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Z Year 2 BRS MSK > Childrens Orthopeadics 2 > Flashcards

Childrens Orthopeadics 2 Flashcards

1
Q

What are the stages of paediatric fractures?

A
  1. Pattern
  2. Anatomy
  3. Intra/extra-articular
  4. Displacement
  5. Salter-harris
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2
Q

What are the patterns of paediatric fractures?

A
  1. Transverse
  2. Oblique
  3. Spiral
  4. Comminuted
  5. Avulsion
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3
Q

Where do transverse, oblique, spiral and comminuted paediatric fractures happen?

A

middle 1/3 diaphysis

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4
Q

Where do avulsion paediatric fractures happen?

A

distal 1/3

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5
Q

What happens in primary bone healing?

A
  1. Heals by direct union
  2. No Callus formation
  3. The preferred healing pathway in intra-articular fracture as minimises risk of post traumatic arthritis
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6
Q

What are the stages of secondary bone healing?

A
  • Bone healing by callus
    1. Haematoma formation
    2. Fibrocartilagenous callus formation
    3. Bony callus formation
    4. Bone remodelling
  • but remember physis
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7
Q

What are the types of displacement?

A
  1. Displaced
  2. Angulated
  3. Shortened
  4. Rotated
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8
Q

What does salter harris do?

A

Classification of physeal injuries (SALT)

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9
Q

What are the stages of Salter Harris?

A
  1. Physeal Separation
  2. Fracture traverses physis and exits metaphysis (Above)
  3. Fracture traverses physis and exits epiphysis (Lower)
  4. Fracture passes Through epiphysis, physis, metaphysis
  5. Crush injury to physis
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10
Q

What type of injury is most common and how does the risk of growth arrest increase?

A
  • Risk of growth arrest increases from 1 -5

- Type 2 injuries most common

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11
Q

What is growth arrest?

A
  • Injuries to the physis can cause growth arrest

- The location and timing is key

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12
Q

What happens in whole physis growth arrest?

A

limb length discrepancy

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13
Q

What happens in partial physis growth arrest?

A

angulation as the non affected side keeps growing

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14
Q

What is the treatment of growth arrest?

A

Aim is to correct the deformity
•Minimise angular deformity
•Minimise limb length difference

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15
Q

What are the options for limb length correction in growth arrest?

A
  1. Shorten the long side

2. Lengthen the short side

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16
Q

What are the options for angular deformity in growth arrest?

A
  1. Stop the growth of the unaffected side

2. Reform the bone (osteotomy)

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17
Q

What are the stages of fracture management?

A
  1. Resuscitate
  2. Reduce
  3. Restrict
  4. Rehabilitate
18
Q

What does reducing involve?

A
  • Correct the deformity and displacement

* Reduce secondary injury to soft tissue / NV structures

19
Q

What happens in a closed reduction?

A
  • Reducing a fracture without making an incision

* Such as traction and manipulation in A&E

20
Q

What happens in an open reduction?

A
  • Making an incision

* The realignment of the fracture under direct visualisation

21
Q

What are the options in a closed reduction?

A
  • Gallows traction
  • Holding the skin, the long bones of the lower limb can be reduced
  • Closed reduction to correct deformity
22
Q

What is restricting?

A
  • Maintain the fracture reduction
  • Provides the stability for the fracture to heal
  • Children rarely have issues with bone not healing
  • Can have issues with too much healing!
  • But remember the child’s quicker fracture healing times and remodeling potential
23
Q

What is an external restriction?

A
  • splints

- plaster

24
Q

What is an internal restriction?

A
  • plate and screws

- intra-medullary device

25
Q

What restriction is mostly used in paediatric fractures?

A
  • Plasters and splints commonly used in paediatric fracture

* Remodeling and huge healing potential means that operative internal fixation often can be avoided

26
Q

What is internal restriction used?

A
  • Operative intervention may be required
  • Consider the ongoing growth at the physis
  • Metalwork may need to be removed in the future
27
Q

What is involved in the rehabilitation of paediatric fractures?

A
  • Children generally rehabilitate very quickly
  • Play is a great rehabilitator
  • Stiffness not as major issue as in adults
  • Use it, Move it and Strengthen!
28
Q

What can be the reasons for the limping child?

A
  1. Septic arthritis
  2. Transient synovitis
  3. Perthes
  4. SUFE
29
Q

What is septic arthritis?

A

in a child is a orthopaedic emergency

30
Q

What can septic arthritis cause?

A
  • Can cause irreversible long term problems in the joint

* Therefore needs surgical washout of the joint to clear the infection

31
Q

What is Kocher’s classification in septic arthritis?

A 
-can help score probability
•Non weight bearing
•ESR >40
•WBC >12,000
•Temperature >38
32
Q

Why is history key for septic arthritis?

A
  • Duration
  • Other recent illness
  • Associated joint pain
33
Q

What is transient synovitis?

A
  1. Transient synovitis is a diagnosis once septic arthritis has been excluded
  2. Is a inflamed joint in response to a systemic illness
34
Q

What is the treatment of transient synovitis?

A

supportive treatment with antibiotics

35
Q

What is perthes disease?

A

Idiopathic necrosis of the proximal femoral epiphysis

36
Q

When does perthes disease happen?

A
  • Usually in those 4-8 years old

* Male 4:1 Female

37
Q

What is the treatment of perthes disease?

A

•Septic arthritis needs to be excluded first (its more chronic and unlikely to see temp and inflammatory markers)
•Treatment is usually supportive in the first instance
-plain radiograph

38
Q

What is SUFE?

A
  • Slipped upper femoral epiphysis

* The proximal epiphysis slips in relation to the metaphysis

39
Q

When does SUFE happen?

A
  • Usually obese adolescent male
  • 12-13 years old during rapid growth
  • Associated with hypothyroidism/hypopituitrism
40
Q

What is the treatment for SUFE?

A

•Septic arthritis needs to be excluded first
•Treatment is operative fixation with screw to prevent further slip and minimise long term growth problems
-acute/chronic but no temp/inflam markers

41
Q

What is important to consider in children orthopaedics?

A

If physis involved!!!

42
Q

What are different type of MSK conditions in children due to?

A

Packaging disorders or due to conditions that not only affect biochemistry that affects bone itself (osteogensis imperfecta) but also of physis itself e.g. achondroplasia

Z Year 2 BRS MSK (18 decks)

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