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3. PEDIATRICS > PEDIATRIC Section 13: MSK > Flashcards

PEDIATRIC Section 13: MSK Flashcards

1
Q

When will you get a repeat radiograph after fracture in PEDS?

A

7-10 days.

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2
Q

Periosteal reaction is expected in how many days?

A

7-10 days

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3
Q

What is the major concern regarding pediatric fracture?

A

Growth arest

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4
Q

What is this?

A

Physeal bar

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5
Q

What is a physeal bar?

A

“early” bony bridge crossing the growth plate after physeal involvement of the fracture or pior infection

Trauma is a classic way to ask it

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6
Q

SALTER-HARRIS Classification
Complete physeal fracture, with or without displacement.

A

Type I: Slipped

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7
Q

SALTER-HARRIS Classification

Fracture involves the metaphysis. This is the most common type (75%).

A

Type 2: A —Above (or “Awayfrom the Joint”)

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8
Q

SALTER-HARRIS Classification

Fracture involves the epiphysis. These guys have a chance of growth arrest, and will often require surgery to maintain alignment

A

Type 3: L - Lower
(3 is the backwards “E”for Epiphysis)

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9
Q

SALTER-HARRIS Classification
Fracture involves the metaphysis and epiphysis. These guys don’t do as well, often end up with growth arrest, or focal fusion. They require anatomic reduction and often surgery.

A

Type 4: T - Through

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10
Q

SALTER-HARRIS Classification

Compression of the growth plate. It occurs from axial loading injuries, and has a very poor prognosis.

A

Type 5: R - Ruined

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11
Q

SALTER-HARRIS Classification

These are easy to miss, and often found when looking back at comparisons (hopefully ones your partner read).

The buzzword is “bony bridge across physis”.

A

Type 5: R - Ruined

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12
Q

This is an injury which occurs after repetitive trauma, usually after new activity (walking).

A

Stress Fracture in Children:

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13
Q

The most common fracture of the elbow

A

supracondylar fracture (>60%)
followed by lateral condyle (20%)
and medial epicondyle (10%).

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14
Q

This is a line through the center of the radius, which should intersect the middle of the capitellum on every view (regardless of position).

A
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15
Q

Diagnosis?

A

Radial dislocation

Will NOT pass through the center of teh capitellum

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16
Q

A line along the anterior surface of humerus, should pass through the middle third of the capitellum.

A

Anterior humeral line

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17
Q

Diagnosis?

A

supracondylar fracture

you’ll see this line pass through the anterior third.

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18
Q

ELBOW Ossification Centers in order

A

CRITOE

Capitellum (Age I)
Radius (Age 3)
Internal (medial) epicondyle (Age 5)
Trochlea (Age 7)
Olecranon (Age 9)
External (Lateral) epicondyle (Age 11)

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19
Q

This is the second most common distal humerus fracture in kids.

A

Lateral Condyle fracture

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20
Q

Lateral condyle fx criteria

A

If it passes through the capitello-trochlear groove

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21
Q

Displacement of the lateral Condyle fracture =

A

surgery

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22
Q

Little League EWiovi

A

Medial Epicondyle Avulsion

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23
Q

The last plate in the elbow to fuse

A

medial epicondyle

24
Q

Because medial epicondyle is an extra-articular structure, its avulsions will NOT necessarily result in

A

Joint effusion

25
Q

Medial epicondyle avulsion fracture can get interposed between this two structures

A

Articular surface of the humerus and olecranon

26
Q

Anytime you see an elbow dislocation - ask yourself

A

Is teh patiend 5 y.o.? where is the medial epicondyle?

27
Q

The importance ofIT (crIToe) -

A

You should never see the trochlea and not see the internal (medial epicondyle), if you do it’s probably a displaced fragment

28
Q

When a child’s arm is pulled on, the radial head may sublux into the annular ligament.

A

Nursemaids Elbow

29
Q

Obvious Ulnar Shaft Fracture + Subtle Radial Head Dislocation

A

Monteggia fracture- dislocation

30
Q

Why are avulsion fractures more common in kids?

A

Kids tendons tend to be stronger than their bones, so avulsion injuries are more common (when compared to aduUs).

