paediatric orthopaedics Flashcards
what are growth plates (physis)
found in the bones of children not adults
found at the end of long bones
allows bone to grow in length
made of hyaline cartilage and sit between epiphysis and the metaphysis > which then fuses together > epiphyseal lines
do children have more cancellous or cortical bone
cancellous
ie more flexible but less strong > greenstick fractures
what is bone remodelling
the process where bone tissue is taken from areas of low tension and deposited in areas of high tension
this allows bone to change to the optimum shape for function
what are the different types of fracture
buckle
transverse
oblique
spiral
segmental
salter-harris (growth plate)
comminuted
greenstick
Salter-Harris classification mnemonic
SALTR
type:1 Straight
2: Above - often a triangular fragment, better remodelling. Most common
3:beLow - goes through hypertrophic zone, germinal zone and so can lead to growth arrest, often happens in the ankle
4:Through - similar to 3 - growth arrest risk
5:cRush
management of fractures
1st = achieve mechanical alignment via closed / open reduction
2nd = relative stability to allow healing via external casts , plate and screws etc
pain management
1 - paracetamol or ibuprofen
2 - morphine
*morphine needs admission
what are the common congenital conditions in paediatric orthopaedics
clubfoot
CTV
neurofibromatosis
skeletal dysplasia
what are the common neuromuscular conditions paediatric orthopaedics
cerebral palsy
DMD
caves feet
adult vs child bone image
areas to ascertain in history
mechanism
time
location
analgesia !!!
PMHx
last meal
was it an accident ..? (NAI)
how would you examine a child
keep it simple
>rock paper scissors (ulnar, radial, median)
>A-OK
>thumbs up
>condylar - make sure CRT
T/F the periosteum in children is biologically active and is very thick
T - bend or bow
buckle vs greenstick fracture
buckle is a bend - compressive force - undisplaced pattern
greenstick is a split - powerful force - displaced
what is plastic deformation
child’s bone are ductile - do not get a distinct fracture line
advantage of children fracture
shorter immobilisation time
disadvantage of children fracture
elbow fractures
most are supracondylar fracture
-check ossificationa
-anterior humeral line and radiocapitellar line are ones to look at (if not in place, probably an elbow fracture)
what is fat pad sign
may be only clue in non-displaced fractures
supracondylar fractures
weakest part of the elbow joint
Gartland classification
potential for vascular compromise - check radial pulse and CRT
if its rotational you need to put in K wires
Gartland classification
toddler fractures
often undisplaced spiral fracture of tibia with no fibular fracture
need to examine everything if child refuses to bear weight
management of toddler fracture
above knee cast - not hard
remodels well
most common sites for NAI
rib fractures
femoral shaft fractures - red flag
unexplained fractures at different stages of healing - red flag
epiphyseal and metaphysical fractures of the long bones
femoral fracture <1 year
greater risks of abuse
first born
premature infants
stepchildren
children with learning or physical disability
