Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

BRS - Year 2 > 🩻MSK🩻 - Children's Orthopaedics > Flashcards

🩻MSK🩻 - Children's Orthopaedics Flashcards

(62 cards)

Start Studying
1
Q

What is important to note about the paediatric skeleton?

A

NOT a miniaturised version of an adult
Has 270 bones and is a system that is in continuous change

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

What are the physes?

A

A physis is a growth plate
The area from which long bone growth occurs post-natally

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

Outline bone development for flat bones

A

Intramembranous ossification
Mesenchymal cells -> bone

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

Outline bone development for long bones?

A

Endochondral ossifications
Mesenchymal cells -> cartilage -> bone

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

What type of bone growth do cranial bones and the clavicle follow?

A

Intramembranous ossification

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

What are mesenchymal cells?

A

Type of stromal stem cell that can differentiate into various connective tissue cells like bone, cartilage, and fat

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

What is the first step of intramembranous ossification?

A

Condensation of mesenchymal cells
Differentiate into osteoblasts
Ossification centre forms

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

What occurs in intramembranous ossification after formation of the ossification centre?

A

Secreted osteoid traps osteoblasts
Trapped osteoblasts become osteocytes
Some osteoblasts further differentiate into osteoclasts

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

What occurs after the formation of osteocytes in intramembranous ossification?

A

Trabecular matrix forms
Mesenchyme forms the periosteum
Angiogenesis - blood vessels incorporated between the woven bonetrabeculae

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

What occurs after trabecular matrix and periosteum formation in intramembranous ossification?

A

Compact bone develops superficially to cancellous bone
Crowded blood vessels condense to form red bone marrow

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

Where does long bone formation take place?

A

At primary and secondary ossification centres

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

What are primary ossification centres?

A

Sites of pre-natal bone growth through endochondral ossification from the central part of the bone

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

What are secondary ossification centres?

A

Occurs post-natal after the primary ossification centre
Long bones often have several (the physes)

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

What are the first steps in primary/pre-natal endochondral ossification?

A

Mesenchymal differentiation at the primary centre
Cartilage model of the future bony skeleton forms
Capillaries penetrate cartilage
-Calcification at the primary ossification centre – spongy bone forms
Perichondrium transforms into periosteum

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

What occurs after capillaries penetrate the cartilage and the periosteum forms in primary/pre-natal endochondral ossification?

A

Cartilage and chondrocytes continue to grow at ends of the bone
Secondary ossification centres develop with its own blood vessel and calcification at the proximal and distal end – calcification of the matrix
Cartilage remains at epiphyseal (growth) plate and at joint surface as articular cartilage.

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

Where does secondary ossification occur?

A

The physis (physeal plate)

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

What is the physis?

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 then replaced by bone

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

What is the significance of the physis in children?

A

Responsible for the skeletal growth of a child
Congenital malfunction or acquired insult to this area (traumatic, infective or otherwise) will have a subsequent impact of the growth of that child

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

How are children’s bones structurally and mechanically different to adult bones?

A

Children’s bones can bend
Increased density of Haversian canals in children - more porous bone than adults
Leads to more elastic bones than adults

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

Due to the nature of their bones, what injuries can children sustain to their bones that adults cannot?

A

Buckle fracture - tarus, like the column
Plastic deformity - bends before breaking
Greenstick - like a tree, one cortex fractures but doesn’t break the other side

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

How does growth at the physis change throughout life?

A

Growth occurs at varying rates at varying sites
Growth stops as the physis closes
Gradual physeal closure, Puberty, Menarche, Parental height
Complete at:
Girls 15-16
Boys 18-19

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

What can physeal injuries lead to?

A

Growth arrest
Growth arrest can lead to deformity

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

Which physes have the most growth?

A

Physis at extremes of upper limb (wrist and shoulder) grow more
Physis at the knee grows most of all

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

What are the common children’s congenital conditions (in the context of paediatric orthopaedics?

