Principles of paediatric orthopaedics + paediatric trauma

Question 1

Describe the variants of normal that commonly present to paediatric orthopaedics (physiological bow legs and knock knees, intoeing, variable walking age, flexible fat feet, curly toes)

Recognise that childhood knee pain could be hip pathology

Recognise that bone or joint pain worse at night is infection or tumour until proven otherwise

Answer 1

.

Question 2

What are the variants of normal that commonly present to paediatric orthopaedics

Answer 2

Physiological bow legs and knock knees

Intoeing (feet turn inward instead of pointing straight ahead

Variable walking age

Flexible flat feet

Curly toes

Question 3

Bow legs are common at what age

Answer 3

under 2s - usually resolves itself

Question 4

Intoeing (feet turn inward instead of pointing straight ahead) is developmentally normal due to what causes

Answer 4

Femoral anteversion
Internal tibial torsion
Metatarsus adductus

Question 5

Simple test for flexible flat feet

Answer 5

Tip toeing reveals foot arch

Question 6

Gait cycle begins and ends when

Answer 6

Begins when reference foot contacts the ground

Ends with subsequent floor contact of the same foot

Question 7

Common gait abnormalities

Answer 7

Antalgic Gait
Lateral Trunk tilt - Trendelenberg
Functional Leg-Length Discrepancy

Question 8

A gait cycle has 2 phases - describe these

Answer 8

Stance phase - reference limb in contact with floor

Swing phase - reference limb not in contact with floor

Question 9

What is an antalgic gait, e.g. splinter in foot, OA

Answer 9

Gait pattern in which stance phase on affected side is shortened

Corresponding increase in stance on unaffected side

(see other flashcard for what stance phase is)

Question 10

What is a trendelenberg gait, e.g. painful hip, leg length discrepancy

Answer 10

Unilateral weakness of the hip abductors (so can’t contract to keep pelvis level) –> causing the contralateral side of the pelvis to drop

Question 11

What is a functional leg length discrepancy gait

Answer 11

Leg in swing phase is longer in length than that in stance phase

Question 12

Childhood knee pain could be related to primary pathology where

Answer 12

HIP

Question 13

Bone or joint pain worse at night is indicative of what

Answer 13

infection or tumour until proven otherwise

Question 14

Commonest cause of death in children

Answer 14

Trauma

Question 15

Define salter Harris, greenstick and torus fractures

Describe different types of growth plate fractures according to Salter Harris classification

Common sites of injury and suspicious features of non-accidental injury

Management of childhood fractures

Complications of childhood fractures, e.g. growth restriction (was in formative)

Answer 15

Epidemiology

Children’s Fracture Principles

Examples
The forearm
The knee
The ankle

Infection – septic arthritis & osteomyelitis

NAI

Question 16

Define a greenstick fracture

Answer 16

Fracture in a young, soft bone in which the bone bends and cracks, instead of breaking completely into separate pieces

Question 17

A greenstick injury in the forearm is usually a low or high energy fracture

(see other flashcard for greenstick injury)

Answer 17

Low

Question 18

Most forearm fractures are where

Answer 18

Distal radius

Question 19

Define a buckle (torus) fracture

Answer 19

INCOMPLETE FRACTURE of the shaft of a long bone that is characterised by bulging of the cortex

Only one side of the bone is compressed and buckles but does not break all the way through

Extremely common injury seen in children as they have softer, more flexible bones, so one side of the bone may buckle upon itself without disrupting the other side

Question 20

Management options of forearm fractures (2 principles)

Answer 20

Closed treatment - MAJORITY

• analgesia
• reduction
• immobilise - cast

Open treatment (surgery)

Question 21

Differentials of knee pain (5)

Answer 21

Trauma
Infection
Inflammatory - arthritis 
Neoplastic
Hip pathology

Question 22

Knee trauma could cause injury to what areas of the knee

Answer 22

Growth plate (physical injury)
Tibial spine
Tibial tubercle
Patellar fracture - RARE
Patellar dislocation

Question 23

Describe different types of GROWTH PLATE fractures according to salter Harris classification

(use SALTER as pneumonic)

Answer 23

Type I - transverse fracture through the growth plate

Type II - fracture through the growth plate AND metaphysis

Type III - fracture through growth plate AND epiphysis

Type IV - fracture through all 3 - growth plate, epiphysis + metaphysis

Type V - compression fracture of growth plate

Pneumonic:
I – S = Slip (straight across). Fracture of the cartilage of the physis (growth plate)

II – A = Above. The fracture lies above the physis, or Away from the joint.

III – L = Lower. The fracture is below the physis in the epiphysis.

IV – TE = Through Everything. The fracture is through the metaphysis, physis, and epiphysis.

V – R = Rammed (crushed). The physis has been crushed.

Question 24

Warning signs of non-accidental injuries in children

Answer 24

Incompatible history
Specific pattern of bruising
Burns
Multiple fractures, multiple stages of healing

Question 25

Define a salter Harris fracture

Answer 25

Fracture that involves the epiphyseal plate or growth plate of a bone

Common injury found in children

Question 26

Types of forearm injuries in children

Answer 26

Shaft fracture

Special fractures

• galeazzi
• monteggia

Distal radial fracture

Question 27

Define a galeazzi fracture

Answer 27

Fracture of the distal third of the radius with dislocation of the distal radioulnar joint

Question 28

Define a monteggia fracture

Answer 28

Fracture of the proximal third of the ulna with dislocation of the proximal head of the radius