Paediatric Orthopaedics and Normal Variation Flashcards
Anatomy of a childs bone
epiphysis (cartilage) physis metaphysis diaphysis (shaft) apophysis
What part of the bone is the growth plate?
physis
What part of the bone contains the secondary ossification centre?
epiphysis
What part of the bone contains the primary ossification centre?
metaphysis and diaphysis
Features of a babys knee compared to an adults X ray
no platella
no proximal tibia
no joints
BECAUSE LARGE PORTION IS STILL CARTILAGE
Biomechanical differences of childrens bones compared to adults
Bones are bendy
Ligaments stronger than growth plate
more porous bones
- tolerates more deformation (plasticity)
- fails in compression as well as tension
Physiological differences of childrens bones vs adults
remodelling - doesn't occur in adults - heals with an angle, then straightens - over a few months overgrowth progressive deformity speed of healing much faster
What is a self correcting or non concerning pathology?
Will sort itself out, not a true pathology
Examples of self correcting pathologies
persistent femoral anteversion
metatarsus adductus
posterior tibial bowing
curly toes
What are some possible parental presenting concerns?
out/in toeing bow legs knock knees tip toe walking flat feet curved feet curly toes
David jones system of 5Ss
symmetrical symptomatic systemic illness skeletal dysplasia stiffness
types of alignment
rotational alignment (around the axis angular alignment (usually coronal)
Presentation of angular alignment
knocked knees
bow legs
flat feet
What is natural about babies feet?
they are flat - large medial foot pat in the arch and have not learnt yet to walk or weight bear
What is the main immunoglobulin found in breast milk?
IgA
What is a complete fracture?
Both sides of cortex are breached
What is a toddlers fracture?
Oblique tibial fracture in infants
What is a plastic deformity?
Stress on bone resulting in deformity without cortical disruption
What is a greenstick fracture?
Unilateral cortical breach only
What is a buckle fracture?
Incomplete cortical disruption resulting in periosteal haematoma only
What classification system is used to classify paediatric fractures that affect the growth plate?
Salter-Harris system
Salter harris system scores
I - fracture through physis only (x ray often normal)
II - Fracture through metaphysis and physis
III - fracture through the physis and the epiphysis to include the joint
IV - fracture involving the physis, metaphysis and epiphysis
V - crush injury involving physis (x ray might resemble type I and appear normal)
What is the name for clubfoot and when is it picked up?
Talipes Equinovarus
Picked up on newborn exam
Presentation of clubfoot
Inverted and plantar flexed foot
Not passively correctable
