Paeds Ortho

Question 1

Parts of bones

Answer 1

Epiphysis
-cartilaginous in infants, site of secondary ossification centre in older children
Physis
-growth plate
Metaphysis
-where the bone flares
-contains the physics
Diaphysis
-shaft
Only the diaphysis and the metaphysis are present in adults

Question 2

Salter Harris

Answer 2

1a - traumatic
1b - endocrine factors likely (eg SUFE), avascular necrosis can occur, late adolescence
2 - “above” - on the epiphyseal side of growth plate. commonest, need to reduce <48 hours, early adolescence
3 - lower and upper tibia most affected (lower = Tillaux)
4 - lateral condyle humerus most commonly
5 - “ruined” can be crushed in severe abduction/adduction

Question 3

Clavicle fracture classification

Answer 3

1 - medial end
3 - distal end
(A - undisplaced
B - displaced
1 - extra-articular
2 - intra-articular)
2 - midshaft
A1 - undisplaced
A2 - angulated
B1 - simple or wedge comminuted
B2 - isolated or comminuted segmental

Question 4

Toddlers fracture

Answer 4

9months -3 years
Result of twisting
Spiral/oblique distal tibial shaft #
Intact fibular

Question 5

CRITOE

Answer 5

Capitallum - 1
Radial head - 3
Internal condyle - 5
Trochlea - 7
Olecranon - 9
External epicondyle - 11

Question 6

Supracondylar # - complications

Answer 6

Vascular injury
Volkmann’s contracture
Myositis ossificans
Malunion
Median nerve injury
Compartment syndrome

Question 7

Supracondylar fractures - classifications and diagnosis

Answer 7

98% extension injuries with posterior displacement, anterior is rare (2%) and occurs in flexion injuries
Garland system
-draw the anterior humeral line - does the capitellum pass through this? (normal or type 1 - undisplaced) or behind? (abnormal - either type 2 - angulated - or 3 - displaced)

Question 8

Pulled elbow

Answer 8

<4yo
partial displacement of the radial head from the annular ligament
XR will be normal
Correct with extension and hyperpronation or supination and flexion

Question 9

Limp - hx

Answer 9

Duration
Fever/night sweats
Recent illness
Chronic illnesses
Night pain
Precipitating activities
Trauma
Day/night pattern of pain
Pain - location/character/duration
Previous MSK injuries
Sports

Question 10

Types of non-antalgic limp

Answer 10

Steppage
-foot drop
Trendelenburg
-affected side lifts during swing phase
Circumduction
-affected leg is abducted and externally rotated due to knee/ankle issues or leg length discrepancy
Equinus
-talipes, CP, tight TA

Question 11

Examination in limp

Answer 11

Hip held in FABER position - joint effusion
Loss of internal rotation - hip joint pathology eg Perthes disease
Loss of abduction - DDH
Obligate external rotation when hip is flexed - SUFE
Positive FABER test - SIJ pathology

Question 12

SUFE

Answer 12

85% are chronic
Antalgic gait, out-toeing
Shortening
Pain in hip or groin OR knee
More common in boys 60:40
Obesity main cause
12-13yo
0.2-10/100 000
Obligatory external rotation and abduction when hip is flexed passively
Loss of internal rotation

Question 13

Injuries that are common in NAI

Answer 13

Multiple fractures
Multiple rib fractures - 70% chance of abuse
Femur fracture - 25-33% chance
Midshaft humeral fracture - more likely abuse than not
Skull fracture - 33% chance