Principles of paediatric orthopaedics + paediatric trauma Flashcards
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
.
What are the variants of normal that commonly present to paediatric orthopaedics
Physiological bow legs and knock knees
Intoeing (feet turn inward instead of pointing straight ahead
Variable walking age
Flexible flat feet
Curly toes
Bow legs are common at what age
under 2s - usually resolves itself
Intoeing (feet turn inward instead of pointing straight ahead) is developmentally normal due to what causes
Femoral anteversion
Internal tibial torsion
Metatarsus adductus
Simple test for flexible flat feet
Tip toeing reveals foot arch
Gait cycle begins and ends when
Begins when reference foot contacts the ground
Ends with subsequent floor contact of the same foot
Common gait abnormalities
Antalgic Gait
Lateral Trunk tilt - Trendelenberg
Functional Leg-Length Discrepancy
A gait cycle has 2 phases - describe these
Stance phase - reference limb in contact with floor
Swing phase - reference limb not in contact with floor
What is an antalgic gait, e.g. splinter in foot, OA
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)
What is a trendelenberg gait, e.g. painful hip, leg length discrepancy
Unilateral weakness of the hip abductors (so can’t contract to keep pelvis level) –> causing the contralateral side of the pelvis to drop
What is a functional leg length discrepancy gait
Leg in swing phase is longer in length than that in stance phase
Childhood knee pain could be related to primary pathology where
HIP
Bone or joint pain worse at night is indicative of what
infection or tumour until proven otherwise
Commonest cause of death in children
Trauma
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)
Epidemiology
Children’s Fracture Principles
Examples
The forearm
The knee
The ankle
Infection – septic arthritis & osteomyelitis
NAI
Define a greenstick fracture
Fracture in a young, soft bone in which the bone bends and cracks, instead of breaking completely into separate pieces
A greenstick injury in the forearm is usually a low or high energy fracture
(see other flashcard for greenstick injury)
Low
Most forearm fractures are where
Distal radius
Define a buckle (torus) fracture
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
Management options of forearm fractures (2 principles)
Closed treatment - MAJORITY
- analgesia
- reduction
- immobilise - cast
Open treatment (surgery)
Differentials of knee pain (5)
Trauma Infection Inflammatory - arthritis Neoplastic Hip pathology
Knee trauma could cause injury to what areas of the knee
Growth plate (physical injury) Tibial spine Tibial tubercle Patellar fracture - RARE Patellar dislocation
Describe different types of GROWTH PLATE fractures according to salter Harris classification
(use SALTER as pneumonic)
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.
Warning signs of non-accidental injuries in children
Incompatible history
Specific pattern of bruising
Burns
Multiple fractures, multiple stages of healing
Define a salter Harris fracture
Fracture that involves the epiphyseal plate or growth plate of a bone
Common injury found in children
Types of forearm injuries in children
Shaft fracture
Special fractures
- galeazzi
- monteggia
Distal radial fracture
Define a galeazzi fracture
Fracture of the distal third of the radius with dislocation of the distal radioulnar joint
Define a monteggia fracture
Fracture of the proximal third of the ulna with dislocation of the proximal head of the radius
