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BRS Year 2 > orthopaediatrics > Flashcards

Flashcards in orthopaediatrics Deck (46)
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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
2
Q

development of flat bones

A

intramembranous ossification

3
Q

development of long bones

A

endochondral ossification

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

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

6
Q

what ossification centre is there pre-natally

A

primary

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

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)

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

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

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

12
Q

when does bone growth stop

A

when physis closes - puberty

13
Q

what is physis closure dependent on

A

parental height
menarche
puberty

14
Q

when are boys and girls’ physis closed

A

boys - 18/19

girls - 15/16

15
Q

what is a physeal injury

A

salter harris

may lead to growth arrest

16
Q

remodelling potential of children

A

greater the younger they are

17
Q

common congenital ortho conditions

A

developmental dysplasia of the hip
club foot
achondroplasia
osteogenesis imperfecta

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

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
Q

treatment of club foot

A

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

26
Q

what is achondroplasia

A

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

27
Q

pathophysiology of achondroplasia

A

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

28
Q

what is osteogenesis imperfecta

A

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

29
Q

problems caused by osteogenesis imperfecta

A
fragility fractures
short stature
scoliosis
blue sclera
brown, soft teeth
30
Q

classification of salter harris fractures

A
SALT
Separation
through then up Above physis
through then goes Lower physis
Through epiphysis (vertically)
crush injury
31
Q

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

A

type 5 - crush injury

32
Q

how is growth arrest affected by the fracture

A

whole physis - complete arrest

partial physis - angulation

33
Q

principles of treatment of salter harris fractures

A

correct deformity - minimise angular deformity and limb length difference

34
Q

limb length corretcing

A

shorten long side

lengthen short side - plates

35
Q

angular deformity correction

A

stop growth of affected side

reform bone - osteotomy

36
Q

closed reduction for paediatric fracture

A

gallows traction for long bones

correction for deformity

37
Q

4 rs of paediatric fractures

A

resuscitate
reduce
restrict
rehabilitate

38
Q

restriction for paediatric fractures

A

plasters and splints most common

operative internal avoided but titanium nails more elastic so best for growing bones

39
Q

rehabilitation techniques for children

A

play

use it move it strengthen it

40
Q

differential Dx for limping child

A

septic arthritis
transient synovitis
perthes
slipped upper femoral epiphysis

41
Q

septic arthritis in children kochers classification

A

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

42
Q

when can transient synovitis be diagnosed in children

A

after exclusion of septic arthritis

43
Q

perthes disease

A

idiopathic necrosis of proximal femoral epiphysis

boys 4-8 more likely

44
Q

SUFE usual presentation

A

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

45
Q

treatment for SUFE

A

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

46
Q

what is transient synovitis

A

inflamed joint in repsonse to a systemic illness

treated by antibiotics

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