Pediatric Classifications Flashcards
SCHF Gartland
Type I Nondisplaced, beware of subtle medial comminution leading to cubitus varus
Type II Displaced, posterior cortex intact
Type III Completely displaced
Type IV*
Complete periosteal disruption with instability in flexion and extension
CRITOE
Ossification center/Years at ossification/Years at fusion Capitellum 1 / 12 Radius 4 / 15 Medial epicondyle 6 / 17 Trochlea 8 / 12 Olecranon 10 / 15 Lateral epicondyle 12 / 12
SCFE Loder
Stable
Able to bear weight with or without crutches
Minimal risk of osteonecrosis (<10%)
Unstable
Unable to ambulate (not even with crutches)
Associated with high risk of osteonecrosis (~47%)
SCFE ? From frog
Southwick Angle Classification
Mild 50°
SCFE %
Grading System for SCFE
Grade I 0-33% of slippage
Grade II 34-50% of slippage
Grade III >50% of slippage
Hip Septic
Kocher's 90% chance of septic arthritis if 3 out of 4 of the following are present q 1. WBC > 12,000 cells/µl 2. inability to bear weight 3. fever > 101.3° F (38.5° C) 4. ESR > 40 mm/h 5. CRP > 2.0 (mg/dl) * temperature > 101.3° (38.5° C) is the best predictor of septic arthritis followed by CRP of >2.0 (mg/dl)
OI
Type I Autosomal dominant blue Mildest form. Presents at preschool age (tarda). Hearing deficit in 50%. Divided into type A and B based on tooth involvement
Type II Autosomal recessive blue Lethal in perinatal period
Type III Autosomal recessive normal Fractures at birth. Progressively short stature. Most severe survivable form
Type IV Autosomal dominant normal Moderate severity. Bowing bones and vertebral fractures are common. Hearing normal. Divided into type A and B based on tooth involvement
Lateral Condyle Fracture
Milch or Lateral Displacement 1. Lateral to trochlear groove 2. Into trochlear groove Lateral 1. 4mm - displaced and rotated
Neurofibromatosis
NF1 (von Recklinghaussen disease)
most common
NF2
associated with bilateral vestibular schwannomas
Segmental NF
features of NF1 but involving a single body segment
Brachial Plexus
Narakas Classification
Group Roots Characteristics
Group I (Duchenne-Erb’s Palsy) C5-C6 Paralysis of deltoid and biceps. Intact wrist and digital flexion/extension.
Group II (Intermediate Paralysis) C5-C7
Paralysis of deltoid, biceps, and wrist and digital extension. Intact wrist and digital flexion.
Group III (Total Brachial Plexus Palsy) C5-T1 Flail extremity without Horner’s syndrome
Group IV (Total Brachial Plexus Palsy with Horner’s syndrome) C5-T1 Flail extremity with Horner’s syndrome
Radial head fractures
Chambers Classification Group 1: Primary displacement of radial head (most common) Valgus Injury A: Salter-Harris I or II B: Salter-Harris IV C: metaphyseal
Elbow Dislocation
D: reduction injury
E: dislocation injury
Group 2: Primary displacement of radial neck Monteggia variant
Group 3: Stress injury Osteochondritis dissecans
Langenskiold Classification
type I thru IV consist of increasing medial metaphyseal beaking and sloping
type V and VI have an epiphyseal-metaphyseal bony bridge (congenital bar across physis)
provides prognostic guidelines
CP (Function)
Gross Motor Function Classification Scale (GMFCS)
Level I Near normal gross motor function, independent ambulator
Level II Walks independently, but with limitations
Level III Dependent ambulator
Level IV Minimal walking ability, uses adult assisted or powered devices for community ambulation
Level V Nonambulator with global involvment, dependent in all aspects of care
CP (Anatomic)
Anatomic Classification
Quadriplegic Total body involvement and nonambulatory with a low IQ and a high mortality
Diplegic Legs more than arms but usually still ambulatory. IQ may be normal (injury in brain is midline)
Hemiplegic
Arms and legs on one side of the body, usually with spasticity; all will eventually be able to walk, regardless of treatment
CP (Physiologic)
Physiologic Classification
Spastic (most common) Velocity-dependent increased muscle tone and hyperreflexia with slow restricted movement due to simultaneous contraction of agonist and antagonist muscles. Most amenable to operative treatments.