31
Q

Pelvic Avulsion fracture muscle attechments

Iliac crest =
ASIS -
AIIS -
Greater Trochanter -
LEsser Trochanter -
Ischial Tuberosity -
Symphysis -

A

Iliac crest = Abdominal muscles
ASIS - Sartorius, Tensor Fascia lata
AIIS - Rectus femoris
Greater Trochanter - Gluteal muscles
LEsser Trochanter - Iliopsoas
Ischial Tuberosity - Hamstrings
Symphysis - ADDuctor Group

32
Q

This an acute avulsion of the inferior patellar pole.

A

Patellar Sleeve Avulsion Fracture

33
Q

Diagnosis?

A

Patellar Sleeve Avulsion Fracture
The classic look is a fragment of bone at the inferior patella with associated soft tissue swelling.

34
Q

Patellar Sleeve Avulsion vs Sinding-Larsen-Johansson

A
  • Patellar Sleeve Avulsion is acute
  • SLJ is chronic
35
Q

Age 10-14 + chronic traction injury at the insertion of the patellar tendon on the patella. + Cerebral palsy

A

Sinding-Larsen-Johansson

36
Q

This is due to repeated micro trauma to the patellar tendon on its insertion at the tibial
Sinding Larsen Johansson
Schlatter
tuberosity. It’s bilateral 25% of the time, and more common in boys.

A

Osgood-Schlatter

37
Q

“Celery Stalk”

A

Congenital Rubella

38
Q

DIagnosis?

A

Celery stalk in Congenital rubelaoral metaphysis

39
Q

Diagnosis?

A

Syphillis

destruction of the medial portion of the proximal metaphysis of the tibia.
“Wimberger SIng”

40
Q

In Syphillis, Bony changes do NOT occur until when?

A

6-8 week sof life (Rubella changes are earlier)

41
Q

Soft tissue swelling + periosteal reaction + irritability + Self limiting =

A

Caffey Disease

42
Q

Caffey disease is seen within

A

first 6 months of life

43
Q

really hot mandible on bone scan

A

Caffey Disease (hot cAffey>) hehe

44
Q

Prostaglandin E l and E2 (often used to keep a PDA open) can cause

A

Periosteal reaction

45
Q

Sternotomy wires in CXR (Congenital heart) + Periosteal reaction

A

Prostaglandin Therapy

46
Q

This is really the only childhood malignancy that occurs in newborns and mets to bones.

A

Neuroblastoma Mets

47
Q

“Physiologic Periostitis of the Newborn”

A

Physiologic Growth

48
Q

Physiologic periostitis inovlement.

A

Proximal involvement (femur) comes before distal involvement (tibia). It always involves the diaphysis.

49
Q

It is N O T physiologic periostitis if:

A

You see it before 1 month
You see it in the tibia before thefemur
It does not involve the diaphysis.

50
Q

LAngerhans Cell Histiocystosis (LCH)

A

Also known as EG (eosinophilic granuloma).
x2 common in boys
Skeletal manifestations are highly variable,

51
Q

Most common site of LCH

A

Sull

52
Q
A

LCH

Uneven destruction of the innter and outer tables
“Beveld Edge”

53
Q

Round lucent lesion in the skull of a child =

A

Think:

Neuroblastoma mets or LCH

54
Q

Appearance of LCH in the ribs and spine

A

Ribs: Multiple lucent lesions

Spine: Vertebra plana

55
Q

Osteomyelities usullay occurs in?

A

babies (30% of cases < 2 y.o.)
usually hematogeneous (adults it direcly spreads - typically from a dibetic ulcer)

56
Q

Describe osteomyelitis in the newborns vs kids vs Adults

A

Newborn: Open growth plates + perforating vesells - travel from metaphysis to epiphysis
Infection starts @metaphysis (most blood supply, growing the fastest) then spread from the perforaties to the epiphysis

Kids
- perforators regress - Epiphysial plate is avasular
- stops infection from crossing over
- “septic tank” scenario - Infection smolders.
- 75% involves metaphyses of long bones (Femur most common)

Adults
- Growth plates fuse
- avasscular plate barrier absent
- infection AGAIN cross over to theepiphyses to caus mayhem

57
Q

Boney changes in osteomyelitis don’t occur on x-ray for how many days?

A

around 10 days

3. PEDIATRICS (32 decks)

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