MSK - paeds ortho/trauma

Question 1

What is the most common traumatic injury in children?

Answer 1

Broken forearm

Question 2

What are the principles of childrens’ fractures?

Answer 2

Often simple, incomplete and heal quickly
They remodel well in plane of joint movement
A thick periosteal hinge helps recovery (usually)
Fractures involving physes can result in progressive deformity

Question 3

What are the different types of facture?

Answer 3

Transverse
oblique
spiral
Buckle
Impacted
Communicated
Greenstick
Intra/extra articular
Butterfly
Burst
Crash

Question 4

What are the low energy fractures that occur in the forearm?

Answer 4

Buckle

Greenstick (buckle on ine side, snap on other)

Question 5

What are the high energy fractures that occur in the forearm?

Answer 5

Open
Displaced
Often with soft tissue injury

Question 6

What is the important consideration in forearm injuries?

Answer 6

Maintaining the supination/pronation range of movement

Question 7

How do you assess a fracture?

Answer 7

History - ask for mechanism of injury
Deformity
Look at soft tissue - whole limb
Wounds
Sensation, motor function
Vascular status

Document
Repeat post-intervention

Question 8

What radiological investigations are needed into fractures?

Answer 8

X-rays in 2 planes
Must see above and below joint in both

PA, true lateral

Question 9

What is the primary symptom of comparmtnet syndrome?

Answer 9

Pain ou of proportion

Question 10

What are the complications of forearm fractures?

Answer 10

Compartment syndrome (volkman's)
Non-union
Refracture
Radioulnar synstosis (abnormal fusion of bone)
Radial nerve injury
Radiocapitellat problems

Question 11

What is radioulnar synstosis?

Answer 11

Abnormal fusion of radial and ulna bones
Happens more proximally
High energy, same level

Question 12

How do you prevent radioulnar synstosis?

Answer 12

Single incicsion between two bones

Question 13

How do you manage a buckle fracture of the forearm?

Answer 13

cast for 3-4 weeks

Question 14

How do you manage a greenstick fracture of the forearm?

Answer 14

Cast for 4-6 weeks

Question 15

How do you manage a complete fracture of the forearm?

Answer 15

Cast for 6 weeks

Sometimes K wires

Question 16

What are the risks for remanipulation?

Answer 16

Complete fractures

Failed anatomic reduction

Question 17

What are the differentials for knee trauma?

Answer 17

Infection
Inflammatory arthropathy
Neoplasm
Apophysitis
Sickle cell, haemophilia
"Anterior knee pain"

Question 18

What bony injuries occur in knee injuries?

Answer 18

Physeal/metaphyseal
Tibial spine
Patellar fracture
Sleeve fracture
Patellar dislocation

Question 19

What are the complications of a physeal injury?

Answer 19

Hyperextension - vascular injury

Varus - CPN injury

Question 20

How do you treat a physeal injury?

Answer 20

Cast immbolise
Percutaneous fix
Earlly loss of range of movement

Question 21

How do you monitor a physeal frature?

Answer 21

Look for Harus lines
Angulation
Length (growth arrest - resect if occurs)

Question 22

What is a tibial spine injury?

Answer 22

ACL injury pulls off tibial spine

Only occurs in children as bone is weaker than tendon

Question 23

What is a tibial spine injury?

Answer 23

Patella tendon rips off tibial spine

Question 24

How do you treat a patellar fracture?

Answer 24

Undisplaced = cylinder cast
Displaced = ORIF (open reduction internal fixation)

Question 25

What are the risk factors for patella dislocation?

