Orthopaedics Flashcards
Medical term for growth plate
Epiphyseal plates
What are epiphyseal plates made of
Hyaline cartilage
Structure of growth plates and location
Hyaline cartilage between epiphysis and metaphysis
Greenstick fracture type
Only one side of the bone
Common in children as more cancellous bone than cortical bone
Buckle fracture type
Two bones pushed together and bulging
Transverse fracture type
Straight across
Oblique fracture type
Straight across bone but at an angle
Segmental fracture type
Two brakes in long bone leaving a segment in between
A fracture across a growth plate is called
Salter Haris fracture
Comminuted fracture type
Lots of pieces
Mnemonic to remember growth plate fractures
SALTR
Straight across, above, below, through, cRush
How many types of Salter Harris fractures are there
5 using SALTR mnemonic
Growth plate fracture splitting the epiphysis type
4 Salter Harris
3 causes of hip pain 0-4 years
Septic arthritis
DDH
Transient sinovitis
3 cause of hip pain 5-10 years
Septic arthritis
Transient sinovitis
Perthes disease
3 causes of hip pain in 10-16 year olds
Septic arthritis
Slipped upper femoral epiphysis (SUFE)
Juvenile idiopathic arthritis
Should codeine be used in children
No as big metabolic differences so hard to calculate therapeutic dose
Most common cause of septic arthritis
Staph aureus
Neisserua gonorrhoea in sexually active teenagers
Common age for transient synovitis
3-10 years
Joint pain + fever likely dx?
Septic arthritis
What is transient synovitis associated with preceding the condition
URTI a couple of weeks before
Transient synovitis management
Simple analgesia
Safety net - A&E if develop a fever
Review in 48 hours and 7/7
Symptoms usually resolve in 1-2 weeks
Age of presentation for Perthes disease
4-12 years
5-8 years most common
Pathophysiology in Perthes disease
Acascular necrosis of femoral head
Likely due to repeated mechanical stress
Main complication of Perthes disease
Early osteoarthritis after revascularistion healing process leading to total hip replacement in 5%
4 symptoms/ signs or Perthes disease
Pain in hip/groin
Limp
Restricted hip movements
referred pain to knee
NO TRAUMA
How to differentiate between Perthes disease and SUFE
Perthes disease = no trauma
SUFE = mild trauma triggers pain
Diagnostic test in Perthes disease
X-ray but can be normal
Management of perthes disease
Bed rest, traction, crutches, analgesia
?surgery if realignment is needed
Age of presentation SUFE
8-15 years
OBEASE BOYS
Typical history of SUFE
Obese boy going through growth spirt with minor trauma
Hip/ groin/ knee pain
RESTRICTED INTERNAL ROTATION
Clinical examination of SUFE
Rest in external rotation
Pain and limited movement on internal rotation
Investigation for SUFE
X RAY
Management of SUFE
Surgery to return femoral head to correct position
Where does oesteomylitis typically occur
Mataphyisis (m=middle) of long bones
Most common infective organism in osteomyelitis
Staph aureus
6 key risk factors for osteomyelitis
HIV, immunocompromised Orthopaedic surgery Open bone fracture Sickle cells TB
Investigations for osteomyelitis
Xray first line
MRI best
Blood tests show increased WCC CRP ESR
Cultures / biopsy
Oestosarcoma most common site and age
Femur
10-20 years
Osteosarcoma key symptoms
Persistent bone pain that IS WORSE AT NIGHT - may wake them up from sleep
Swelling, restricted joint movements, mass
How should a child with unexplained bone pain or swelling be managed
urgent x ray within 48 hours
X ray appearance of osteosarcoma
Poorly defined lesion with a ‘fluffy’ appearance
“sun-burst” appearance lateral from inflammation/ irritation
key blood test in osteosarcoma
Raised ALP
What is talipes?
Fixed abnormal ankle position
Two types of talipes
Talipes equinovarus - plantar flexion and supernates
Talipes calcaneovalgus - dorsi flexion and pronation
How are Talipes treated
Ponseti method
What is the ponseti method and which condition does it treat
Talipes
Manipulation of foot and cast applied
Tenotomy is performed to release tension
What is positional talipes
Form of talipes that does not require cast as foot can move into normal position
3 key risk factors for DDH
Breach (any point after 36 weeks, or birth)
1st degree family history
Multiple pregnancy
Which babies get a hip USS at 4-6 weeks
FH of DDH
Breach at any point after 36 weeks (even if corrected)
Breach at birth
Which babies get a hip USS at 4-6 weeks
FH of DDH
Breach at any point after 36 weeks (even if corrected)
Breach at birth
Two key clinical tests for DDH
Ortolani test - baby on back, abduct hip to try dislocate anteriorly
Barlow test - knees at 90 degrees, down ward pressure applied
Treatment of DDH
Pavlik harness if baby less than 6 months (hip flexed and abducted)
Surgery if after 6 months
Name of osteomalacia in children
Rickets disease
Cause of Ricketts
Vitamin D or calcium deficiency
Genetic form of rickets
Hereditary hypophosphataemic rickets
X- linked low levels of phosphate in blood
Three types of organ dysfunction that causes low vitamin D
Kidney disease
GI malabsorption
Parathyroids :)
What Is needed for phosphate absorption
Vitamin D (also helps absorb calcium(
Rickets blood results
Ca low
PO4 low
ALP high
PTH high
VIT D LOW
What baby diets are at a higher risk of rickets
Breast fed instead of bottle as not fortified with vitamin D
Achondrasplasia meaning
Disproportionate short stature
Genetic cause of achondroplasia
FGFR3 gene on chromosome 4
AD inheritance
Homozygous inheritance is fatal
Effect on skull of achondroplasia
Disproportionate skull
Foramen magnum stenosis
Non skeletal associations with achondroplasia
Recurrent otitis media
Slope apnoea
Hydrocephalus/ cervicial cord compression (foramen magnum stenosis)
Life expectancy in achondroplasia
Normal
Normal development and intelligence too
Joint part effected in Osgood Schlatter
Tibial tuberosity where petella ligament inserts
Osgood Schalters physiology
Physical stress -> inflammation of tibial epiphyseal plate (e=end) -> multiple small avulsion fractures where patella ligament pulls away tiny pieces of bone
Avulsion fracture type
Tendon pulls away a piece of bone
Oesteogenesis imperfecta pathophysiology
Genetic mutation -> abonormal collagen formation
Key symptoms of OI
Hypermobility BLUE/ GREY SCLERA Short stature and triangular face Deafness from early adulthood Dental and bone malformation
Osteogenesis imperfecta management
Bisphosphates to increase BD
VIT d supplementation
