Pediatric MSK Flashcards
what is the most common salter Harris fracture?
type 2 (75%)
Which SH fractures are ass w/ complications. What are they and mx?
- Type 3-Growth arrest. Require surgery
- Type 4: growth arrest, focal fusion. Require anatomic reduction (often sx)
- type 5-poor prognosis.
“bony bridge across physics”
type 5 SH
A physeal bar or partial premature physeal arrest is a result of injury or infection to an unfused physis. It consists of a bony bridge crossing the growth plate that results in growth disturbance and/or deformity.
These bars form when the cartilage barrier is breached as a result of infection or trauma, this abnormal connection of metaphysis and epiphysis can be fibrous or osseous.
physeal bar
early bony bridge crossing growth plate
-inf or trauma
how long for periosteal rxn to appear on xray?
7-10 d
toddler fx
oblique fracture; 9 mo-3 yr
-if spiral, question child abuse
Wimberger sign
destruction of medial portion proximal metaphysis of tibia ass w/ syphilis. Pathogmonic.
torch infections w/ osseous change
-rubella (50%, appears ~wks) & syphilis (95%, appears ~6-8 wks)
syphilis osseous change
95%
- app 6-8 wks
- metaphyseal lucent bands, periosteal rxn
- “wimberger sgx”-destruction of medial portion proximal tibial metaphysis
*Treponema pallidum
rubella osseous change
50%
- ~wks
- “celery stall”-generalized lucency of metaphysics
Caffey dx
aka infantile cortical hyperostosis
- ST swelling, periosteal rx, irritability ~6 mo’s life
- HOT MANDIBLE –> clavicle –> ulna
- self-limiting
Effects of PgE 1 & 2
periosteal rxn
-look for sternotomy wires
neonatal periosteal rxn
- cong rubella, syphilis
- caffey
- PgE 1 & 2
- NB mets
- physiologic (NOT newborns, ~3 mo)
- abuse
physiologic periostitis of newborn-rules
NOT newborns (~3mo’s)
- first involves femur THEN tibia
- always involves DIAPHYSIS
3 classic appearances LCH
- beveled edge (uneven destruction inner and out tables)
- ribs-mult lucent lesions, expanded appearance
- spine-pancake/vertebra plant
“septic tank”
crossing vess close and infection cannot escape
when does OM bony change appear?
day 10
Define:
-brachy-, poly-, syn-, camp-, clino-, arachnodactyly
- short
- too many
- fused
- contracture
- radially angulated (usually 5th)
- spider like
a-, mero-, acro-, meso-, rhizo-, micromelia
- limb absent
- mostly absent
- hands/feet (distal limbs) are short
- forearm/lower leg (middle limb) short
- femur/humerus (prox lims) short
- short all over
Dwarfism-subtypes to know
- achondroplasia=mc
- thanatophoric=mc lethal
- asphyxiating thoracic dystrophy (Jeune)-usually fatal
- ellis-van crevald
- pseudoachondroplasia
- pyknodysostosis
achondroplasia-moa, RF, classic findings
- mc skel dysplasia
- fibroblast GF rec problem. FGFR3–> abN cartilate formation. Affects bones formed by endochondra oss, not mesenchymal
- RF-advanced paternal age
- Symmetric shortening of all bones, rhizomelia=most prom.
- tomb stone iliac crest, narrowing interpedicular distance, trident hands (3rd/4th long fingers), rhizomelia, flat acetabula w/ short femoral necks
thanatophoric dysplasia
- mc lethal dwarfism
- rhizomelia-“telephone receiver”
- very short ribs w/ long thorax
- small/squared iliac bones
- cloverleaf skull
- flat vertebral bones (platyspondyly)
asphyxiating thoracic dystrophy (jeune)
- usually fatal
- “bell shaped thorax” w/ short ribs that are bulbous anterior
- high-riding handlebar clavicle
- trident acetabulum
- vs thenatophoric dysplasia: Jeune has normal vb’s
- chronic nephritis if survive
Gorlin syndrome
bifid ribs
falx calcifications
basal cell cancers
odontogenic keratocysts