Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4 Paeds > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What are growth plates ( epiphyseal plates ) ?

A

They are areas of at the ends of long bones that allow the bones to grow in length. They are made of hyaline cartilage and sit between the epiphysis and metaphysis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some bone features that differ in children to adults ?

A

Children have growth plates where adults dont
Children have more cancellous bone - spongy
Adults have more cortical bone.
Children more prone to greenstick fractures due to increases flexibility.
Bones in children have a better blood supply so heal quicker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some types of fractures ?

A

Buckle
Transverse
Oblique
Spiral
Segmental
Salter-Harris ( growth plate fracture )
Comminuted
Greenstick

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What can fractures at the growth plate cause ?

A

Issues of growth in that bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What classification is used for growth plate fractures ?

A

Salter-Harris classification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the different types of fractures in the salter-Harris classification ?

A

Type 1 - straight across
Type 2 - above the growth plate
Type 3 - below the fracture
Type 4 - through the growth fracture
Type 5 - crush fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the first principle of fracture management and how is it achieved ?

A

Mechanical alignment :
- closed reduction via manipulation of the joint
- open reduction via surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the second principle of fracture management and how is it achieved ?

A

Relative stability done by fixing the bone in the correct position
-External cast
-K wires
- intramedullary wires
- intramedullary nails
- screws
- plate and screws

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the pain management of fractures ?

A

Step 1 - paracetamol or ibuprofen
Step 2 - morphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What can present alongside hip pain ?

A

Limp
Refusal to use the affected leg
Refusal to weight bear
Inability to walk
Pain
Swollen or tender joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the most common causes of joint pain in 0-4 years old ?

A

Septic arthritis
Developmental dysplasia of the hip
Transient sinovitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the most common causes of joint pain in 5-10 years old ?

A

Septic arthritis
Transient sinovitis
Perthes disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the most common causes of joint pain in 10-16 years old ?

A

Septic arthritis
Slipped upper femoral epiphysis
Juvenile idiopathic arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some red flags for hip pain suggesting a serious pathology ?

A

Child under 3 years
Fever
Waking at night with pain
Weight loss
Anorexia
Night sweats
Fatigue
Persistent pain
Stiffness in the morning
Swollen and red joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some criteria for an urgent referral in relation to a limping child ?

A

Child under 3
Child over 9 with a restricted or painful hip
Not able to weight bear
Evidence of neurovascular compromise
Severe pain or agitation
Suspicion of abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What investigations should be performed for hip pain and what will they show ?

A

Blood tests - CRP and ESR for juvenile inflammatory arthritis
X-rays - fractures, SUFE
USS - effusion
Joint aspiration - septic arthritis
MRI - osteomyelitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is septic arthritis ?

A

Refers to infection inside a joint and can occur at any age.
It is an emergency as the infection can quickly begin to destroy the joint and cause serious systemic illness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is septic arthritis a common complication of ?

A

Joint replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How does septic arthritis present ?

A

Usually affects a single joint
Rapid onset of :
- hot, red, swollen and painful joint
- refusing to weight bear
- stiffness and reduced range of motion
- systemic symptoms such as fever, lethargy and sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the most common bacteria to cause septic arthritis and some others ?

A

Staph aureus - most common
Neisseria gonorrhoea
Group A strep
Haemophilus influenza
E.coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some differentials for septic arthritis ?

A

Transient sinovitis
Perthes disease
Slipped upper femoral epiphysis
Juvenile idiopathic arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What investigations should be performed if septic arthritis is suspected ?

A

Joint aspirate - gram staining, crystal microscopy, culture and antibiotic sensitivities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the management of septic arthritis ?

A

Empirical IV antibiotics for 3- 6 weeks
Surgical drainage and washout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is transient synovitis ?

A

Irritable hip - temporary irritation and inflammation in the synovial membrane of the joint.
Often associated with a viral URTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the presentation of transient synovitis ?

A

Symptoms of a viral illness
Limp
Refusal to weight bear
Groin or hip pain
Mild low grade temperature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the management of transient synovitis ?

A

Simple analgesia
Safety netting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the prognosis of transient synovitis ?

A

Resolution within 1-2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is Perthes disease ?

A

Involves disruption of blood flow to the femoral head causing avascular necrosis of the bone. This affects the epiphysis of the femur which is the none distal to the growth plate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the main complication of perthes disease and how does it occur ?

A

Hip osteoarthritis - over time there is revascularisation or neovascularisation and healing of the femoral head. There is remodelling of the bone as it heals.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How does perthes disease present ?

A

Slow onset of :
- pain in the hip or groin
- limp
- restricted hip movements
- referred pain to the knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What investigations should be performed when suspecting Perthes disease ?

A

X ray
Blood tests - especially inflammatory markers
Technetium bone scan
MRI scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the management of perthes disease ?

A

Bed rest
Traction
Crutches
Analgesia
Physiotherapy
Surgery - older children that might not have healed properly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is slipped upper femoral epiphysis ?

A

It is where the head of the femur is displaced along the growth plate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

When does slipped upper femoral epiphysis usually present ?

A

More common in boys 8-15 years old - average age of 12
Slightly younger in females at 11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How does Slipped upper femoral epiphysis present ?

A

Adolescent obese males
History of minor trauma
Hip, groin, thigh or knee pain
Restricted range of hip movement
Painful limp
Restricted range of motion
Limited internal rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What investigations should be used to help the diagnosis of Slipped upper femoral epiphysis ?

A

X ray
Blood tests - usually normal but used to exclude other pathologies
Technetium bone scan
CT scan
MRI scan

37
Q

What is the management of Slipped upper femoral epiphysis ?

A

Surgery is required to correct the position and fix it from further slipping

38
Q

What is osteomyelitis ?

A

An infection in the bone and bone marrow and typically occurs in the metaphysis of the long bones

39
Q

What is the most common bacteria to cause osteomyelitis ?

A

Staph aureus

40
Q

What is chronic osteomyelitis ?

A

A deep seated slow growing infection with slow developing symptoms.

41
Q

What are some risk factors of osteomyelitis ?

A

Open bone fractures
Orthopaedic surgery
Immunocompromised
Sickle cell anaemia
HIV
TB

42
Q

How does osteomyelitis present ?

A

Refusing to use the limb or weight bear
Pain
Swelling
Tenderness
Afebrile / low grade fever

43
Q

What investigations should be performed when suspecting osteomyelitis ?

A

X rays as initial
MRI or bone scan as an alternative
Blood tests - inflammatory markers ( CRP or ESR and WBC )
Blood culture
Bone marrow aspiration or bone biopsy

44
Q

What is the management of osteomyelitis ?

A

Extensive and prolonged antibiotic therapy
Surgery - drainage and debridement

45
Q

What is osteosarcoma ?

A

A type of bone cancer usually affecting the femur

46
Q

How does osteosarcoma present ?

A

Persistent bone pain particularly worse at night
May disturb or wake them from sleep
Bone swelling
Palpable mass
Restricted joint movement

47
Q

How is osteosarcoma diagnosed ?

A

Very urgent direct access X-ray within 48 hours for children presenting with bone pain or swelling
X-rays
Blood tests - ALP
CT scan, MRI scan, bone scan, PET scan, bone biopsy

48
Q

How does osteomyelitis present on X-ray ?

A

Poorly defined lesion in the bone, with destruction of the normal bone and a fluffy appearance.
Periosteal reaction that is classically described as a sun-burst appearance.

49
Q

What is the management of osteosarcoma ?

A

Surgical resection of lesion often with limb amputation. Adjuvant chemotherapy is used alongside surgery

50
Q

What is the main complication of osteosarcoma ?

A

Pathological bone marrow
Metastasis

51
Q

What is talipes ?

A

A fixed abnormal ankle position that presents at birth
It is also known as clubfoot

52
Q

What is talipes equinovarus ?

A

The ankle is in plantar flexion and supination

53
Q

What is talipes calcaneovalgus ?

A

The ankle is in dorsiflexion and pronation

54
Q

What is the Ponseti method ?

A

A way of treating talipes without surgery. It is usually very successful.
Treatment is started immediately after birth.

55
Q

How is talipes treated by the Ponseti method ?

A

The foot is manipulated towards a normal position and a cast is applied to hold it in position. This is repeated over and over until the foot is in the correct position.
At some point an Achilles tenotomy to release tension in the achilles tendon is performed

56
Q

What is positional talipes ?

A

A common condition where the resting position of the ankle is in plantar flexion and supination.
The muscles are slightly tight around the ankle bu the bone is unaffected.

57
Q

How is positional talipes treated ?

A

Physiotherapist

58
Q

What is developmental dysplasia of the hip ?

A

A condition where there is a structural abnormality in the hips caused by abnormal development of the foetal bones during pregnancy. This leads to instability in the hips and a tendency or potential for subluxation or dislocation.

59
Q

What can occur if you have structural abnormalities from developmental dysplasia of the hip into adulthood ?

A

The potential for weakness, recurrent subluxation or dislocation, an abnormal gait and early degenerative changes

60
Q

when should degenerative dysplasia of the hip be diagnosed ?

A

First degree family history
Breech presentation from 36 weeks onwards
Breech presentation at birth if 28 weeks onwards
Multiple pregnancy

61
Q

What are the 2 special tests to check for degenerative dysplasia of the hip ?

A

Ortolani test
Barlow test

62
Q

How is the ortolani test performed ?

A

Baby on their back with the hips and knees flexed.
Palms are placed on the baby’s knees with thumbs on the inner thigh and four fingers on the outer thigh.
Gentle pressure is used to abduct the hips and apply pressure behind the legs with the fingers to see if the hips will dislocate anteriorly.

63
Q

What is the Barlow test ?

A

Baby on their back with hips adducted and flexed at 90 degrees and knees bent at 90 degrees.
Gentle downward pressure is placed on knees through femur to see if the femoral head will dislocate posteriorly.

64
Q

What is clicking ?

A

Common examination finding and is usually due to soft tissue moving over bone.
USS is needed

65
Q

What sounds during a hip exam would indicate developmental dysplasia of the hips ?

A

Clunking

66
Q

How is a diagnosis of developmental dysplasia of the hip ?

A

USS of the hips
X-rays

67
Q

What is the management of developmental dysplasia of the hip ?

A

Pavlik harness if the baby presents at less than 6 months of age. The harness keeps the babys hips flexed and abducted.
Surgery if harness fails

68
Q

What is rickets ?

A

A condition affecting children where there is defective bone mineralisation causing soft and deformed bones.

69
Q

what are some causes of rickets ?

A

A deficiency in vitamin D or calcium.
Genetic causes - hereditary hypophosphataemic rickets.

70
Q

What is the pathophysiology of rickets ?

A

Vitamin D is hormone created in response to UV radiation.
Vitamin D is essential in calcium and phosphate absorption from the intestines and kidneys.
Inadequate vitamin D leads to a lack of calcium and phosphate.

71
Q

What are some potential symptoms of rickets ( not bone deformities ) ?

A

Lethargy
Bone pain
Swollen wrists
Poor growth
Dental problems
Muscle weakness

72
Q

What are some bone deformities that can occur in rickets ?

A

Bowing of the legs
Knock knees - legs curve inwards
Rachitic rosary
Craniotabes - soft skull with delayed closure of the sutures and frontal bossing
Delayed teeth

73
Q

What are some investigations for rickets ?

A

Serum 25-hydroxyvitamin D
X ray
Serum calcium
Serum phosphate
Serum ALP
Parathyroid hormone

74
Q

What is the management of rickets ?

A

Prevention is most important
Breast fed babies are at a higher risk
Vitamin D deficiency can be treated with ergocalciferol
Vitamin D and calcium supplementation

75
Q

What is achondroplasia ?

A

The most common cause of disproportionate short stature. It is a type of skeletal dysplasia.

76
Q

What are the genetics behind achondroplasia ?

A

The achondroplasia gene, fibroblast growth factor receptor 3 is on chromosome 4.
Sporadic mutation or inheritance of an abnormal copy of this gene.
The condition is inherited in autosomal dominant pattern.
Homozygous gene mutations is fatal

77
Q

What does a mutation in the FGFR gene cause ?

A

Causes abnormal function of the epiphyseal plates. This restricts the bone growth in length leading to short bones and short stature.

78
Q

What are some features of achondroplasia ?

A

Disproportionate short stature ( average - 4ft )
Short digits
Bow legs
Disproportionate skull
Foramen magnum stenosis

79
Q

What are some associations of achondroplasia ?

A

Recurrent otitis media
Kyphoscoliosis
Spinal stenosis
Obstructive sleep apnoea
Obesity
Foramen magnum stenosis which can lead to cervical cord compression and hydrocephalus

80
Q

What is the management of achondroplasia ?

A

No cure
Can have leg lengthening surgery can add height

81
Q

What is osgood-schlatter disease ?

A

Caused by inflammation at the tibial tuberosity where the patella ligament inserts.
Anterior knee pain
Unilateral

82
Q

What is the pathophysiology of osgood-schlatters disease ?

A

The patella tendon inserts into the tibial tuberosity. Stress from running, jumping and other movements at the same time as growth result in inflammation on the tibial epiphyseal plate.
There are multiple small avulsion fractures, where the patella ligament pulls away tiny pieces of the bone.

83
Q

How does osgood-schlatters disease present ?

A

Gradual onset -
Visible or palpable hard and tender lump at the tibial tuberosity
Pain in the anterior aspect of the knee
Pain exacerbated by physical activity, kneeling and on extension of the knee.

84
Q

What is the management of osgood-schlatter disease ?

A

Reducing physical activity
Ice
NSAIDs
Physiotherapy

85
Q

What is a rare complication of osgood-schlatter disease ?

A

Full avulsion fracture

86
Q

What is osteogenesis imperfecta ?

A

A genetic condition that results in brittle bones that are prone to fractures.
Caused by a range of genetic mutations that affect the formation of collagen

87
Q

How does osteogenesis imperfecta present ?

A

Hypermobility
Blue/grey sclera
Triangular face
Short stature
Deafness
Dental problems
Bone deformities - bowed legs or scoliosis
Joint and bone pain

88
Q

What is the management of osteogenesis imperfecta ?

A

Bisphosphonates
Vitamin D supplements
Physiotherapy

89
Q

What are some investigations for osteogenesis imperfecta ?

A

Clinical diagnosis
X-rays
Genetic testing

Y4 Paeds (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions