Brainscape's Knowledge GenomeTM

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


See full index

Physiotherapy Across Lifespan I > Orthopaedics in Children > Flashcards

Orthopaedics in Children Flashcards

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

common orthopaedic presentations in children

A

fractures - salter harris classification
osteochondritis - perthes
SCFE
Scoliosis

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

common musculoskeletal and sports presentation

A

apophyseal inflammation and avulsion
hip complaints e.g FAIS

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

What outcome measure may be used to examine the child’s musculoskeletal system

A

pediatric gait, arms, legs, spine screen
screening questions - ask about pain or stiffness across joints muscle back, ask about difficulty with functional tasks e.g going up/down stairs or dressing yourself
gait assessment - do they walk in tip toes/heels

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

what should be assessed before you approach the child for an orthopaedics physio session

A
  • Review notes
  • PEWS*
  • Talk to Nursing Staff
  • Has the child had pain relief
  • Has the child had any anxiety/fear
  • Is there a parent present
  • Communication – is the child likely to be impulsive
  • Are there any attachments IVs etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what physical differences are between between children and adults

A

articular cartilage thicker in children
junction b/w epiphyseal plate and metaphysis is vulnerable to shear forces and disruption in children
relatively weak apophyses
metaphysis of long bones in kids resilient and elastic - prone to greenstick fracture
growth temporarily impacts co-ordination

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

classification salter harris fracture

A

fracture involving physis/growth plate

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

describe a type 1 salter harris fracture

A

slipped - complete physeal break comprised of 2 components
2 components are slightly displaced

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

describe a type 2 salter harris fracture

A

physeal fracture extends to Metaphysis = produce chip fracture

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

describe a type 3 salter harris fracture

A

a physeal fracture that extends to the articular epiphysis

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

describe a type 4 salter harris fracture

A

a complete physeal fracture that includes metaphysis and ephiphysis

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

describe a type 4 salter harris fracture

A

a complete compression physeal fracture of the growth plate

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

what are the clinical implications of a type 1 salter harris fracture

A

Most common (75%), uncomplicated and 2-3 week healing time

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

what are the clinical implications of a type 2 salter harris fracture

A
  • Triangular fragment can be reduced normally and cast applied
  • Sometimes open reduction needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the clinical implications of a type 3 salter harris fracture

A
  • Mostly seen in older children when growth plates have begun to close
  • Most require ORIF
  • Can form a pyseal bar leading to assymetric growth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the clinical implications of a type 4 salter harris fracture

A
  • Fracture through all elements – ORIF often
  • If growth hs ceassed then ok
  • If not, careful monitoring needed to ensure no physeal bar/grwoth disturbance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the clinical implications of a type 5 salter harris fracture

A
  • Often missed, spotted when growth has be impacted.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

SCFE what is it?

A

Slipped upper femoral epiphysis/ Slipped capital femoral epiphysis
damage to the growth plate of the femur
resulting in the head of the femur to slip and become misaligned with the remaining femur

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

what is a risk factor of slipped capital femoral epiphysis

A

obesity

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

explain the epidemiology of slipped capital femoral epiphysis

A

Bilateral in ~ 20% of cases
* Affects boys more than girls
* Affects boys later (10-17) than girls (8-15

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

what are the presentations of slipped capital femoral epiphysis

A
  • Antalgic gait
  • Pain in groin thigh or knee
  • If you flex the hip it will externally rotate and abduct
  • Advise to restrict weight bearing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

potential complications of slipped capital femoral epiphysis

A

Osteonecrosis (risk up to 50% in untreated SUFE)
Chondrolysis (risk 7%)
Osteoarthritis
Femoral acetabular impingement - severe

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

what is osteochondritis

A

joint disorder in which a segment of bone and cartilage starts to separate from the rest of the bone after repeated stress or trauma.

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

what is perthes disease

A
  • Idiopathic avascular necrosis of the head of the femur
  • Ostechondrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are risk factors of perthes disease

A

transient synovitis*, paternal smoking/passive smoking in pregnancy,
thrombophilia,
low birthweight,
family history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

where in the body does osteochondritis dessicans typically occur

A

medial femoral condyle
capitellum
talar dome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is the typical presentation of perthes disease

A
  • Pain and limp
  • Pain in groin, thigh or knee
  • Pain increases with hip movement
  • Decreased hip medial rotation and abduction
  • Thigh muscle atrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what are the possible consequences of perthes disease not being appropriately addressed

A

can cause leg length discrepancy
may need THR long term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what long surgical interventions available for perthes disease

A
  • Pain relief with anti-inflammatories
  • Observation
  • Protected weight bearing
  • Splinting/casting - Petrie
  • 4-6 weeks
  • Bed rest with traction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what surgical interventions are available for perthes disease

A

Femoral Osteotomy with plates and screws to fix alignment
* May require pelvic osteotomy if child is under 8

31
Q

what is the aetiology of scoliosis

A

idiopathic
neuromuscular - CP, Muscular dystrophy
Secondary - leg length discrepancy

32
Q

what is the typical presentation of idiopathic scoliosis

A

strong family hx
present around early adolescence (Adolescent Idiopathic Scoliosis - AIS)
Uneven shoulder - symmetric scapular prominence
uneven pelvis
rib prominence

33
Q

What tests are conducted during an objective of a patient with suspected idiopathic scoliosis

A

leg length - measure in supine
adams forward bend test - may still be impacted by LLD
feet together, knees straight, bend forward, free arms
+ive if asymmetry in ribs is present
cobb angle

34
Q

how is scoliosis classified using the cobb angle

A

angle opposite apex
and between the end vertebrae
0-10 degree ignore unclassified
10-20 - mild monitor and reassure
20 and young child - intervene
30-40 in skeletally mature - unlikely to progress

35
Q

conservative management of scoliosis

A

bracing - no evidence in fully grown
some evidence if more than 40 degrees lateral curvature
high risk of progression

36
Q

what is the schroth method

A

a conservative intervention for scoliosis
provide exercises based on unique curvature of spine
address anatomical planes - sagittal, frontal, transverse
3 components
muscular symmetry
rotational angular breathing
awareness of posture
methods include - self elongation and postural correction to specific curve patterns

37
Q

what are the indications for surgical intervention patients with scoliosis

A

curve above 40 degrees and non responding

38
Q

describe the surgical intervention for idiopathic scoliosis

A
  • Intervertebral fusion using bony grafting
  • Held in place with rods until fused
39
Q

describe the discharge plan for children post op scoliosis correction surgery

A

day 1 walk w/o brace
day 4 - d/c
4/52 - return to school
6-9/12 - return to sport - no contact may be advised

40
Q

what are the apophyses

A

secondary ossification centre
Fuses with bone in second decade
Site of insertion for tendons and ligaments

41
Q

common apophysis locations of lower limb

A

iliac crest
ASIS
AIIS
Ischial tuberosity
pubic symphysis
lesser and greater trochanter
inferior patellar pole
tibial tuberosity
calcaneal tuberosity
5th metatarsal base

42
Q

apophysitis

A

Vulnerable to ‘overload’ in early adolescence
inflamamtion of apohysis

43
Q

severs disease

A

inflammation in TA insertion

44
Q

Sinding Larsen Johansson Syndrome

A

Distal Patella inflammation

45
Q

Osgood Schlatters Disease

A

Tibial Tubercle inflammation

46
Q

Iselin disease

A

base of 5th meta-tarsal

47
Q

what is the typical presentation of apophysitis

A

subjective - pain, participation limiting, can be from overloading, higher suspicion of red flag indicators
objective - observe swelling,
palpation - isolated pain in apophysis
biomechanics - hop, single leg squat, landing, cutting,
ROM, MMT

48
Q

Intervention for apophysitis

A
  • Reduce training load
  • Focus on movement control/quality, S+C etc
  • Graded return to load in a controlled manner
  • Persistent pain, exostosis and pseudoarthrosis can occur if not
    managed well
49
Q

what is apophyseal avulsion fracture

A

sudden forceful contraction causes avulsion of apophysis to which tendon attaches
typically in pelvis

