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Year 3 MSK pathologies > Paediatric orthopaedic trauma > Flashcards

Paediatric orthopaedic trauma Flashcards

1
Q

What children are most likely to get traumatic injuries

A

boys more likely
Increased hyseal injury with age
Previous fracture
Metabolic bone disease

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2
Q

What are the principles of children’s fractures

A

Often simple, incomplete and heal quickly
Metabolically active periosteum
Cellular bone
Plastic

Fixation is not typically required
Do not over immobilise
Do not over treat

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3
Q

What occurs at the growth plates

A

Remodelling
Physeal arrest- fusion of the epiphyseal plates
Displacement
Lenght discrepancies

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4
Q

What is involved at the growth plates

A

Collagen
Porosity
Cellularity
Plasticity

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5
Q

What occurs at the periosteum?

A

Metbolically active

thick and strong

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6
Q

How should remodelling take place in a childs fracture

A

Remodel well in plane of joint movement
Appostional periosteal growth/resorption
Differential physeal growth
Application younger child, polar fractures, intact growing physis, saggital> frontal, X transverse

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7
Q

What can occur during a physeal fracture

A

Progressive deformity
Deformity- elbow
Arrest- knee,ankle
Overgrowth-femur

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8
Q

What bone is most commonly fractured in children?

What kind of fractures can occur

A

Forearm

Low energy- buckle, greenstick
High energy- open, displaced, soft tissue injury

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9
Q

Explain the different types of forearm fractures

A

Shaft fractures-
Galeazzi- fractures of the dital third of radius including RU joint
Monteggia- fracture of the proximal head of the ulna with dislocation of the proximal radius head
Distal radius fractures

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10
Q

What deforming forces can affect a forearm fracture

A

Biceps supinator- displace fracture superiorly
Supinator- supiante/pronate fracture
Pronator teres- pronate fracture
Pronator quadratus- pronate fracture

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11
Q

How do you assess a fracture?

A

History
Deformity
Soft tissues- whole limb, wounds, sensation, motor, vascular status.
Document findings, repeat post intervention

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12
Q

What are the different treatment outcomes?

A

Closed (non surgical)- good 90-95% functional results

Open/flex nail- resotred anatomy, early mobilisaiton, nerve injury, delayed union

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13
Q

What are indications for surgery

A

Open fracture
segmental fracture
nerurovascularly compromised
Failed close treatment

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14
Q

What are the principles of closed management

A 
Analgesia, anaesthesia
Theatre set up
Reudce (disempact, bend force over apex)
Verift
Check radiographs week 1,2 &4
Change loose casrs
Remoce when callus evident
Restrict activity
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15
Q

What surgical options are available?

A 
External fixator, rare, soft tissue injuries
ORIF(internal fixation)
Adolesccents
communciated fracture
Limietd immboilisation
singe bone technique
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16
Q

What are the benefits of flexible nailing

A

Needs 2yrs predicated growth remaining
Allows early ROM
Wires out when healed

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17
Q

What are the complications of surgery

A 
Compartments syndrome- Volkmann's
5% non union, refracture
Radioulnar synostoss 
PIN injury
Superfifical radial injury`
18
Q

What are the management of distal radial fractures

A 
Buckle cast- 3-4 weeks
Greenstick- cast 4-6 weeks
Complete cast
Risk for reminipulation
-complete fracyres
failed anatomcial reduction
Not B/E pop
19
Q

What are the differential diagnosis to knee trauma?

A 
Infection
Inflammatory arthropathy
Neoplasm
Apophysis
Apophysitis
Hip
Foot
Sickle, heamophilia
Anterior knee pain
20
Q

What bony injuries occur during knee trauma?

A 
Physeal/metaphyseal injuries
Tibial spine
Tibial tubercle
Patellar fracture
Sleeve fracture
Patellar dislocation
Referred pain
21
Q

What is involved in physeal injuries

A 
Can be femoral or tibial
Capsuel and ligaments also involved
hyperextnesion causes vascular injury
Varus- CPN injury
SH not predictive
22
Q

What is the treatment for a physeal injury

A

Cast, immobolise
Percutaneous fix
ORIF articular diplacement
ROM early

23
Q

What is the treatment of physeal arrest

A 
Monitor- harris lines, angulation and length
Resect bar
Complete epiphysoidesis
Contralateral epiphysiodesis
Corrective osteotomy
24
Q

What occurs during tibial spine injuries?

A 
Overlap with ACL
Meyers and McKeever
I- undiscplaced
II hinged
III displaced
I/II long leg cast
II/III ORIF, AxIF
25
Q

What occurs during a patellar fracture

A

Rare- cartilagenous to age 4
Sleeve type
Undisplaced-cylinder cast
Displaced- ORIF

26
Q

Patella dislocation risk factors?

A 
Laxity
Poor VMO
Q angle
Femoral antevesrion
Tibial external rotation
Patella alta
27
Q

How do you manage patellar dislocation

A 
Controversial 
Cast- repair medial ligament
Mobilise- lateral release
VMO exercises- medial tib tubercle
SemiT tenodesis
28
Q

What are osteochondral lesions?

How are they treated?

A

Small fracture of the cartilage of the surface of the talus.
Single traumatic injuries that cause a fracture of the talus cartilage
Type I-cartilage intact- immobilise
Type II- flap/Type II fragment- drilling/fix

29
Q

How do youu diagnose anterior knee pain

A

diagnosis of exclusion
Inflammatory, neoplasm
Oschar schatts, SLJ?

30
Q

What is a risk in ankle fractutes

A

Physis is a plae of fracture

It is weaker than the ligaments and carries a risk of growth arrest

31
Q

What are the classifications of ankle injuries

A

Mehanistic- lauge hansen, dias-tachdjan

Anatomical-salterharris, vahvanene and aalto

32
Q

How are patients with ankle injuries assesed

A

History-mechanism
Deformity
Soft tissues
AP + lateral radiograpgs- ottowa rules

33
Q

What are the ottowa rules

A

X rays are not required unless:
There is pain in malloeolar zone
There is bone tenderness at posterior edge of lateral malleolus
Base of fifth metatarsal
Navicular
Inability to bear weight both immediately and in emergency department

34
Q

How do you manage an SH1 fracture

A

Displaced<3cm- pop 6

Displaced >3cm MUA, POP 6

35
Q

How do you manage an SH2 fracture

A

most common
Displaced <3mm POP 4+2
Displaced >3mm MUA, POP

36
Q

How do you manage an SH3 fracture

A

Supination inversion
Epiphyseal fgt medial
Management- undisplaced- POP 6
Displaced (open) red’n and interfag screw

37
Q

How do you manage an SH4 fracture

A

ORIF

Monitor for growth arrest

38
Q

What is a growth plate transitional fracture

A

Fracture that occurs around age 13-14
Affects central>medial>lateral fusio
Articuar congruity is favoured over phsyical integrity

39
Q

What is a tillaux fracture?

A

External rotation leading to
Anterior tibiofibualr leg avulsion
SH3
can be treated with a closed/ open reduction

40
Q

What is a triplane fracture?

A

Caused by a triplane fracture that is evident on external rotation
SH3 on AP and SH2 on lateral leg
CT, ORIF is management process

41
Q

What are two common overuse injuries?

A

Osgood-schlatter’s disease and sever’s disease

Year 3 MSK pathologies (34 decks)

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