SM 251/252: Peds MSK, Peds/Adult Sports Med Flashcards
1
Q
How do you describe a fracture?
A
Location: Bone involved, area in the bone, and SH classification Fracture type or pattern Displacement
2
Q
What is the treatment for Medial Epicondlyle Apophysitis?
A
Rest and PT to strengthen core/spine while improving baseball throwing abiliity
3
Q
What is this?
A
Anterior Superior Iliac Spine Apophysis Avulsion Fracture
4
Q
What’s the treatment for a muscle strain?
A
RICE and strengthening/stretching
5
Q
What fracture pattern is this?
A
Comminuted fracture pattern
6
Q
What are the main functions of bone?
A
Structure/skeletal support, mineral + electrolyte regulation, and hematopoiesis
7
Q
What is Rotational displacement?
A
Rotational movement along the mid-axial line that can be difficult to detect Not the same as Angulation
8
Q
How does Sever disease present?
A
Insidious onset heel pain with mild weakness in dorsiflexion and tight calf muscles - in an 8 - 11 y/o
9
Q
What meds can cause tendinopathy?
A
Fluoroquinolones and NSAIDS
10
Q
What is the treatment for Nursemaid’s elbow?
A
Supination and Flexion to pop the radius back into place
11
Q
What is the most common SH injury pattern?
A
Salter II
12
Q
How does mechanical overload lead to Tendinopathy in adults?
A
Mechanical overload involves repeated microdamage with a failed healing response, causing a rise in inflammatory markers like IL-1b
13
Q
How are Muscle strains graded?
A
Grade I = no tear Grade II = partial tear Grade III = full tear
14
Q
What is Osgood-Schlatter syndrome?
A
Inflammation of the patellar ligament at the Tibial Tuberosity in teenagers playing sports, that gets worse with running/jumping
15
Q
What is Sever disease?
A
A calcaneal apophysitis that effects children 8 - 11y/o causing mild weakness in dorsiflexion and tight calf muscles
16
Q
What fracture is this and why?
A
Toddler’s fracture - oblique, nondisplaced fracture of a Tibia, likely due to twisting motion while falling
17
Q
What is an ankle sprain?
A
Athletic activity that leads to injured ligaments
18
Q
How is Slipped Capital Femoral Epiphysis treated?
A
Immediate surgical fixation to prevent further slippage and avoid avascular necrosis of the head of the Femur
19
Q
What injury predisposes Osgood-Schlatter?
A
None
20
Q
Does a Type I SH injury effect growth?
A
Generally no
21
Q
What is imaging used for in Achilles Tendinopathy?
A
Look for tear or calcification with Ultrasound or MRI
22
Q
Where on the tendon does Achilles Tendinopathy occur?
A
Mid-tendon > Calcaneal insertion
23
Q
What are the complications of Slipped Capital Femoral Epiphysis?
A
Avascular necrosis of the hip, which increases in likelihood the longer the slip is untreated and the larger the slip
24
Q
What fracture pattern is this?
A
Transverse fractures
25
What unique effects does the different composition of pediatric bones have in comparison to adult bones?
Decreased mineral content allows them to absorb more energy without fracturing, creating incomplete fractures and unique fracture patterns
26
Should you consider a gradual onset muscle strain?
Nope, they're acute; consider alternatives like stress fracture or tendinopathy and get imaging
27
What is fusiform swelling?
A form of swelling that can create nodules on inflammed areas, such as an Achilles Tendon nodule in a tendinopathy
28
How does a Toddler's fracture present?
A child \< 5y/o is limping or can't put weight on a leg with minimal to no swelling Subtle line on Xray
29
What are the types of fractures?
Transverse fracture, Oblique fracture, Spiral fracture, Comminuted fracutre
30
What are the advantages of open Physes?
High potential for bone healing and remodeling as well as fractures often being easier to heal
31
What is a fracture pattern and why does it arise?
Bones fail in a predictable way to force, and the fracture pattern tells us how the bone was injured
32
Does a Type V SH injury effect growth?
Worst prognosis and may lead to growth arrest
33
How do fetal skeletons mature into adult skeletons?
As the fetus develops, the Cartiagenous skeleton is transformed into a bony skeleton via Endochondral ossification
34
What fracture this this?
Nursemaids elbow since the Annular ligament is dislocated and no longer holding the Radius in place
35
How should imaging be used for ankle sprains?
Imaging is not used to diagnose; assess for other pathologies/injuries and order an MRI if pain is not improving in a few weeks
36
What are the risk factors for Slipped Capital Femoral Epiphysis?
Males \> Females, Obesity, Endocrinopathies
37
What occurs during Stage I of the healing response?
Inflammation; RBC's and WBC's infiltrate to remove necrotic material and begin angiogenesis
38
What are fetal skeletons made of?
Cartilage
39
What Type of fracture is this?
Salter Type II fracture because it's above the Physis (the end of the distal end of the bone is treated as the bottom, so up is down)
40
What is this?
Calcaneal Apophysitis
41
How does a proinflammatory environment lead to Tendinopathy in adults?
Sedentary individuals have a high levels of pro-inflammatory cytokines at rest and low levels of COL-I
42
What is a Type IV SH injury?
A growth plate injury where the fracture is both above and below the growth plate, as well as the Metaphysis and Epiphysis
43
How can Medial Epicondyle Apophysitis be prevented?
Proper pitch progression and resting
44
Is remodeling extensive or limited in Pediatric bones?
Extensive; large degrees of angulation can be fixed and nonunion is rare
45
What is the term to describe irritation of a Physis or Apophysis?
Juvenile Epiphyseolysis or Apophysitis
46
How does Sinding-Larsen Johansson present?
Bilateral achy anterior knee pain with mild tenderness to palpation over the lower pole of the patella, with full ROM
47
How does Slipped Capital Femoral Epiphysis present?
A 10-16 y/o presents with pain in the groin/thigh/knee and a limp, with the leg externally rotated at the hip and pain/limitation with flexion and internal rotation
48
What is Slipped Capital Femoral Epiphysis?
A SH Type I fracture in the hip that occurs in adolescents due to slippage of the Epiphysis due to growth plate instability during periods of rapid growth
49
What are the risk factors for tendinopathy?
Age, Obesity, DIIM, HTN, Muscle weakness, Abnormal biomechanics, excessive mechanical load, training error, some medications
50
What is this and what might it suggest?
Fusiform swelling near the Achilles Tendon = Achilles Tendonopathy
51
How does a Type I SH injury present?
Radiograph mostly normal, dx based on hx of trauma, swelling, pain and tenderness with a repeat XR showing healing callus after 7 days
52
How is Osgood-Schlatter treated?
Patellar strap + Physical Therapy + activity modification + NSAIDS
53
How does Achilles Tedinopathy present?
No sudden injury, pain while performing activity but not at rest, not warm or erythematous and localized to mid-portion or insertion
54
How does a Transverse fracture arise?
Force exerted perpendicular to the long axis of a bone, typically a higher force direct impact
55
How does an Oblique fracture arise?
Caused by a bending force oblique to the long axis of the bone, and leads to significant displacement
56
Are Buckle fractures stable or unstable, and how does that effect healing?
Buckle fractures are stable and heal with with simple immobilization
57
What is Medial Epicondyle Apophysitis?
"Little league Elbow" = A type of Apophysitis with slow onset that effects the medial elbow and causes occasional swelling in people who play baseball
58
What is a Type II SH injury?
A growth plate injury where the fracture is above the growth plate
59
What is Proximal Humeral Epiphysiolysis?
"Little league Shoulder" = a type of Epiphysiolysis that presents with pain in the shoulder and full shoulder ROM
60
What are common sites of injury in adults?
Tendons and ligaments more than bone itself, because the bone is harder and stronger
61
What muscles are strained more often?
Two joint lower-limb muscles: hamstrings, calf, quadriceps
62
What are the two broad ways to develop Tendinopathy in adults?
Mechanical overload and Proinflammatory involvement
63
What occurs during Stage III of the healing response?
Remodeling; consolidation and maturation phase
64
What is the physis?
The growth plate between two ossification centers
65
How can Proximal Humeral Epiphysiolysis be treated and prevented?
Same as Medial Epicondyle Apophysitis - rest and PT
66
What are the 3 stages of healing injured soft tissue?
Stage I = inflammatory response Stage II = proliferative phase Stage III = remodeling phase
67
What's strong in kids, a Ligament or a Bone?
Ligaments are stronger than bones in kids, meaning sprains are less likely than fracture
68
What fracture pattern is this?
Oblique fracture
69
What imaging should be ordered for Nursemaid's elbow?
None - just supinate and flex the arm to fix it
70
How does a muscle strain present?
Sudden onset pain, impairs function and tender to palpation at site of injury, often due to acceleration or deceleration injury
71
What type of fracture is this?
Type IV of the Tibula, since it's on both sides of the growth plate
72
What is a Greenstick fracture?
A fracture due to compression or bending force that involves two bones, such as the forearm; the bone on the convex side fails but the fracture does not fully crack the bone on the other side
73
What is Sinding-Larsen-Johansson?
An inferior patella apophysitis common in 11 - 12 year olds that presents with bilateral achy knee pain and mild tenderness to palpation over the bottom of the patella with full ROM
74
Are Comminuted fractures common in children?
High force mechanism fracture, but rare in children and requires operative treatment
75
Whats more likely in a kid, a Sprain or a fracture?
Fractures are more likely because Ligaments in kids are stronger than bones
76
Describe the Periosteum in Pediatric bones?
Thick, strong, metabolically active and allows for better fracture reduction, healing, and remodeling
77
How can a Spiral fracture arise?
