orthopaediatrics Flashcards

(46 cards)

1
Q

child vs adult bones

A
Child's has 270 bones - in continuous change
Physis (growth plates)
Elasticity greater
Speed of healing faster
Remodelling always
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

development of flat bones

A

intramembranous ossification

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

development of long bones

A

endochondral ossification

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

intramembranous ossification

A

formation of ossification centre - condensation of mesenchymal cells to osteoblasts
secreted osteoid traps osteoblasts – osteocytes
trabecular matrix and periosteum form
compact bone develops superficially, crowded blood vessels become red bone marrow

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

ossificaiton centres

A

primary ossification centres - pre-natal bone growth through endochondral oss from central part of bone
secondary ossification centres - post-natal after primary ossification centres, forms the physis

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

what ossification centre is there pre-natally

A

primary

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

endochondral primary ossification

A

mesenchymal differentiation creates a cartilage model in diaphysis
angiogenesis penetrates, primary centre forms and spongy bone
continues up the shaft, cartilage and chondrocytes form bone ends.
secondary ossification centres form at bone ends now

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

endochondral secondary ossification

A

centre calcifies and dies to immature spongy bone
epiphyseal side contains active hyaline cartilage which continues dividing to form hyaline cartilage matrix (epiphyseal growth plate)

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

What happens if the physis are faulty

A

Any congenital malfunction or acquired insult – traumatic/infective or otherwise will have impact on growth of the child

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

why are childrens bones more elastic

A

increased density of haversian canals (need blood supply for growing tissue)
dissipation of energy means it can bend more before breaking

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

importance of childrens bone elasticity

A

plastic deformations - bends before breaking
buckle fractures - pushes outwards like roman column
greenstick fractures - one cortex fractures but other side doesnt break

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

when does bone growth stop

A

when physis closes - puberty

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

what is physis closure dependent on

A

parental height
menarche
puberty

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

when are boys and girls’ physis closed

A

boys - 18/19

girls - 15/16

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

what is a physeal injury

A

salter harris

may lead to growth arrest

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

remodelling potential of children

A

greater the younger they are

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

common congenital ortho conditions

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
18
Q

what is developmental dysplasia of the hip

A

head of femur unstable or incongruous with acetabulum

may result in subluxation - hip popping in and out

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

risk factors for developmental dysplasia of hip

A

female
first born
breech
family history

20
Q

examination for DDH

A

baby check - hip RoM

21
Q

investigation for DDH

A

ultrasound - measure acetabular dysplasia and hip position

22
Q

treatment of DDH

A

if reducible - pavlik harness

if failed/irreducible - MUA+closed reduction and spica

23
Q

what is club foot

A

congenital deformity of foot
CAVE - cavus, adductus foot, varus, equinous
familial disorder

24
Q

what does CAVE mean in relation to club foot

A

Cavus - high foot arch
Adductus of foot - tight tib post and ant
Varus - tight tendoachilles, tib post tib ant
Equinous - tight tendoachilles

25
treatment of club foot
ponseti method - casts, operation (soft tissue release), brace, may need additional operations
26
what is achondroplasia
skeletal dysplasia - normal trunk, femur smaller than tibia and humerus smaller than forearm G380 mutation of FGFR3
27
pathophysiology of achondroplasia
inhibition of chrondrocyte proliferation in proliferative zone of physis results in defect in endochondral bone formation
28
what is osteogenesis imperfecta
hereditary autosomal D/R decreased type I collagen - decreased secretion and production of abnormal leads to insufficient osteoid production
29
problems caused by osteogenesis imperfecta
``` fragility fractures short stature scoliosis blue sclera brown, soft teeth ```
30
classification of salter harris fractures
``` SALT Separation through then up Above physis through then goes Lower physis Through epiphysis (vertically) crush injury ```
31
what type of salter harris fracture has greatest risk of growth arrest
type 5 - crush injury
32
how is growth arrest affected by the fracture
whole physis - complete arrest | partial physis - angulation
33
principles of treatment of salter harris fractures
correct deformity - minimise angular deformity and limb length difference
34
limb length corretcing
shorten long side | lengthen short side - plates
35
angular deformity correction
stop growth of affected side | reform bone - osteotomy
36
closed reduction for paediatric fracture
gallows traction for long bones | correction for deformity
37
4 rs of paediatric fractures
resuscitate reduce restrict rehabilitate
38
restriction for paediatric fractures
plasters and splints most common | operative internal avoided but titanium nails more elastic so best for growing bones
39
rehabilitation techniques for children
play | use it move it strengthen it
40
differential Dx for limping child
septic arthritis transient synovitis perthes slipped upper femoral epiphysis
41
septic arthritis in children kochers classification
non-weight bearing ESR over 40 WBC over 12,000 temp over 38
42
when can transient synovitis be diagnosed in children
after exclusion of septic arthritis
43
perthes disease
idiopathic necrosis of proximal femoral epiphysis | boys 4-8 more likely
44
SUFE usual presentation
obese adolescent males 12-13 yo associated with hypothyroid/pituitarism
45
treatment for SUFE
operative fixation with screw to prevent further slip and minimise long term growth problems
46
what is transient synovitis
inflamed joint in repsonse to a systemic illness | treated by antibiotics