Peds MSK/Peds injury Flashcards
What is a Salter-Harris type I injury?
Separation through the physis usually through areas of hypertrophic and degenerating cartilage of cell columns
S**traight across **ALTER
What is a Salter-Harris type II injury?
Fracture thorugh a portion of the physis that extends through the metaphyses
SA**bove**LTER
What is a Salter-Harris type III injury?
Fracture through a portion of the physis that extends through the epiphysis and into the joint
SA** be**L**ow **TER
What is a Salter-Harris type IV injury?
Fracture across the metaphysis, physis, and epiphysis
SAL T**hrough **ER
What is a Salter-Harris type V injury?
Crush injury to the physis
SALT ERasure of growth plate/cRush
What are secondary ossification centers?
Areas of bones that are growing butt are not the primary spot of growth. They are often found near the epiphyses and look brighter white on x-ray.
What is a transverse fracture?
A fracture straight across the bone
What is an oblique fracture?
A fracture diagonally through the bone
What is a spiral fracture?
A twisting fracture around the bone
What is a comminuted fracture?
A fracture where the bone breaks into multiple pieces
What is fracture displacement?
When the fractured bones are moved laterally, angulated, rotated, or shortened in relation to their normal position
What is the cause of a torus or buckle fracture?
A fracture from a compressive load (ex. falling on outstretched hands) that causes the bony cortex of the metaphysis to buckle
When are torus/buckle fractures most common?
In a child with an immature skeletal structure, the incidence decreases when the metaphyseal region is stiffer
What fracture would be caused if a child falls on their outstretched hands?
A torus or buckle fracture
Where does a greenstick fracture typically occur?
They are incomplete fractures that often occur at the junction of the diaphysis and metaphysis
What is a bowing fracture?
A fracture that occurs when the bone bends without a clear fracture line. It occurs in children due to pliability of pediatric bones.
What is a toddler’s fracture?
An oblique, non-displaced fracture in the distal tibia of an ambulating child under 5 y.o.
What causes a toddler’s fracture?
Ususally a result of a twist in the lower leg, often when running or falling. It could happen if the child’s leg is caught and they twist their leg to free it.
What are the clinical signs of a toddler’s fracture?
Limping or refusal to bear weight on the affected leg. Usually minimal swelling and diffuse tenderness. Subtle changes on x-ray.
What is nursemaid’s elbow?
Radial head subluxation that can occur by pulling on a child’s extended arm
What injury might occur if a 4 year old gets their leg stuck between chairs and twists it to pull it out?
A toddler’s fracture (oblique non-displaced fracture of distal tibia)
What injury might happen if an adult pulls a falling child up by the hand?
Nursemaid’s elbow - radial head subluxation
What is the mechanism of injury in nursemaid’s elbow?
The traction from pulling on the radius moves the radial head distally from the elbow joint, trapping the annular ligament between the radial head and the capitellum
What is the clinical presentation of nursemaid’s elbow?
The child will not use the affected arm. The child will have no pain at rest, no tenderness to palpation. The arm will be at the child’s side pronated and partially flexed. Movement is painful.
How do you treat nursemaid’s elbow?
Hyperpronation or supination flexion methods to pop the ligament back in place
What is a slipped capital femoral epiphysis?
An injury that results from instability of the proximal femoral growth plate, resulting in slippage of the epiphysis relative to the femoral neck
When does slipped capital femoral epiphysis normally occur?
In adolescents during periods of rapid growth (particularly in boys, obese patients, and patients with endocrine disorders)
What is the clinical presentation of slipped capital femoral epiphysis?
Chronic knee, thigh, or groin pain with a limp. Hip is externally rotated with limited flexion and internal rotation on physical exam. X-ray shows widened growth plate with epiphyseal slippage.
What is the treatment for slipped capital femoral epiphysis?
Pinning to prevent further slippage until the epiphysis closes
A 3 y.o. girl has leg pain and a limp after falling and twisting her leg. Is she more likely to have a fracture or a sprain? Why?
A fracture - pediatric bones are more pliable and ligaments are relatively stronger than pediatric bone
she probably has a toddler’s fracture of her distal tibia
What type of fracture is most likely to cause growth disturbance in a child?
A Salter-Harris type V injury (crushed growth plate) because it completely destroys the growth plate
What are the differences in radiographic appearance of a bowing fracture compared with a greenstick fracture?
A bowing fracture is when the bone bends without a clear break in the cortex.
A greenstick fracture is an incomplete fracture.
The non-broken side of a greenstick fracture can look like a bowing fracture, but the other side will have a clear break on x-ray.
What is the main difference in trends of pediatric and adult overuse injuries?
Adults tend to injure tendons/ligaments because they are weaker than adult bones. Kids tend to injury bones at the physis or apophysis because their bones are relatively weaker than their tendons/ligaments
What is Sinding-Larsen-Johansson injury?
Inferior patella apophysitis caused by irritation of the accessory growth area (apophysis) of the inferior patella
What is the treatment for Sinding-Larsen-Johannson apophysitis?
Treatment of symptoms, stretching, patellar strap around knee
What age groups are most affected by Sinding-Larsen-Johansson?
11-12 year olds
What is Osgood-Schlatter syndrome?
Inflammation of the patellar ligament at the tibial tuberosity, leads to a bump on the tibial tuberosity
What condition is suggested by this x-ray?
Osgood-Schlatter Syndrome (inflammation of patellar ligament at tibial tuberosity)
What is the epidemiology of Osgood-Schlatter?
Boys 12-15, girls 10-13
Often athletes, often bilateral
What is the treatment for Osgood-Schlatter?
Activity modification, patellar strap, PT, consider immobilization
What does this x-ray suggest?
Sever disease (calcaneal apophysitis)
What age groups are most affected by Sever disease?
Children aged 8-11
What is the clinical presentation of Sever disease?
Mild weakness with ankle dorsiflection, pain in the heel, tight calf muscles, presents like a childhood version of achilles tendinopathy (but not in the tendon, in the bone)
What does this x-ray suggest?
Anterior superior iliac spine apophysis avulsion fracture
What is the treatment for apophysis avulsion injuries?
Rest, physical therapy, return to sports after a few months
What does this x-ray suggest?
Little league elbow - medial epicondyle apophysitis
What is the typical clinical presentation of little league elbow?
A child who pitches for little league with medial elbow pain and swelling with an insidious onset
What is the treatment for little league elbow?
Rest and PT
What is little league shoulder?
Proximal humerus epiphysiolysis, often caused in catchers on little league teams. Leads to widening of physis in the shoulder (humerus)
What does this x-ray suggest?
A buckle or torus fracture (subtle bumps along the junction of metaphysis and diaphysis in distal forearm)
What does this x-ray suggest (on the radial side)?
Greenstick fracture - incomplete radial fracture
What does this x-ray suggest?
Toddler’s fracture
What does this x-ray suggest?
Slipped capital femoral epiphysis
