orthopaediatrics

Question 1

child vs adult bones

Answer 1

Child's has 270 bones - in continuous change
Physis (growth plates)
Elasticity greater
Speed of healing faster
Remodelling always

Question 2

development of flat bones

Answer 2

intramembranous ossification

Question 3

development of long bones

Answer 3

endochondral ossification

Question 4

intramembranous ossification

Answer 4

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

Question 5

ossificaiton centres

Answer 5

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

Question 6

what ossification centre is there pre-natally

Answer 6

primary

Question 7

endochondral primary ossification

Answer 7

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

Question 8

endochondral secondary ossification

Answer 8

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)

Question 9

What happens if the physis are faulty

Answer 9

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

Question 10

why are childrens bones more elastic

Answer 10

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

Question 11

importance of childrens bone elasticity

Answer 11

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

Question 12

when does bone growth stop

Answer 12

when physis closes - puberty

Question 13

what is physis closure dependent on

Answer 13

parental height
menarche
puberty

Question 14

when are boys and girls’ physis closed

Answer 14

boys - 18/19

girls - 15/16

Question 15

what is a physeal injury

Answer 15

salter harris

may lead to growth arrest

Question 16

remodelling potential of children

Answer 16

greater the younger they are

Question 17

common congenital ortho conditions

Answer 17

developmental dysplasia of the hip
club foot
achondroplasia
osteogenesis imperfecta

Question 18

what is developmental dysplasia of the hip

Answer 18

head of femur unstable or incongruous with acetabulum

may result in subluxation - hip popping in and out

Question 19

risk factors for developmental dysplasia of hip

Answer 19

female
first born
breech
family history

Question 20

examination for DDH

Answer 20

baby check - hip RoM

Question 21

investigation for DDH

Answer 21

ultrasound - measure acetabular dysplasia and hip position

Question 22

treatment of DDH

Answer 22

if reducible - pavlik harness

if failed/irreducible - MUA+closed reduction and spica

Question 23

what is club foot

Answer 23

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

Question 24

what does CAVE mean in relation to club foot

Answer 24

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

Question 25

treatment of club foot

Answer 25

ponseti method - casts, operation (soft tissue release), brace, may need additional operations

Question 26

what is achondroplasia

Answer 26

skeletal dysplasia - normal trunk, femur smaller than tibia and humerus smaller than forearm G380 mutation of FGFR3

Question 27

pathophysiology of achondroplasia

Answer 27

inhibition of chrondrocyte proliferation in proliferative zone of physis results in defect in endochondral bone formation

Question 28

what is osteogenesis imperfecta

Answer 28

hereditary autosomal D/R decreased type I collagen - decreased secretion and production of abnormal leads to insufficient osteoid production

Question 29

problems caused by osteogenesis imperfecta

Answer 29

``` fragility fractures short stature scoliosis blue sclera brown, soft teeth ```

Question 30

classification of salter harris fractures

Answer 30

``` SALT Separation through then up Above physis through then goes Lower physis Through epiphysis (vertically) crush injury ```

Question 31

what type of salter harris fracture has greatest risk of growth arrest

Answer 31

type 5 - crush injury

Question 32

how is growth arrest affected by the fracture

Answer 32

whole physis - complete arrest | partial physis - angulation

Question 33

principles of treatment of salter harris fractures

Answer 33

correct deformity - minimise angular deformity and limb length difference

Question 34

limb length corretcing

Answer 34

shorten long side | lengthen short side - plates

Question 35

angular deformity correction

Answer 35

stop growth of affected side | reform bone - osteotomy

Question 36

closed reduction for paediatric fracture

Answer 36

gallows traction for long bones | correction for deformity

Question 37

4 rs of paediatric fractures

Answer 37

resuscitate reduce restrict rehabilitate

Question 38

restriction for paediatric fractures

Answer 38

plasters and splints most common | operative internal avoided but titanium nails more elastic so best for growing bones

Question 39

rehabilitation techniques for children

Answer 39

play | use it move it strengthen it

Question 40

differential Dx for limping child

Answer 40

septic arthritis transient synovitis perthes slipped upper femoral epiphysis

Question 41

septic arthritis in children kochers classification

Answer 41

non-weight bearing ESR over 40 WBC over 12,000 temp over 38

Question 42

when can transient synovitis be diagnosed in children

Answer 42

after exclusion of septic arthritis

Question 43

perthes disease

Answer 43

idiopathic necrosis of proximal femoral epiphysis | boys 4-8 more likely

Question 44

SUFE usual presentation

Answer 44

obese adolescent males 12-13 yo associated with hypothyroid/pituitarism

Question 45

treatment for SUFE

Answer 45

operative fixation with screw to prevent further slip and minimise long term growth problems

Question 46

what is transient synovitis

Answer 46

inflamed joint in repsonse to a systemic illness | treated by antibiotics