50
Q

what is the typical presentation of an apophyseal avulsion fracture

A
  • May describe pop, pain and sudden loss of function
51
Q

what is the intervention of an apophyseal avulsion fracture

A

Generally managed with immobilisation and graded return to load

52
Q

clinical signs of FAIS

A
  • Restricted flexion (+ adduction and internal rotation) - FADIR
  • CAM defomity may begin to develop in adolescence due to plastic
    nature of femoral neck
53
Q

What possible physio interventions are available for FAIS

A

Current drive is to use graded exposure, loading/strengthening approaches
+/- biomechanical intervention

54
Q

what surgical interventions are available for FAIS

A
  • Excise CAM/Acetabular osteophytes & overgrowth - Femoral or pelvis osteotomy
  • Repair any labral damage
  • Outcomes not great
55
Q

types of FAIS

A

Cam impingement - overgrowth of neck of femur
pincer impingement - overgrowth of socket of pelvis

56
Q

describe epidemiology of pars defect fracture/aponylolysis

A
  • 6-7 % incidence in adolescent
    athletes
  • 47%+ cause of LBP in adolescents
57
Q

in what athletes is pars defects fracture/spondylolysis common

A

Repeated extension in LSP – javelin, fast bowler, tennis

58
Q

how can spondylolysis turn into spondylolisthesis

A
  • Bilateral spondylolysis may result in anterior translation of vertebral segment
59
Q

what is the management of undisplaced fracture of spondylolysis

A
  • Rest
  • Graded exposure
  • Biomechanical re-ed
60
Q

what is the possible intervention of pars defect displacement

A

possible surgical intervention

61
Q

there types of musculoskeletal tumors

A
  • Rhabdomyosarcoma
  • Ewings Sarcoma
  • Osteosarcoma
62
Q

what is rhabdomyosarcoma

A

cancer of the muscle or connective tissue e.g. tendon or cartilages

63
Q

describe epidemiology of rhabdomyosarcoma

A

50% in head and neck, 25% in genital area, 15% in extremities

64
Q

describe signs of rhabdomyosarcoma

A
  • A lump or swelling that keeps getting bigger or does not go away. It may be painful.
  • Crossed-eyes or bulging of the eye.
  • Headache.
  • Trouble urinating or having bowel movements.
  • Blood in the urine.
  • Bleeding in the nose, throat, vagina, or rectum.
65
Q

Ewings sarcoma

A

cancer of bones and tissue around bones

66
Q

what are the common locations for Ewings sarcoma

A

bones of the legs,
arms,
feet,
hands,
chest,
pelvis,
spine,
skull.

67
Q

signs for ewings sarcoma

A
  • A lump (which may feel soft and warm) in the arms, legs, chest, or pelvis.
  • Pain and/or swelling near the lump.
  • Fever for no known reason.
  • A bone that breaks for no known reason
68
Q

treatment ewing’s sarcoma

A

excision of tumour + chemo and radiation
* May necessitate amputation of limb

69
Q

osteosarcoma

A

most common type of bone cancer
common in adolescents

70
Q

where does osteosarcoma typically develop in the body

A

Commonly forms in the
ends of the long bones of
the body often near
the knee

71
Q

signs of osteosarcoma

A
  • Swelling over a bone or bony part of the body.
  • Pain in a bone or joint.
  • A bone that breaks for no known reason
72
Q

subtypes of juvenile idiopathic arthritis

A

oligoarthritis - < 4 joints
polyarthritis > 5 joints
Psoriatic arthritis - joints and rash
enthesitis - tendon insertion
undifferentiated - not fitting with subtype

73
Q

what pharmaceutical interventions are available for juvenile idiopathic arthritis

A
  • Pain control meds
  • Non-steroidal anti-inflammatories
  • Disease Modifying Anti-rheumatic drugs (DMARDs)
  • Biologic Therapies
  • tanercept, adalimumab, infliximab, tocilizumab, abatacept, anakinra
  • Intravenous infusion

Physiotherapy Across Lifespan I (14 decks)

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