Peds MSK Flashcards
Salter Harris Fracture Classification
- S = Straight across the physis
- A = Above the physis (most common)
- L = BeLow the physis
- T = Through the metaphysis and epiphysis
- R = CRushed physis
Meta-Diaphyseal Fractures
- Complete
- Greenstick - one-sided
- Buckle/Torus - buckled cortex without frank fracture
- Pipe (greenstick + buckle)
- Bow/Plastic - bending without fx
Apophyseal Fractures
Avulsion Fx
Apophysis is avulsed off
Common sites of Apophyseal Fractures
- ASIS (sartorius, extension with knee flexed)
- AIIS (rectus femoris, forceful extension)
- Iliopubic Ramus
- Ilioischial spine
Toddler’s Fracture
3 types
9 mos- 3 years (walking babies)
Type of stress fracture
- Oblique through tibial shaft
- Calcaneal
- Incomplete fx of anterior cortex of prox. femur
IF SPIRAL – concern for NAT
Peds Stress Fractures
Repetetive trauma
After new activity or new walking
Usually Prox Tibia, posterior cortex
Calcaneal fractures after cast comes off and child starts walking again
Elbow ossification centers and ages
CRITOE
1, 3, 5, 7, 9, 11 in girls
2, 4, 6, 8, 10, 12 in boys
Capitellum
Radial Head
Internal Epicondyle
Trochlea
Olecranon
External Epiphysis
Radiocapitellar Line
Through center of proximal radius
Should intersect middle of capitellum on EVERY view
If not- radial dislocation/subluxation
Anterior Humeral Line
ONLY on LATERAL view
Passes through middle 1/3 of capitellum
Supracondylar fracture – will run through anterior 1/3
Unstable Lateral Condyle Fracture (elbow)
Passes through capitello-trochlear grooce
Tx is based on displacement of the fracture fragment >2 mm
Salter Harris 4
Lateral Condyle fractures are 2nd most common distal humerus fx’s in kids
Medial Epicondyle Avulsion Fracture
Common
Little League Elbow
Fragment can get stuck b/w articular surfaces of humerus and olecranon
Won’t necessarily cause joint effusion b/c extra-articular structure
If trochlea is seen- the medial epicondyle should also be ossified (CRITOE)
UNCOMMON Elbow fractures
Lateral EPIcondyle fx
Medial CONDYLE fx
Nursemaid’s Elbow
Radial Head subluxes into annular ligament
XR needs to be done with arm supinated in lateral position (often relocates it)
Siding-Larsen-Johansson
Chronic traction injury
Patellar tendon on inferior pole of patella
Thickened patellar tendon
Edema of inferior pole of patella can be seen
Ossific bodies can be seen in tendon
Active kids 10-14 yo
Cerebral Palsy increases risk
Osgood Schlatter
Repeated microtrauma to patellar tendon on insertion onto TIBIAL TUBEROSITY
20% bilateral
M>F
Active kids
Overlying STS
Cortical Desmoid
AKA Distal Femoral Metaphyseal Irregularity
Posteromedial distal femur
Seen best on lateral, also AP sometimes
“Scoop Like Defect”
Irregular but intact cortex
Blount’s Disease
Tibia Vara
Growth d/o of medial proximal tibial metaphysis
Varus angulation results (at metaphysis NOT at knee)
Incidence at Age 2 and again at Age 12
Usually bilateral (2 sides, not before age 2)
Later –> Medial metaphysis depression + osseous outgrowth
Assoc. with Medial Meniscus Hypertrophy
Periosteal reaction in Newbowns DDx
- Congenital Rubella
- Syphilis
- Caffey’s DIsease (infantile Cortical Hyperostosis)
- Prostaglandin therapy
- Neuroblastoma mets
- Physiologic growth
- Abuse
Congenital Rubella
Celery stalk appearance of metaphysis from generalized lucency of the bone
first few weeks of life
Syphilis
Bony changes at 6-8 weeks old (later than Rubella)
Lucent Metaphyseal bands and periosteal reaction along LONG bones
Wimberger’s Sign = destruction of medial prox. tibial metaphysis (95% of cases)
Caffey’s Disease
Infantile Cortical Hyperplasia
Self limiting
First 6 months of life
STS + periosteal reaction –> bone thickening
Really hot mandible on bone scan
Clavicle and Ulna also common sites
VERY RARE
