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Baz: Semester 1 > Locomotor: Young MSK > Flashcards

Locomotor: Young MSK Flashcards

Paediatric Bone Disease, Paediatric Trauma, Non-Accidental Injury

1
Q

Describe the age distribution of the common diseases resulting in a limping child

Hint: Alphabetical except for transient synovitis because this is flipped around in itself

A
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2
Q

What is transient synovitis?

A

It is a benign condition where the synovial membrane around the hip is inflamed, often in children 2-5yo

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3
Q

What is DDH?

A

Developmental dysplasia of the hip, the hip joint of the baby is either dislocated or prone to dislocation

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4
Q

DDH risk factors

A
  • Hereditary
  • Born in breach
  • First born
  • Female:Male 5:1
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5
Q

DDH examinations

A
  • Barlows/Ortolani - passive dislocation of hip by practitioner with relocation, only useful for babies
  • When slightly older you are looking for leg length discrepancy, assymetry of leg creases is a good sign
  • When older can also look for reduce abduction in one side
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6
Q

DDH Treament

A

Stirrups/Strap

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7
Q

What is Perthes disease?

A

It is where blood supply to the femoral head is cut off resulting in osteonecrosis of the femoral head

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8
Q

Perthes disease treatment

A

Because the loss of blood supply is only tempory the femoral head can actually heal

Treatment is therefore focussed around ensuring this heals well

This is mainly done by keeping the femoral head within the acetabulum and treating symptoms. Sometimes with surgury.

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9
Q

Perthes causes and risk factors

A
  • Causes not really know but it is non genetic
  • Male:Female 4:1
  • 4-8 years
  • Lower social class increases risk, maybe due to smoking
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10
Q

What does SUFE stand for?

A

Slipped Upper Femoral Epiphysis

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11
Q

What is actually happening in SUFE?

A

The femoral head (epiphysis when growing) slipped downward at the growth plate

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12
Q

SUFE causes and risk factors

A
  • Males:Females 3:1
  • Happens during rapid growth at puberty
  • Happens slightly earlier in females and not after menarche (first menstrual period)
  • Obesity or Lanky are both risk factors
  • Small 7% risk if a family member is involved
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13
Q

SUFE signs, symptoms and presentation

A
  • Limp
  • Pain at groin/thigh/knee
  • Externally rotated and adducted limb
  • Roughly bilateral 50% of the time
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14
Q

SUFE surgical treatment

A

Screw throught he growth plate in order to stop it slipping further

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15
Q

Red flag: back pain but can be non specific

A

Discitis

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16
Q

Red flag: warm swelling

A

Infection

  • Septic arthrisits
  • Osteomyelitis
  • Cellulitis
17
Q

Red flag: atraumatic painless swelling

A

Tumour!

Need to get a CT done

18
Q

Red flag:

  • Inconsistent history
  • Injury not consistent with history
  • Multiple bruises at different times
A

Child abuse

19
Q

How does a peadiatric fracture tend to present compared to an adult and why?

Greenstick

A

Peadiatric bones are more supple and hence tend to bend a little bit more before breaking incompletely

This is know as greenstick. You get a partial break on the tension side and a buckle on the compression side

20
Q

What is different about a child’s periosteum and what does this mean for fractures?

A

Child’s periosteum is thicker hence this acts as a stabiliser and sort of hinge that helps with bone to be held in position during healing

21
Q

Are children’s bones better at remodelling?

A

Yes

22
Q

What is Wolf’s law?

A

During remodelling bone is deposited on the compression side and apsorbed on the tension side

23
Q

What does the Salter-Harris classification of fractures describe?

A

Fractures based around the physis

24
Q

The memomic to remeber the Salter-Harris classifications is SALTR

Describe these 5 classiciations

Hint: You have to orient the bone with the physis above the epiphysis

A
  • Type I - Straight
  • Type II - Above
  • Type III - Lower
  • Type IV - Through
  • Type V - Ruined
25
Q

Type I Salter Harris Fracture diagnosis, treatment and prognosis

A

Straight

  • Difficult to diagnose
  • Can usually reduce closed (without surgury)
  • Immobilise with cast/wires
  • Good prognosis, unlikely to cause growth abnormalities
26
Q

Type II Salter Harris Fracture diagnosis, treatment and prognosis

A

Above

  • Most common
  • Immobilise with cast/wires
  • Can usually reduce closed
  • Good prognosis, unlikely to cause growth abnormalities
27
Q

Type III Salter Harris Fracture diagnosis, treatment and prognosis

A

Lower

  • Chance of growth deformity
  • Monitor growth deformity
  • Anatomic reduction
28
Q

Type IV Salter Harris Fracture diagnosis, treatment and prognosis

A

Through

  • Chance of growth deformity
  • Monitor growth deformity
  • Anatomic reduction
29
Q

Type V Salter Harris Fracture diagnosis, treatment and prognosis

A

Ruined

  • Caused by a crush injury
  • Worst prognosis
  • Growth arrest
  • Monitor growth arrest
  • Perform an epiphysiodesis (surgically destroy other physis) on the other limb in order to prevent growth deformity
30
Q

NAI (non accidental injury) of soft tissue giveaways

A
  • In children < 18 months soft tissue injuries to head/face extremely rare, but these are common in NAIs
  • In children < 5 lumbar injuries extremely rare, these common in NAIs
  • Human bite marks
  • Burns
  • Bruises in line with hand prints
31
Q

NAI fracture to long bones

A

Metaphysis corner fracture

Indicative of shaking

Ocurrs in NAIs of children < 2years

32
Q

NAI fractures to ribs?

A

This is a sign of an NAI and can be due to crushing during shaking

33
Q

Femoral fractues < 4yo?

A

Can be a sign of NAI

About 30% due to NAI and child isn’t walking much femoral fracture uncommon

34
Q

Where do physis occur?

A

Physis (growth plates) occur on the ends of long bones and at the base of boney structures serving as attachments for tendons.

They are called proximal/distal physis or if on a boney structure apophysis.

Baz: Semester 1 (30 decks)

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