paediatric orthopaedics

Question 1

what are growth plates (physis)

Answer 1

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

Question 2

do children have more cancellous or cortical bone

Answer 2

cancellous

ie more flexible but less strong > greenstick fractures

Question 3

what is bone remodelling

Answer 3

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

Question 4

what are the different types of fracture

Answer 4

buckle
transverse
oblique
spiral
segmental
salter-harris (growth plate)
comminuted
greenstick

Question 5

Salter-Harris classification mnemonic

Answer 5

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

Question 6

management of fractures

Answer 6

1st = achieve mechanical alignment via closed / open reduction
2nd = relative stability to allow healing via external casts , plate and screws etc

Question 7

pain management

Answer 7

1 - paracetamol or ibuprofen
2 - morphine
*morphine needs admission

Question 8

what are the common congenital conditions in paediatric orthopaedics

Answer 8

clubfoot
CTV
neurofibromatosis
skeletal dysplasia

Question 9

what are the common neuromuscular conditions paediatric orthopaedics

Answer 9

cerebral palsy
DMD
caves feet

Question 10

adult vs child bone image

Answer 10

Question 11

areas to ascertain in history

Answer 11

mechanism
time
location
analgesia !!!
PMHx
last meal
was it an accident ..? (NAI)

Question 12

how would you examine a child

Answer 12

keep it simple
>rock paper scissors (ulnar, radial, median)
>A-OK
>thumbs up
>condylar - make sure CRT

Question 13

T/F the periosteum in children is biologically active and is very thick

Answer 13

T - bend or bow

Question 14

buckle vs greenstick fracture

Answer 14

buckle is a bend - compressive force - undisplaced pattern
greenstick is a split - powerful force - displaced

Question 15

what is plastic deformation

Answer 15

child’s bone are ductile - do not get a distinct fracture line

Question 16

advantage of children fracture

Answer 16

shorter immobilisation time

Question 17

disadvantage of children fracture

Question 18

elbow fractures

Answer 18

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)

Question 19

what is fat pad sign

Answer 19

may be only clue in non-displaced fractures

Question 20

supracondylar fractures

Answer 20

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

Question 21

Gartland classification

Question 22

toddler fractures

Answer 22

often undisplaced spiral fracture of tibia with no fibular fracture
need to examine everything if child refuses to bear weight

Question 23

management of toddler fracture

Answer 23

above knee cast - not hard
remodels well

Question 24

most common sites for NAI

Answer 24

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

Question 25

greater risks of abuse

Answer 25

first born
premature infants
stepchildren
children with learning or physical disability