Athetoid Characterized by constant succession of slow, writhing, involuntary movements
Ataxic Characterized by inability to coordinate muscle movements. Results in unbalanced wide based gait.
Mixed
Usually mixed spastic and athetoid features and involves the entire body
Hypotonic Usually precedes spastic or ataxic for 2-3 years
Myelodysplasia
Forms of myelodysplasia spinal bifida oculta defect in vertebral arch with confined cord and meninges meningocele protruding sac without neural elements myelomeningocele protruding sac with neural elements rachischisis neural elements exposed with no covering
Bado Classification
Type I Apex anterior proximal ulna fracture with anterior dislocation of the radial head
Type II Apex posterior proximal ulna fracture with posterior dislocation of the radial head
Type III Apex lateral proximal ulna fracture with lateral dislocation of the radial head
Type IV Fractures of both the radius and ulna at the same level with an anterior dislocation of the radial head (1-11% of cases)
Proximal Femoral fractures (Delbet)
Type Description Incidence AVN Nonunion Images
Type I Transphyseal (IA, without dislocation of epiphysis from acetabulum; IB, with dislocation of epiphysis) <10%, 90-100%
Type II Transcervical 40-50%, 50%, 15%
Type III Cervicotrochanteric (or basicervical) 30-35%, 25% , 15-20%
Type IV Intertrochanteric 10-20, 10%, 5%
Tibial Eminence Fracture
Meyers and McKeever Classification
Type I Nondisplaced
Type II Minimally displaced with intact posterior hinge
Type III Completely displaced
Tibial Tubercle fracture
Ogden Classification (modification of Watson-Jones)
Type I fracture of the secondary ossification center near the insertion of the patellar tendon
Type II
fracture propagates to proximal to the junction with the primary ossification center
Type III
fracture extend posteriorly to cross the primary ossification center
Modifier: A (nondisplaced), B (displaced)
Newer descriptions have been added to the original system
Type 4 is a fracture through the entire proximal tibial physis
Type 5 is a periosteal avulsion of the extensor mechanism from the secondary ossification center
Proximal humerus fracture
Neer-Horowitz Classification
Type I • Minimally displaced (< 1/3 of shaft width
Type III • Displaced greater than 1/3 and less than 2/3 of shaft width
Type IV • Displaced greater than 2/3 of shaft width
Stages of LCP
Stages of Legg-Calves-Perthes (Waldenström)
Initial • Infarction produces a smaller, sclerotic epiphysis with medial joint space widening • Radiographs may remain occult for 3 to 6 mos
Fragmentation •Femoral head appears to fragment or dissolve
• Result of a revascularization process and bone resorption producing collapse and subsequent increased density • Hip related symptoms are most prevalent
•Lateral pillar classification based on this stage
Reossification •Ossific nucleus undergoes reossification as new bone appears as necrotic bone is resorbed • May last up to 18m
Healing or remodeling •Femoral head remodels until skeletal maturity • Begins once ossific nucleus is completely reossified trabecular patterns returns
Lateral Pillar
Lateral Pillar (Herring) Classification Group A • lateral pillar maintains full height with no density changes identified • uniformly good outcome Group B • maintains >50% height • poor outcome in patients with bone age > 6 years B/C Border • lateral pillar is narrowed (2-3mm) or poorly ossified with approximately 50% height • recently added to increase consistency & prognosis of classification Group C • less than 50% of lateral pillar height is maintained • poor outcomes in all patient
Stages of Hip Deformity
Stages of Hip Deformity in Cerebral Palsy
Hip at risk
Hip abduction of 33%
Disrupted Shenton’s line
Treat with adductor tenotomy if abduction is restricted.
Consider proximal femur and pelvic osteotomies if significant dysplasia is present
Spastic dislocation
Frankly dislocated hip
Reimers index >100%
Open reduction with varus derotational osteotomy, + femoral shortening, and pelvic osteotomies
Windswept hips
Abduction of one hip with adduction of the contralateral hip
Brace adducted hip with or without tenotomy and release abduction contracture of abducted hip
