

What is the preferred route of healing in an intra-articular fracture?

A

Primary bone healing- heals by direct union, no callus

Minimises risk of post traumatic arthritis

61
Q

What is the preferred route of healing in an extra-articular fracture?

A

Secondary bone healing- healing by callus

62
Q

How do outcomes of Developmental dysplasia of th hip vary?

A

Dysplasia- acetabular socket does not develop into right place (more common)
Subluxation- shallow socket
Dislocation

BRS Year 2 (110 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions