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Physiotherapy Across Lifespan I > Orthopaedics in Children > Flashcards

Orthopaedics in Children Flashcards

1
Q
A
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2
Q

common orthopaedic presentations in children

A

fractures - salter harris classification
osteochondritis - perthes
SCFE
Scoliosis

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3
Q

common musculoskeletal and sports presentation

A

apophyseal inflammation and avulsion
hip complaints e.g FAIS

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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

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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
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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

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7
Q

classification salter harris fracture

A

fracture involving physis/growth plate

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8
Q

describe a type 1 salter harris fracture

A

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

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9
Q

describe a type 2 salter harris fracture

A

physeal fracture extends to Metaphysis = produce chip fracture

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10
Q

describe a type 3 salter harris fracture

A

a physeal fracture that extends to the articular epiphysis

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11
Q

describe a type 4 salter harris fracture

A

a complete physeal fracture that includes metaphysis and ephiphysis

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12
Q

describe a type 4 salter harris fracture

A

a complete compression physeal fracture of the growth plate

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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

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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
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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
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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
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17
Q

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

A
  • Often missed, spotted when growth has be impacted.
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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

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19
Q

what is a risk factor of slipped capital femoral epiphysis

A

obesity

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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

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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
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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

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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.

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24
Q

what is perthes disease

A
  • Idiopathic avascular necrosis of the head of the femur
  • Ostechondrosis
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25
what are risk factors of perthes disease
transient synovitis*, paternal smoking/passive smoking in pregnancy, thrombophilia, low birthweight, family history
26
where in the body does osteochondritis dessicans typically occur
medial femoral condyle capitellum talar dome
27
what is the typical presentation of perthes disease
* Pain and limp * Pain in groin, thigh or knee * Pain increases with hip movement * Decreased hip medial rotation and abduction * Thigh muscle atrophy
28
what are the possible consequences of perthes disease not being appropriately addressed
can cause leg length discrepancy may need THR long term
29
what long surgical interventions available for perthes disease
* Pain relief with anti-inflammatories * Observation * Protected weight bearing * Splinting/casting - Petrie * 4-6 weeks * Bed rest with traction
30
what surgical interventions are available for perthes disease
Femoral Osteotomy with plates and screws to fix alignment * May require pelvic osteotomy if child is under 8
31
what is the aetiology of scoliosis
idiopathic neuromuscular - CP, Muscular dystrophy Secondary - leg length discrepancy
32
what is the typical presentation of idiopathic scoliosis
strong family hx present around early adolescence (Adolescent Idiopathic Scoliosis - AIS) Uneven shoulder - symmetric scapular prominence uneven pelvis rib prominence
33
What tests are conducted during an objective of a patient with suspected idiopathic scoliosis
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
how is scoliosis classified using the cobb angle
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
conservative management of scoliosis
bracing - no evidence in fully grown some evidence if more than 40 degrees lateral curvature high risk of progression
36
what is the schroth method
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
what are the indications for surgical intervention patients with scoliosis
curve above 40 degrees and non responding
38
describe the surgical intervention for idiopathic scoliosis
* Intervertebral fusion using bony grafting * Held in place with rods until fused
39
describe the discharge plan for children post op scoliosis correction surgery
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
what are the apophyses
secondary ossification centre Fuses with bone in second decade Site of insertion for tendons and ligaments
41
common apophysis locations of lower limb
iliac crest ASIS AIIS Ischial tuberosity pubic symphysis lesser and greater trochanter inferior patellar pole tibial tuberosity calcaneal tuberosity 5th metatarsal base
42
apophysitis
Vulnerable to 'overload' in early adolescence inflamamtion of apohysis
43
severs disease
inflammation in TA insertion
44
Sinding Larsen Johansson Syndrome
Distal Patella inflammation
45
Osgood Schlatters Disease
Tibial Tubercle inflammation
46
Iselin disease
base of 5th meta-tarsal
47
what is the typical presentation of apophysitis
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
Intervention for apophysitis
* 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
what is apophyseal avulsion fracture
sudden forceful contraction causes avulsion of apophysis to which tendon attaches typically in pelvis
50
what is the typical presentation of an apophyseal avulsion fracture
* May describe pop, pain and sudden loss of function
51
what is the intervention of an apophyseal avulsion fracture
Generally managed with immobilisation and graded return to load
52
clinical signs of FAIS
* Restricted flexion (+ adduction and internal rotation) - FADIR * CAM defomity may begin to develop in adolescence due to plastic nature of femoral neck
53
What possible physio interventions are available for FAIS
Current drive is to use graded exposure, loading/strengthening approaches +/- biomechanical intervention
54
what surgical interventions are available for FAIS
* Excise CAM/Acetabular osteophytes & overgrowth - Femoral or pelvis osteotomy * Repair any labral damage * Outcomes not great
55
types of FAIS
Cam impingement - overgrowth of neck of femur pincer impingement - overgrowth of socket of pelvis
56
describe epidemiology of pars defect fracture/aponylolysis
* 6-7 % incidence in adolescent athletes * 47%+ cause of LBP in adolescents
57
in what athletes is pars defects fracture/spondylolysis common
Repeated extension in LSP – javelin, fast bowler, tennis
58
how can spondylolysis turn into spondylolisthesis
* Bilateral spondylolysis may result in anterior translation of vertebral segment
59
what is the management of undisplaced fracture of spondylolysis
* Rest * Graded exposure * Biomechanical re-ed
60
what is the possible intervention of pars defect displacement
possible surgical intervention
61
there types of musculoskeletal tumors
* Rhabdomyosarcoma * Ewings Sarcoma * Osteosarcoma
62
what is rhabdomyosarcoma
cancer of the muscle or connective tissue e.g. tendon or cartilages
63
describe epidemiology of rhabdomyosarcoma
50% in head and neck, 25% in genital area, 15% in extremities
64
describe signs of rhabdomyosarcoma
* 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
Ewings sarcoma
cancer of bones and tissue around bones
66
what are the common locations for Ewings sarcoma
bones of the legs, arms, feet, hands, chest, pelvis, spine, skull.
67
signs for ewings sarcoma
* 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
treatment ewing's sarcoma
excision of tumour + chemo and radiation * May necessitate amputation of limb
69
osteosarcoma
most common type of bone cancer common in adolescents
70
where does osteosarcoma typically develop in the body
Commonly forms in the ends of the long bones of the body often near the knee
71
signs of osteosarcoma
* 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
subtypes of juvenile idiopathic arthritis
oligoarthritis - < 4 joints polyarthritis > 5 joints Psoriatic arthritis - joints and rash enthesitis - tendon insertion undifferentiated - not fitting with subtype
73
what pharmaceutical interventions are available for juvenile idiopathic arthritis
* 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)

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