A relatively low force twisting mechanism
78
If an 11 y/o comes to you with a limp and this Xray, pain and normal ROM, what's the dx?
Sinding Larsen Jensen Syndrome
79
What are the risk factors for an ankle sprain?
Decreased strength and proprioception
80
What is a Nursemaid's Elbow?
A type of dislocation that arises when there is traction to the arm that dislocates the Annular ligament, and frees the Radius, resulting in not using the arm and no swelling, deformity or bone tenderness
81
What is an ASIS Apophysis Avulsion Fracture?
A fracture that presents acutely with a "pop" and causes pain with full ROM and pain with hip extension
82
What are the anatomic regions of a growing bone?
Diaphysis = shaft Metaphysis = Widening end Growth Plate = Physis (separates Metaphysis and Epiphysis) Epiphysis = end of bone
83
Who does Sever disease effect?
8 - 11 year olds
84
Describe the structure and function of a tendon?
Collagen Type I + Water, conects muscle to bone
85
How is Toddler's fracture treated?
Cast, no weight bearing on the effected leg
86
What is Toddler's fracture?
An oblique, non-displaced fracture of the distal Tibia that effects walking children \< 5y/o due to a twist while running or falling
87
What are common sites of injury in kids?
Physis and Apophysis more than tendons and ligaments, because they are still growing and not fully calcified
88
What is a Type III SH injury?
A growth plate injury where the fracture is below the growth plate
89
What is a fracture displacement?
A fracture fragment being moved out of normal bony alignment, due to Translation, Angulation, or Rotation
90
What fracture is this?
Buckle fracture - increased distance between distal Ulna and Radius
91
What is this showing?
A comparison showing the inflammed Achilles Tendon in Achilles Tendonapathy
92
What is Angulation displacement?
Angular movement, measured in degrees, through the mid-axial line
93
Does a Type II SH injury effect growth?
Generally no
94
What is a Type I SH injury?
A growth plate injury involving separation through the growth plate
95
How should ankle sprains be treated?
RICE, immobilization, taping/bracing, rehab
96
What is a Type V SH injury?
A growth plate injury involving crush injury the to the growth plate
97
Does a Type IV SH injury effect growth?
May interfere with growth
98
What occurs during Stage II of the healing response?
Proliferation; myocytes infiltrate and Type III collagen is produced
99
Where do muscle strains occur?
The myotendinous junction
100
How is an ASIS Apophysis Avulsion fracture treated?
RICE, strengthening, slowly progressing Physical Therapy
101
What is this and why?
Slipped Capital Femoral Epiphysis - Type I fracture at the head of the Femur
102
How does an Ankle sprain present?
Sudden onset pain with impaired function and swelling, causes inversion and plantarflexion
103
What fracture pattern is this?
Spiral fracture
104
What is Achilles Tendinopathy?
A non-inflammatory condition of intratendinous collagen degeneration and scattered vascular ingrowth
105
How do pediatric bones differ from adult bones, and why?
Pediatric bones are more porous and pliable due to decreased mineral content
106
Where are primary ossification centers located, and how does that compare to secondary ossification centers?
Primary ossification center = long bone shaft Secondary ossification center = Epiphyses
107
Do Type III SH injuries effect growth?
May interfere with growth
108
How is Sinding-Larsen-Johansson treated?
Patellar strap + stretching and symptomatic treatment
109
How does a Nursemaids elbow present?
Traction to the arm, pain initially and comfortable at rest, won't use the arm No swelling, deformity, or bony tenderness but pain with movement of elbow
110
What group is at risk for Achilles tendinopathy?
Runners
111
How do bones grow?
Germinal cells on the Epiphyseal side of the growth plate proliferate and calcify on the Metaphyseal side
112
What fracture is this and why?
Greenstick's fracture because it's effecting both bones - the side with the full crack was hit directly while the partial crack is showing bending
113
How is Achilles Tendinopathy treated?
Physical Therapy, rest, heel lift if walking pain occurs - good prognosis overall
114
What is a Buckle fracture, and what group is it common in?
A fracture that results from compression force on a bone, such as falling onto an outstretched hand Common forearm fracture in children, very stable
115
What is the point of PT in Achilles Tendinopathy?
Address weakness and inflexibilities in the Kinetic Chain
116
What scale is used to classify growth plate injuries?
Salter Harris classification: types I to V = SABTR I = Separation II = Above III = Below IV = Through V = cRush
117
What are the disadvantages of open Physes?
Fracture through the physis can lead to growth arrest and irritation may occur at the Physis
118
What is Translation dispalcement?
Lateral movement of a fracture fragment
119
What is an Apophysis?
An accessory growth plate where muscles attach
120
What are general risk factors for adult MSK injury?
Increase in activity, change in exercise, age, etc.
121
What group is affected by Sinding-Larsen-Johansson?
11 - 12 year olds
