Pediatrics Flashcards
What are the important anatomical distinctions between peds and adult fractures?
peds have thicker (and more vascularized) periosteum and high vascularity around growth plate (physis), also increased cartilage and decreased (flexible) bones
define epiphysis, diaphysis, metaphysis, and apophysis
- Epiphysis = end of the bone next to the joint
- Metaphysis = adjacent to the growth plate before the diaphysis
- Diaphysis = shaft of the bone
- Apophysis = developmental outgrowth of bone attachment sites for tendons and ligaments (variable appearances and are often mistaken for fracture
what are the processes of peds fracture healing?
remodeling or growth arrest
what does the presence of a non-fused growth plate indicate?
pt skeletally immature
what site in the bone is most susceptible to avulsions in peds?
apophysis
what is the most common class of peds fracture (Salter-Harris)?
type 2 (SHF) through growth plate and metaphysis
can kids remodel intra-articular fractures?
no
what is the most common peds fracture?
distal radius –> hand –> elbow
what are the ossification centres in kids?
Capitulum, radial head, medial epicondyle, trochlea, olecranon, lateral epicondyle
why are fractures at the wrist and elbow especially dangerous?
proximity to vessels can lead to displaced fracture w vascular compromise (needs emergent surgical reduction) and nerve injuries
what complication is often associated with elbow dislocation?
medial epicondyle impacted fracture
closed reduction; check stability and ROM after reduction
why do ACL tears in peds need special operation?
save growth plate, prevent growth arrest
difference between peds and adult acute knee injuries?
peds commonly need MRI
don’t tend to dislocate their knee when growth plate is still open
what two cranial fractures are indicative of NAT?
bucket handle fracture and corner fracture
what is the reduction maneuver for pulled elbow?
supinate and flex elbow
what is the most common route of infection in septic arthritis?
hematogenous-bacteremia associated w UTI/skin/GI infections
other:
direct inoculation (foreign object)
contiguous spread: osteomyelitis
what is the pathogenesis of septic arthritis?
bacteria deposit in synovium, produce inflammation and spread to synovial fluid, inflammatory products destroy joint components (swelling, pain)
what is the gold standard Dx for septic arthritis?
joint aspirate and WBC count
what are the kocher criteria for septic arthritis?
fever 38.5, refuse to bear wt, ESR 40mm/hr, WBC >12,000
how do we differentiate between septic arthritis and toxic synovitis?
synovitis: inflammatory, after viral illness, fever absent, WBC/ESR normal, bland aspirate, negative culture
diagnosis of exclusion
what is the most common ortho disorder of newborns?
developmental dysplasia of hip (DDH); instability of the hip joint
what maneuvers can be used to Dx DDH?
ortolani, barlow, galleazi
- Ortolani: assumption that ball is out of socket and you are pushing it in
- Barlow: assumption that ball is in socket and you are pushing it out
- Galleazi: leg height discrepancy
what risk factors contribute to DDH?
female, breech birth, low aminotic fluid, first born, swaddling
what is the Tx for DDH?
pavlik harness (concentric reduction; frog leg position), surgery if needed
what causes Slipped capital femoral epiphysis (SCFE)?
prox femoral physis lead to shearing and displacement
things to look for when suspecting NAT
- Subdural hematoma
- Shaken baby
- Old fractures
- Vision
- Failure to thrive
- Inconsistent story
causative agents of septic arthritis
- Neonates: streptococcus, gram negative
- Infants & Children: staph, haemophilus influenza, salmonella
- Adolescent: staph, nesseria gonorrhoea
- Adults: staph, strep, gram negative
- IV drug: pseudomonas and atypical organisms
what is Legg-Calve-Perthes Disease
Idiopathic avascular necrosis of the proximal femoral epiphysis
10 features that make you suspect non-accidental trauma
- Age
- Social situation
- Delayed presentation
- Unlikely story
- Low weight
- Delayed developmental milestones
- Twin
- Difficult/irritable baby
- Previous hospitalizations for respiratory illness
- Bruises on her spine
