Pediatric Pathologies Flashcards
Four phases of pathophysiology of Osteochondrosis.
- Phase of avascularity
- Phase of revascularization
- Phase of bone healing
- Phase of residual deformity.
Osteochondrosis
Idiopathic
Avascular necrosis of epiphysis
May cause permanent deformity
Self limiting.
Most common 3-10; boys >girls
Osteochondrosis: phase of avascularity
First Stage
Obliteration of blood vessels to epiphysis
Asymptomatic
Osteocytes and marrow die. Bone remains unchanged.
Months, years
Osteochondrosis: phase of revascularization …
… With bone deposition and resorption
Revascularization of dead epiphysis
Months later
May lead to pathological fracture, subluxation, deformity.
Pain.
Synovial effusion and hypertrophy
Fibrous and granulation tissue rxn results in excessive resorption
Osteochondrosis: phase of bone healing
Third phase
Resorption ceases. Deposition continues.
Granulation tissue replaced by new bone.
Osteochondrosis: phase of residual deformity
Fourth phase
Once bony healing of epiphysis is complete, contours unchanged
Residual deformity may lead to premature degenerative changes
Scheuerman’s disease
Osteochondrosis of thoracic spine
Kohler’s disease
Osteochondrosis of navicular
Panners disease
Osteochondrosis of capitulum
Freiburg infraction
Osteochondrosis of second/third metatarsal
Keinbock’s disease
Osteochondrosis of lunate
Osgood Schlatter disease
Osteochondrosis of tibial tuberosity
Occurs during period of growth, most commonly in active boys.
Pain, inflammation that goes away with rest.
No necrosis.
Leg-Calves Perthes
Osteochondrosis of femoral head
Inadequate blood supply; typically affects one hip
Most common among boys 2-12.
Can cause permanent deformity, increased risk of OA
Chandlers disease
Osteochondrosis of hip; Legg-Calves Perthes in adults.
Spontaneous; idiopathic
Pain, collapse of femoral head.
Hip reacement surgery.
Sever’s disease
Osteochondrosis of the calcaneus
“Calcaneal apophysitis”
Inflammation in growth plate in heel.
At Achilles’ tendon attachment.
Active children during growth spurt. Mostly boys.
Nursemaids elbow
Subluxation of radial head from annular ligament.
Osteogenesis imperfecta
Brittle bone disease
Congenital
Deficient or poor Type I collagen
Autosomal dominant. Or recessive. Or de novo (8 types).
Blue sclera. Hearing loss. Loose joints. Hypotoned muscles. Growth retardation. Barrel chest. Bad teeth.
No cure.
Rickets
Softening of bones in children
Potentially leading to fractures and deformity.
Breastfed, dark skin, indoors, malnourished.
Related to Vitamin D deficiency; also calcium and/or phosphorus deficiency.
Gigantism/Giantism
Overgrowth of long bones due to excessive HGH secretion BEFORE growth plate closes.
Hyperpituitarism – most commonly pituitary adenoma
Acromegaly
Excessive HGH production AFTER epiphyseal plate has closed.
Most common cause pituitary adenoma
Headaches, DM,CV problems, kidney failure, frontal bossing
Achondroplasia
Dwarfism of short limb type. Most common.
Autosomal dominant or mutation (double dominant = die in infancy)
Failure of longitudinal growth in cartilage of epiphyseal plate.
Thick bones. Hydrocephaly. Genu valgum or varum.
Arthrogryposis Multiplex Congenita.
Congenital contractures (“bent joints”) in two or more joints
Caused by anything that limits fetal joint movement in utero.
– oligohydramnios, CT disorders, neuro disorders.
Aplasia/hypoplasia of muscle groups in utero.
Fat and fibrous tissue invade muscle.
Still’s disease
Systemic juvenile arthritis
Idiopathic
Characterized by high spiking fevers and transient rashes.
Lymphadenopathy
Hepatosplenomegaly
Hepatitis
Serositis
50% remission rate
Spina bifida
Most common congenital abnormality of the spine
Incomplete closure of neural tube, most commonly lumbo-sacral region.
3 forms of spina bifida
- Spina bifida occulta (most common, least severe)
- Meningocele
- Myelomeningocele
Hemivertebrae
Congenital deformity of the body of the vertebrae. Usually upper L and lower T spine.
Usually other vertebral anomies
Can lead to structural scoliosis.
Idiopathic
Syndactyly
Most common congenital abnormally of the hand. Can also affect feet.
Lack of apoptosis. Fusion of digits.
Most common in white males
Polydactyly
Congenital. Extra digit on hands or feet.
Inherited or multifactorial.
Clubfoot
Congenital talipes equinovarus
Most common congenital foot deformity.
Inversion of foot.
Idiopathic. 50% bilateral.
Boys>girls.
Aplasia
Congenital absence of an organ, tissue or part
Hypoplasia
Congenital underdevelopment of an organ, tissue or part.
Hyperplasia
Congenital overdevelopment of an organ, tissue or part.
Pott’s disease
Infectious arthritis of the spine caused by mycobacterium tuberculosis.
Isidious. Develops 2-3 years after infection.
Infection starts in vertebral body and spreads to IVD and adjacent vertebrae
Can lead to vertebral collapse and Potts paraplegia. .
Scoliosis.
Abnormal lateral curvature of the spine.
L spine – left more common
T spine – right more common.
Idiopathic (80%)
Osteopathic – due to bony abnormalities
Myopathic – due to muscle weakness
Neurologic
