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Orthopaedics and Trauma > Paediatric T&O > Flashcards

Paediatric T&O Flashcards

1
Q

What is a greenstick fracture?

A

Fracture of one cortex but not the other, with angulation

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2
Q

Salter-Harris classification of epiphyseal fractures

A

I: Slipped

II: Above physis

III: Lower than physis

IV: Through physis

V: Rammed together (low threshold for MRI if suspected)

Indicates prognosis

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3
Q

Epidemiology of epiphyseal fractures

A

10% of paed fractures

Happen mainly in 10-16yo because muscles/tendons >> than growing bone

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4
Q

Order of ossification centres of the elbow

A

Capitellum - 1yo

Radial head - 3yo

Internal (medial) epicondyle - 5yo

Trochlea - 7yo

Olecranon - 9yo

External (lat) epicondyle - 11yo

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5
Q

Most common paediatric elbow injury

A

Supracondylar humerus fracture from FOOSH, commonly 4-10yo

MUST ASSESS N-V status

requires proper reduction to prevent varus malunion

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6
Q

Gartland classification of supracondylar fractures

A

I: Subtle, undisplaced, posterior fat pad, for splinting/cast 3-4w

II: Displaced but posterior cortex intact

III/IV: Completely displaced, comminuted/rotated, needs operative management (must check radial and median nerve!)

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7
Q

Red flags for NAI

A

Posterior rib fractures

Fractures in non-walkign children <1yo (esp long bone)

Multiple Hx of fractures (or diff stages of healing)

Bruising (or diff stages of healing)

Mechanism not compatible

Parental Hx contradictory

Delay in seeking treatment

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8
Q

Types of paediatric fracutre

A

Plastic deformation

Greenstick fracture

Complete fracture

Buckle/torus fracture (from axial force)

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9
Q

Limping child differential age 0-5

A
  • Painful
    • Septic arthritis, osteomyelitis
    • DDH + dislocation?
  • Painless:
    • Cerebral palsy
    • Limb length discrepancy
    • DDH
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10
Q

Limping child differential age 5-10

A

Trauma

Perthes

haem disease

Malignancy

JRA/SLE

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11
Q

Limping child differential 10-15

A

SUFE

Trauma

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12
Q

Presentation of SUFE

A

Overwight, osteodystrophy, hypothyroid are risk factors

Weight-bearing trauma

Boys 10-15 during growth spurt

Needs operative stabilisation

May lead to knee pain, hip ext rot + abducts during flexion, limited internal rotation

Line drawn through outer femoral neck does not intersect epiphysis

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13
Q

Perthes disease pathophysiology

A

Idiopathic avascular necrosis of femoral head, 10% bilateral

Femoral head dissolves, reossifies, remodels

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14
Q

Presentation of Perthes

A

Males 4-8

Risk: 2nd hand smoke, ADHD, low birth weight

Limp, no history of trauma, hip/knee movement painful

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15
Q

Management of Perthes

A

<6 non-operative (activity modification, physio, analgesia)

>6 or collapsed head –> operative

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16
Q

Pathophysiology of septic arthritis

A

Haematogenous/bone spread

Proteolytic enzymes –> damage cartilage

Effusion –> bone head necrosis

Knee > hip > elbow/ankle

H. influenzae in kids most common

17
Q

Risk stratification of septic arthritis

A

Not weight bearing

Fever

WCC >12

ESR >40

3,40,90,98% risk

18
Q

Risk factors for septic arthritis in children

A

Neonates

Prematurity

C-section

19
Q

Presentation of DDH

A

Young child, limp

Risk: FH, first-born, breech position, female

Bilateral in 20%

20
Q

Pathophysiology of DDH

A

Intrauterine malpositioning and/or ligamentous laxity

Shallow acetabulum –> more prone to hip dislocation

21
Q

Management of DDH

A

<6mo pavlik harness for 6w (discontinue if not reduced by 3w)

6-18mo: arthrogram hip spica for 3mo

>18mo: open surgical management

22
Q

Presentation of transient synovitis

A

Hip pain

5-10 yo

Associated with recent URTI/viral illness

Able to weight bear, no fever or systemic unwellness

23
Q

Management of transient synovitis

A

Analgesia, marked improvement in 24-48h

24
Q

Osgood-Schlatter’s disease presentation

A

Boys 12-15yo

Frequent jumpers/sports

Pain + enlarged tibial tubrcle

25
Q

Pathophysiology of Osgood-Schlatter’s

A

Extensor mechanism stronger than tibial apophysis –> fragmentation + irregular tubercle

26
Q

Management of Osgood-Schlatter’s

A

Self-limiting, reduce activity until more manageable

27
Q

Congenital talipes equinovarus pathophysiology

A

Strong genetic component (5% risk for future children)

Often bilateral

Cavus midfoot

Adducted forefoot

Varus hindfoot

Equinus hindfoot

28
Q

Management of club foot

A

Ponseti cast/brace with weekly changes from birth to 5 years

Surgery if intractable

29
Q

Syndactyly presentation

A

Fusion of fingers, may be soft tissue or bone as well

Commonly middle and ring fingers

Complex hand deformities assoc w/ VACTREL

30
Q

Syndactyly association

A

Vertebral defects

Anal atresia

Cardiac defects

Tracheo-osophgeal fistula

Renal anomalies

Limb abnormalities

31
Q

Pathophysiology of cerebral palsy

A

Non-progressive but permanent CNS injury in utero or <2yo

32
Q

Presentation of cerebral palsy

A

Gait abnormalities, dyskinesia, spasticity

Contractures worsen with growth

33
Q

Management of cerebral palsy

A

MDT + physio

Medical: botox, baclofen for spasticity

Surgical: Tnotomies or tendon lengthening or osteotomies

34
Q

Investigating osteomyelitis

A

Radiographs may be non-specific/normal for 10-14d

WCC normal in 60%

CRP rises within 8h, peaks at 2d, normalises within 1 week

35
Q

Diagnosis of DDH

A

Barlow’s + Ortolani’s tests (<3mo)

Older –> asymmetry of abduction

X-ray after 6mo

USS <6mo

36
Q

What is the Ponseti method?

A

Serial casting in progressive corrective manipulation

Treatment of club foot

37
Q

Barlow test

A

Adduct hip and push back (i.e. posteriorly)

Should passively dislocate hip if DDH present

38
Q

Ortolani test

A

Done after Barlow to confirm

Aims to reduce hip back, should hear audible clunk

39
Q

Hard sign of hip dislocation

A

Limited abduction of hip

Orthopaedics and Trauma (8 decks)

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