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MSK 2 > Children's orthopaedics > Flashcards

Children's orthopaedics Flashcards

1
Q

How are flat bones developed?

A

-Intramembranous ossification
-Mesenchymal cells → bone

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2
Q

How are long bones developed?

A

-Endochondral ossification
-Mesenchymal cells → cartilage → bone

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3
Q

What are examples of flat bones?

A

-Cranial bones
-Clavicle

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4
Q

How does intramembranous ossification work?

A
  1. Condensation of mesenchymal cells which differentiate into osteoblasts- ossification centre forms
  2. Secreted osteoid traps osteoblasts which become osteocytes
  3. Trabecular matrix and periosteum form
  4. Compact bone develops superficial to cancellous bone
  5. Crowded blood vessel condense into red bone marrow
  6. Immature woven bones remodelled and replaced by mature lamellae bone
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5
Q

What are the 2 sites of bone growth in endochondral ossification?

A

-Primary ossification centre= sites of pre natal bone growth from the central part of the bone
-Secondary ossification centre= post natal after primary and growth from ends of bones (physis)

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6
Q

How does endochondral primary ossification work?

A
  1. Mesenchymal differntiation at the primary centre
  2. The cartilage model of future bony skeleton forms
  3. Capillaries penetrate cartilage
  4. Calcification at primary ossification centre= spongy bone forms
  5. Perichondrium transforms into periosteum (soft tissue to bone)
  6. Cartilage and chondrocytes continue to grow at ends of the bone
  7. Secondary ossification centres develop with own blood supply
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7
Q

Where does endochondral secondary ossification occur?

A

Physis (physical plate)

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8
Q

What are the 2 types of bone development?

A

-Intramembranous ossification
-Endochondral ossification

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9
Q

What bones does intramembranous ossification take place in adults?

A

Flat bones

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10
Q

What are examples of flat bones?

A

-Cranial bones
-Clavicle

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11
Q

What bones does endochondral ossification take place in adults?

A

Long bones

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12
Q

How does intramembranous ossification work?

A
  1. Condensation of mesenchymal cells which differentiate into osteoblasts to form ossification centre
  2. Secreted osteoid traps osteoblasts which become osteocytes
  3. Trabecular matrix and periosteum forms
  4. Compact bone develops superficial to cancellous bone
  5. Croweded blood vessels condense into red bone marrow
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13
Q

What are the sites of growth in endochondral ossification?

A

-Primary ossification centre
-Secondary ossification centre

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14
Q

What are characteristic of the primary ossification centre?

A

-Prenatal bone growth
-Central part of bone

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15
Q

What are characteristic of the secondary ossification centre?

A

-Post natal
-Ends of long bones (physis)

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16
Q

How does endochondral primary ossification work?

A
  1. Mesenchymal differntiation at the primary centre
  2. Cartilage model of the future bony skeleton forms
  3. Capillaries penetrate cartilage
  4. Calcification at primary ossification centre forms spongy bone
  5. Perichondrium transforms into periosteum
  6. Cartilage and chondrocytes continue to grow at ends of the bone
  7. Secondary ossification centres develop
  8. Secondary ossification centres have own blood supply
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17
Q

Where does endochondral secondary ossification occur?

A

Physis (physeal plate)

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18
Q

What happens in endochondral secondary ossification?

A

-Zone of elongation in long bone
-Contains cartilage
-Epiphyseal side= hyaline cartilage active and dividing to form hyaline cartilage matrix
-Diaphyseal side= cartilage calcifies and dies and replaced by bone

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19
Q

How does elasticity of children’s skeleton compare to adult skeletons?

A

-It can bend more
-Due to increased density of Haversian canals

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20
Q

What can the increased elasticity in children’s skeleton cause?

A

-Plastic deformity= bends before breaking
-Buckle fracture= Taurus like the column, break does not go all the way through
-Greenstick= one cortex fractures but does not break the other side

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21
Q

What can physeal injuries cause?

A

-Growth arrest
-Growth arrest can lead to deformity

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22
Q

How does speed off healing differ in children compared to adults?

A

Much faster

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23
Q

What physis in the child’s body grows the fastest?

A

-Knee
-Extreme of upper limb

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24
Q

What are common children’s congenital orthopaedic conditions?

A

-Developmental dysplasia of the hip
-Club foot
-Achondroplasia
-Osteogenesis imperfecta

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25
Q

What is developmental dysplasia of the hip?

A

Group of disorders of the neonatal hip where HOF is unstable/incongruous in relation to acetabulum

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26
Q

What are risk factors for development dysplasia of the hip?

A

-Female
-First born
-Breech
-Family history
-Oligohydramnios= decreased amniotic fluid

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27
Q

How can developmental dysplasia of the hip present on a spectrum?

A

-Dysplasia
-Subluxation
-Dislocation

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28
Q

How does dysplasia in developmental dysplasia of the hip look like?

A

Hip within socket but not centrally so socket does not develop into perfect cup socket shape

29
Q

How does subluxation in developmental dysplasia of the hip look like?

A

-Shallow nature of socket means hip will pop in and out

30
Q

How does dislocation in developmental dysplasia of the hip look like?

A

Hip has never been in the socket and develops outside it and acetabulum develops with a shallow cup

31
Q

How is developmental dysplasia of the hip usually picked up?

A

Baby check screening= RoM of hip (limitations in hip abduction and uneven leg length)

32
Q

What is the investigation that can be done to verify DDH?

A

-Ultrasound= measures acetabular dysplasia and the position of the hip

33
Q

What are the treatments for DDH?

A

-Pavlik harness
-MUA+closed reduction and Spica

34
Q

What is clubfoot also known as?

A

Congenital talipes equinovarus

35
Q

What does clubfoot look like?

A

-Cavus foot= high arch, tight intrinsic muscles
-Adductus of foot
-Varus= tight achilles
-Equinous= tight achilles
Usually bilateral

36
Q

What are risk factors for clubfoot?

A

-Male
-Genetic: PITX1 gene

37
Q

What is the gold standard treatment for club foot?

A

Ponseti method

38
Q

What is the ponseti method?

A
  1. First a series of casts to correct deformity
  2. Many require operative treatment= soft tissue releases
  3. Foot orthosis brace
  4. Some will require further operative interventions to correct final deformity
39
Q

What is achondroplasia?

A

-Inhibition of chondrocyte proliferation in the proliferative zone of the physis
-Results in defect in endochondral bone formation

40
Q

What is the genetic component to aschondroplasia?

A

-Autosomal dominant
-G38- mutation of FGFR3

41
Q

What are the characteristics of achondroplasia?

A

-Rhizomelic dwarfism
-Normal cognitive development
-Significant spinal issues

42
Q

What is rhizomelic dwarfism?

A

-Humerus shorter than forearm
-Femur shorter than tibia
-Normal trunk
-Adult height approximately 125cm

43
Q

What is osteogenesis imperfecta?

A

Decreased type 1 collagen

44
Q

What type of condition is osteogenesis imperfect?

A

Hereditary

45
Q

What are reasons for decreased type 1 collagen in osteogenesis imperfecta?

A

-Decreased secretion
-Production of abnormal collagen

46
Q

What does insufficient type 1 collagen production lead to?

A

Insufficient osteoid production

47
Q

What are effects on the bones of osteogenesis imperfecta?

A

-Fragility fractures
-Short stature
-Scoliosis

48
Q

What are non-orthopaedic manifestations of osteogenesis imperfecta?

A

-Heart
-Blue sclera
-Dentinogenesis imperfecta= brown soft teeth
-Wormian skull
-Hypermetabolism

49
Q

What are characteristics of paediatric fractures?

A

-Pattern
-Anatomy
-Intra/extra-articular
-Displacement
(Salter-Harris)

50
Q

What is the pattern of paediatric fractures?

A

-Transverse
-Oblique
-Spiral
-Comminuted
-Avulsion

51
Q

What is the anatomy of a paediatric fracture?

A

-Proximal third
-Middle third diaphysis
-Distal third

52
Q

What is direct bone healing?

A

-Heals by direct union
-No callus formation

53
Q

What is secondary bone healing?

A

Bone healing by callus

54
Q

What is the preferred healing pathway in an intra articular fracture and why?

A

-Primary bone healing
-Minimises risk of post traumatic arthritis

55
Q

What are the different types of displacement in paediatric fractures?

A

-Displaced
-Angulated
-Shortened
-Rotated

56
Q

What is the Salter Harris?

A

Classification of physeal injuries

57
Q

What are the different classifications of Salter Harris?

A

Type I= physeal separation
Type II= fracture transverses physis and exits metaphysis
Type III= Fracture transverses physis and exits through epiphysis
Type IV= Fracture passes through epiphysis, physis, metaphysis
Type V= Crush injury to physis

58
Q

What are the treatment options for growth arrest?

A

-Limb length correction \
-Angular deformity

59
Q

What are the options for limb length correction?

A

-Shorten the long side
-Lengthen the short side

60
Q

What are the options for angular deformity?

A

-Stop the growth of the unaffected side
-Reform the bone (osteotomy)

61
Q

What are the 4 Rs of fracture management?

A

-Resuscitate
-Reduce
-Restrict
-Rehabilitate

62
Q

What is closed reduction of a fracture?

A

Reducing a fracture without making an incision

63
Q

What is open reduction of a fracture?

A

Making an incision

64
Q

What are examples of external restriction?

A

-Splints
-Plaster

65
Q

What are examples of internal restriction?

A

-Plate and screws
-Intra medullary device

66
Q

What is transient synovitis?

A

-Inflamed joint in response to a systemic illness
-Septic arthritis needs to be excluded first

67
Q

What is Perthes disease?

A

-Idiopathic necrosis of the Proximal femoral epiphysis
-Septic arthritis needs to be excluded first

68
Q

What is slipped upper femoral epiphysis?

A

-Proximal epiphysis slips in relation to the metaphysis
-Septic arthritis needs to be excluded first

MSK 2 (5 decks)

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