Answer 25

``` Laxity of ligaments (collagen disorders) Poor Vastus Medialis Obliqus Q angle (angle between long line of tibia and that of femur) Femoral anteversion Tibial external rotation Patella alta ```

Question 26

Who commonly gets osteochondral lesions?

Answer 26

Adolesccant population

Question 27

If there is a knee injury what other joint should you look at?

Answer 27

Hip

Question 28

What is the most common plane of fracture in the ankle?

Answer 28

The physis as it is weaker than ligaments

Question 29

What views should the film be taken in to prevent missed fractures?

Answer 29

Mortise | Oblique

Question 30

What are the different Slater-Harris classifications of fractures?

Answer 30

Type 1 - Fracture Line is within the Physis Type 2 - Extends from the Physis into the Metaphysis Type 3 - Fracture enters the Epiphysis from the Physis Type 4 - Fracture extends across the Physis, from the Articular Surface to the Epiphysis Type 5 - Fractures are Crush Injuries of the Physis

Question 31

What is the most common ankle fracture?

Answer 31

Slater-harris 2 Extending from physis into metaphysis Often displaced

Question 32

What are the worries with a transitional fracture?

Answer 32

That the growth plate with close

Question 33

What are the types of transitional fracture?

Answer 33

Triplane | Tillaux

Question 34

What are the two types of overuse injuries you see in children?

Answer 34

Osgood-schlatter's disease | Sever's disease (football)

Question 35

What are the warnings for non-accidental injuries?

Answer 35

Incongruent history (doesn't quite add up) Bruising patterns Burns Multiple fractures at multiple stages of healing Metapyseal fracture Humeral shaft fracturesRib fractures Non-ambulant fractures

Question 36

Who is most likely to get developmental dysplasia of the hip?

Answer 36

Easten Europe neonates (up to 3%) Not just based on genetics, but also way they carry children Girls 6:1 First born Breech presentation Oligohydramnios

Question 37

What are the clinical features of developmental dysplacia of hip?

Answer 37

Ortolani's sign (will the hip dislocated) Barlow's sign (will joint relocated) Piston motion sign (motion)

Question 38

How do you treat developmental dysplasia of the hip?

Answer 38

An abductive brace

Question 39

Who does Legg-calve-Perthes disease affect?

Answer 39

Mainly primary school children | Males 5:1

Question 40

What are the clinical features of Legg-Calve-Pertes (LCP)?

Answer 40

``` Short stature Limp Knee-pain on exercise Stiff hip joint Systemically well ```

Question 41

What are the phases of LCP?

Answer 41

Avascular necrosis (femoral head) Fragmentation - revascularisation - painful phrase Reossification - bony healing Residual deformity

Question 42

When do patients with LCP usually present?

Answer 42

Fragmentation phase | At which point it is too late to help

Question 43

What are the differentials of LCP (unilateral)?

Answer 43

Septic hip JIA SCFE Lymphoma

Question 44

What are the differentials for bilateral LCP?

Answer 44

Hypothyroid Sickle Epiphyseal dysplasia

Question 45

How do you treat LCP?

Answer 45

Maintain hip motion Analgesia Restrict painful activities Nothing active

Question 46

What is valgus?

Answer 46

Deviation away from midline

Question 47

What is varus?

Answer 47

Deviation toward midline

Question 48

What is SCFE?

Answer 48

Slipped capital femoral epiphysis

Question 49

Who is affected by SCFE?

Answer 49

Tenage boys more than girls | 9-14yrs

Question 50

What is stable vs unstable SFE?

Answer 50

Stable is if you cna weight bear

Question 51

How does SCFE present?

Answer 51

Pain in hip OR knee! Externally rotated posture and gait Reduced internal rotation, especially in flexion

Question 52

What determines mild/moderate/severe SCFE?

Answer 52

Mild is less than 1/3 of femoral head slipping Moderate up to half Severe is more than half Relative on AP film

Question 53

What is the pathology of SCFE?

Answer 53

Displasment through hypertrophic zone | Metaphysis moves anterior and proximally

Question 54

How do you treat SCFE?

Answer 54

Screw across the physis (surgery)

Question 55

What are teh complications of SCFE (surgery)?

Answer 55

AVN - avascular necrosis Chondrolysis (screw too far) Deformity Early osteoarthritis