A

Developmental dysplasia of the hip
Club foot
Achondroplasia
Osteogenesis imperfecta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is developmental dysplasia of the hip?
Group of disorders of the neonatal hip where the head of the femur is unstable or incongruous in relation to the acetabulum (socket for femur in the pelvis) The normal development relies on the concentric reduction and balanced forces through the hip Spectrum with dysplasia – subluxation – dislocation
26
What are the risk factors for developmental dysplasia of the hip?
Female 6:1 First born Breech FH Oligohydramnios (having less amniotic fluid) Native American/Laplanders – swaddling of hip Rare in African/Asian
27
How is DDH picked up?
Usually picked up on baby check - screening in UK Range of motion of hip - usually limitation in hip abduction, leg length (Galeazzi) 3 months or older - Barlow and Ortalani tests are non-sensitive (maneuvers used to test for hip instability/dislocation)
28
What investigation can be used to find DDH?
Ultrasound - birth to 4 moths After 4 months - X-ray Measures acetabular dysplasia and the position of hip
29
What is the treatment for DDH?
Reducible hip and <6months - Pavlik Harness 92% effective
30
When would a Pavlik harness not be suitable for DDH, and what is the alternative?
Failed Pavlik Harness or 6-18 months Secondary changes- capsule + soft tissue MUA + Closed reduction and Spica
31
What is clubfoot?
Congenital Talipes Equinovarus Congenital deformity of the foot 1:1000 Highest in Hawaiians Males 2:1 50% bilateral Genetic component - PITX1 gene
32
What deformity is seen in clubfoot?
CAVE deformity due to muscle contracture Cavus –high arch: tight intrinsic, FHL, FDL Adductus of foot: Tight tib post and ant Varus: Tight tendoachillies, tib post, tib ant Equinous: tight tendoachilles
33
What is the treatment for clubfoot?
Ponseti method - gold standard 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 intervention to correct final deformity.
34
What is achondroplasia?
Most common skeletal dysplasia Rhizomelic dwarfism -Humerus shorter than forearm -Femur shorter than tibia -Normal trunk -Adult height of approx. 125cm Normal cognitive development Significant spinal issues
35
Outline the pathophysiology behind achondroplasia
Autosomal Dominant -G380 mutation of FGFR3 -inhibition of chondrocyte proliferation in the proliferative zone of the physis -results in defect in endochondral bone formation
36
What is osteogenesis imperfecta?
Brittle bone disease Fragile bones due to insufficient osteoid production
37
How does the insufficient osteoid production occur in osteogenesis imperfecta?
Hereditary – autosomal dominant or recessive -Decreased Type I Collagen due to: -Decreased secretion -Production of abnormal collagen Leads to insufficient osteoid production
38
What effects does insufficient osteoid production have in osteogenesis imperfecta?
Bone malformation and fragility Fragility fractures Short stature Scoliosis
39
What are the non-orthopaedic manifestations of osteogenesis imperfecta?
Increased risk of cardiovascular issues Blue Sclera Dentinogenesis imperfecta – brown soft teeth Wormian skull Hypermetabolism
40
What are the standard fracture patterns, and the additional ones only experienced by children?
Transverse Oblique Spiral Comminuted - 3+ pieces Avulsion - tendon or ligament pulls away a piece of bone Children specific: Plastic deformity Greenstick Buckle fracture
41
What are the anatomical categorisations of fractures?
42
What are the two types of bone healing?
43
How are fractures categorised by displacement?
44
How are physeal injuries classified?
Salter Harris scale Risk of growth arrest increases from 1-5 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 Type 2 is the most common
45
How can growth arrest manifest?
Injuries to the physis can cause growth arrest Location and timing is key Whole physis - limb length discrepancy Partial - angulations as the non-affected side continues to grow
46
What are the treatment goals for growth arrest?
Minimise angular deformity - Stop the growth of the unaffected side, reform the bone (osteotomy) Minimise limb length difference - shorten the long side, lengthen the short side
47
What are "The 4 Rs" of fracture managements?
Resuscitate Reduce Restrict Rehabilitate
48
What is "resuscitate"?
Initial step Ensure patient is stable, DR ABC
49
What is "reduce"?
Correct the deformity and displacement Reduce secondary issue to soft tissue / NV structures
50
What are the 2 types of reduction?
Closed Reducing a fracture without making an incision Such as traction and manipulation in A&E Open Making an incision The realignment of the fracture under direct visualisation
51
Give a technique for closed reduction?
52
What is "restrict"?
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 remodelling potential
53
What are the different forms of restriction?
54
What methods of restriction are commonly used in paediatric fracture?
Plasters and splints Remodelling and huge healing potential means that operative internal fixation often can be avoided
55
Outline "rehabilitate" in the context of paediatric fractures?
Children generally rehabilitate very quickly Play is a great rehabilitator Stiffness not as major issue as in adults Use it, Move it and Strengthen!
56
What are the causes of "the limping child"?
Septic arthritis (MOST IMPORTANT - AIM TO RULE OUT IMMEDIATELY) Transient synovitis Perthes SUFE
57
Why is it so important to rule out septic arthritis in children presenting with a limp?
Septic arthritis in a child is a orthopaedic emergency! Can cause irreversible long term problems in the joint - needs surgical washout of the joint
58
How can septic arthritis be diagnosed?
Kocher’s classification can help score probability -Non weight bearing -ESR >40 -WBC >12,000 -Temperature >38 The history is key -Duration -Other recent illness -Associated joint pain
59
What is the treatment for septic arthritis?
Joint washout/lavage IV Abx
60
What is transient synovitis?
Transient synovitis is a diagnosis once septic arthritis has been excluded Is a inflamed joint in response to a systemic illness Supportive treatment with antibiotics is the treatment
61
What is Perthes disease?
Idiopathic necrosis of the proximal femoral epiphysis Usually in those 4-8 years old Male 4:1 Septic arthritis needs to be excluded first Treatment is usually supportive in the first instance Significant affect on QoL, comparable to childhood cancer
62
What is SUFE?
Slipped upper femoral epiphysis The proximal epiphysis slips in relation to the metaphysis Usually obese adolescent male -12-13 years old during rapid growth Septic arthritis needs to be excluded first Treatment is operative fixation to prevent further slip and minimise long term growth problems

BRS - Year 2 (75 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions