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Year 3 - Musculoskeletal > Paediatric Orthopaedics > Flashcards

Paediatric Orthopaedics Flashcards

1
Q

What is stronger ligaments of growth plates? What does this mean?

A

Ligaments stronger than growth plate:
> easy to produce epiphyseal separation
> difficult to produce dislocations or sprains

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2
Q

What is the advantages/disadvantages of children’s bone being more porous?

A

> Tolerates more deformation (plasticity)

> Fails in compression as well as tension:

  • Buckle fractures
  • Green stick fractures
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3
Q

What is considered a normal variation?

A

> Describes a specific pattern of normality for that population/ age

> The range: conventionally lying between 2 Standard deviations from the mean, Gaussian distribution (97% of individuals for that group)

> Data is pop/ age specific

> By definition there will be children who fall out with the norm who have no underlying pathology

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4
Q

What are the subtle differences in physiological development?

A

> Change in shape/ angle/ appearance with growth

> Normal development:

  • Femoral anteversion
  • Bow legs
  • Flat feet
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5
Q

Examples of self correcting or non-concerning pathologies?

A

> Persistent femoral anteversion
Metatarsus adductus
Posterior tibial bowing
Curly toes

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6
Q

Common presenting parental concerns (Excluding true pathology)

A 
> Out toeing
> In toeing
> Bow legs
> Knock knees
> Tiptoe walking
> Flat feet
> Curved feet
> Curly toes
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7
Q

David jones system of assessment - Normal variants?

A 
David Jones system
> Symmetrical- yes
> Symptomatic- no
> Systemic illness- no
> Skeletal dysplasia- no
> Stiffness-no
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8
Q

What is the aim of assessment in paediatric orthopaedics?

A

> What are the parental worries

> Is it a ‘normal variant’?

1) No
- Spot true pathology
- Is the pathology concerning, will it self correct?

2) Yes:
- Future development concerns
- Out of date practices

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9
Q

Rotational alignment is usually?

A

Axial

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10
Q

Angular alignment is usually?

A

Coronal

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11
Q

Why is there a change in feet-walking patterns throughout childhood?

A

Change is related to rotational changes at the hip, tibia and foot

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12
Q

When there is intoeing in a child what should be checked?

A

Identify origin of rotational concern:

  • Hip
  • Tibia
  • Foot
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13
Q

At birth are the hips more internally or externally rotated, why?

A

Externally rotate due to the ST contractors of the hip at birth

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14
Q

If anteversion is excessive during development of the hip what occurs?

A

Internal rotation of the leg and will give the appearance of intoeing

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15
Q

What would you see with the knee cap in intoeing - What is the importance of this?

A

Face inwards if the pathology is arising from the hips - This is considered a correctable pathology

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16
Q

How is tibial torsion assessed?

A

Clinically assessed:
> Thigh foot angle technique

> Patellae position with feet/ ankles facing forward

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17
Q

Is internal tibial torsion normal?

A

> An element of internal tibial torsion is normal

> Combination of in utero moulding and tibial shape

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18
Q

What is normal forefoot adduction?

A

Normal is between the 2nd and 3rd toe

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19
Q

What is mild forefoot adduction?

A

The third toe

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20
Q

What is moderate forefoot adduction?

A

Between third and fourth toe

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21
Q

What is severe forefoot adduction?

A

Between the fourth and fifth toe

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22
Q

How is leg alignment in early life (1-2 yrs)?

A

Vanus

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23
Q

How is leg alignment in early life (2-4 yrs)?

A

Valgus

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24
Q

What is the mean age of walking age?

A

12 months

This isn’t normal though, it is common for children to not walk until up to 18months-2yrs it is more important that they show progress between crawling etc

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25
Q

Causes of intoeing as a child?

A

> Femoral anteversion
Int. tibial torsion
Metatarsus adductus

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26
Q

Is intoeing an issue as a child?

A

No it will not cause issues in degeneration or sports performance

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27
Q

What is the fix for intoeing?

A

Fracturing and fixation this is very rarely ever needed

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28
Q

Measuring femoral anteveriosn?

A

1) Lay in prone position
2) Flex knee 90o
3) Externally rotate and measure the degree

40o is normal at birth, 80% reach 10o by 16 years

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29
Q

How does someone present with internal tibial torsion?

A

Increased thigh foot angle, 90% spontaneously resolve though

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30
Q

At which age should intoeing be corrected, how?

A

At age 10, surgery can be considered

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31
Q

When is flexible flat foot normal?

A

At birth, this will diminish with age even if it doesn’t it is not a worry

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32
Q

What indicates flexible flat foot, what is important?

A

Plantar flexion demonstrate the arch appearing, referral is not required for fixed flat foot

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33
Q

How is gait analysed?

A

Observational
> Equipment: Eyes and floor!
> Limitation: Single aspect, real time

Video
> Equipment: Camera and floor.
> Limitation: Single/orthogonal view

3D instrumented
> Equipment: Lab, force plates, EMG
> Limitation: >5y, walker

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34
Q

Normal gait?

A

> Series of rhythmical , alternating movements of the trunk & limbs which result in the forward progression of the center of gravity

> Series of ‘controlled falls’

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35
Q

Gait cycle?

A

Gait Cycle =
> Single sequence of functions by one limb

> Begins when reference font contacts the ground

> Ends with subsequent floor contact of the same foot

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36
Q

Step length?

A

Step Length =
> Distance between corresponding successive points of heel contact of the opposite feet

> Rt step length = Lt step length (in normal gait)

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37
Q

Stride length?

A

Stride Length =
> Distance between successive points of heel contact of the same foot

> Double the step length (in normal gait)

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38
Q

Walking base?

A

Walking Base =
> Side-to-side distance between the line of the two feet

> Also known as ‘stride width’

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39
Q

Cadence?

A

Cadence =
> Number of steps per unit time

> Normal: 100 – 115 steps/min

> Cultural/social variations

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40
Q

Velocity?

A

Velocity =
> Distance covered by the body in unit time

> Usually measured in m/s

> Instantaneous velocity varies during the gait cycle

> Average velocity (m/min) = step length (m) x cadence (steps/min)

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41
Q

Comfortable walking speed?

A

Comfortable Walking Speed (CWS) =
> Least energy consumption per unit distance

> Average= 80 m/min (~ 5 km/h , ~ 3 mph)

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42
Q

Phase of gait?

A

1) Stance phase = Reference limb in contact with floor

2) Swing phase = Reference not in contact with the floor

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43
Q

Single support in gait cycle?

A

Single Support: only one foot in contact with the floor

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44
Q

Double support support in gait cycle?

A

Double Support: both feet in contact with floor

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45
Q

Stance phase of gait?

A
  1. Heel contact: ‘Initial contact’
  2. Foot-flat: ‘Loading response’, initial contact of forefoot w. ground
  3. Midstance: greater trochanter in alignment w. vertical bisector of foot
  4. Heel-off: ‘Terminal stance’
  5. Toe-off: ‘Pre-swing’
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46
Q

Swing phase of gait?

A
  1. Acceleration: ‘Initial swing’
  2. Midswing: swinging limb overtakes the limb in stance
  3. Deceleration: ‘Terminal swing’
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47
Q

Time frame in gait?

A

A. Stance vs. Swing:
> Stance phase = 60% of gait cycle
> Swing phase = 40%

B. Single vs. Double support:
> Single support = 40% of gait cycle
> Double support= 20%

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48
Q

With increasing walking speed stand phase….

A

Decreases

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49
Q

With increasing walking speed swing phase…

A

Increase

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50
Q

With increasing walking speed double support…

A

Decreases

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51
Q

Definition of running?

A

> By definition: walking without double support

> Ratio stance/swing reverses

> Double support disappears. ‘Double swing’ develops

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52
Q

Centre of gravity?

A

Center of Gravity (CG):
> midway between the hips
> Few cm in front of S2

Least energy consumption if CG travels in straight line

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53
Q

Centre of gravity - Vertical displacement?

A 
> Rhythmic up & down movement
> Highest point: midstance
> Lowest point: double support
> Average displacement: 5cm
> Path: extremely smooth sinusoidal curve
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54
Q

Centre of gravity - lateral displacement?

A

> Rhythmic side-to-side movement
Lateral limit: midstance
Average displacement: 5cm
Path: extremely smooth sinusoidal curve

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55
Q

Centre of gravity - overall displacement?

A

> Sum of vertical & horizontal displacement

> Figure ‘8’ movement of CG as seen from AP view

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56
Q

Forces that have the most significance influence on gait are?

A

(1) gravity
(2) muscular contraction
(3) inertia
(4) floor reaction

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57
Q

Common Gait abnormalities?

A

> Antalgic Gait

> Lateral Trunk tilt - Trendelenberg

> Functional Leg-Length Discrepancy

> Increased Walking Base

> Inadequate Dorsiflexion Control

> Excessive Knee Extension

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58
Q

Common Gait abnormalities - Antalgic gait?

A

> Gait pattern in which stance phase on affected side is shortened

> Corresponding increase in stance on unaffected side

> Common causes: Splinter in foot (!), OA, tendinitis

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59
Q

Common Gait abnormalities - lateral trunk tilt?

A

> Trendelenberg gait

> Usually unilateral

> Bilateral = waddling gait

> Common causes:
A. Painful hip
B. Hip abductor weakness
C. Leg-length discrepancy
D. Abnormal hip joint
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60
Q

Common Gait abnormalities - Functional Leg-Length Discrepancy?

A

> Swing leg: longer than stance leg

> 4 common compensations:
A. Circumduction
B. Hip hiking
C. Steppage
D. Vaulting
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61
Q

Common Gait abnormalities - Increased Walking Base?

A

> Normal walking base: 5-10 cm

> Common causes:
A) Deformities:
- Abducted hip
- Valgus knee
B) Instability:
- Cerebellar ataxia
- Proprioception deficits
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62
Q

Common Gait abnormalities - Inadequate Dorsiflexion Control?

A

> In stance phase (Heel contact – Foot flat): Foot slap

> In swing phase (mid-swing): Toe drag

> Causes:

  • Weak Tibialis Ant.
  • Spastic plantarflexors
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63
Q

What does Trendelenburg sign indicate?

A

A positive test is one in which the pelvis drops on the contralateral side during a single leg stand on the affected side.

A positive Trendelenburg test usually indicates weakness in the hip abductor muscles: gluteus medius and gluteus minimus.

Think:
A. Painful hip
B. Hip abductor weakness
C. Leg-length discrepancy
D. Abnormal hip joint
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64
Q

The 5 S’s in Ortho?

A

Symptoms – night pain, NWB

Symmetry – lack of it!

Stiffness – of joints, paralysis, Knees = Hips

Syndromes – associated features

Systemic Illness - pyrexia

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65
Q

When there is knee pain what should you think of?

A

Hip

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66
Q

When there is night pain what should you think of in orthopaedics?

A

Infection or tumour until proved otherwise

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67
Q

When there is night pain what should you think of in orthopaedics?

A

Infection or tumour until proved otherwise

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68
Q

Angular alignment?

A

> Knocked knees
Bow legs
Flat feet

Occasional underlying pathology that may require treatment but usually a combination of normal physiology and variation

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69
Q

After what age id there is still bowing of the legs when should a pathology be considered?

A

The age of 8

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70
Q

Why do babies naturally have flat feet?

A

Due to a large medial fat pad in their arch and have not yet learnt to walk or weight bear

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71
Q

Tests to determine foot arch abnormalities?

A

> Heel raise test

> Jacks test

> Foot rotational alignment

> Foot progression in gait

> Standing:

  • Alignment from front
  • Patella position
  • Heels/ arch/ toes/ leg length from behind

> Tip toes (If old enough)

> Staheli rotational profile

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72
Q

What is assessed in rotation profile examination - Supine?

A 
Supine
> Leg lengths
> Hips 
> Galeazzi
> FFD
> ROM
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73
Q

What is assessed in rotation profile examination - Prone?

A 
Prone
> Staheli Rotational:
- Profile
- Hip rotation/ version
- Thigh foot angle
- Foot bisector line
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74
Q

When born is a child varus or valgas?

A

Varus up until around 2 at which point it begins to become valgas

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75
Q

At which age is valgas normal

A

Around 3 leading into teen years when they straighten

76
Q

What is varus?

A

Outwards bowing of the legs, measure distance between knees

77
Q

What is valgas?

A

Inwards bowing of the legs, measure distance between ankles to determine

78
Q

At which age should varus be referred to an orthopaedic surgeon?

A

After >18 months old

79
Q

When should Valgas be referred to an orthopaedic surgeon?

A

1) <18 months old
2) >7 years old
3) Non-symmetric

80
Q

What is the mean waling age?

A

12 months

81
Q

Causes of “intoeing” and tripping?

A

> Femoral anteversion
Int. tibial torsion
Metatarsus adductus

82
Q

When is femoral anterversion normal?

A

At birth, it is usually around 40o and decreases 1-2o per year reaching 10o by 16years in most

83
Q

How to measure internal tibial rotation?

A

Thigh foot angle

84
Q

How to manage internal tibial torsion?

A

> 90% + spontaneously resolve
Splints
Wedges
Insoles

85
Q

How to measure metatarsus adductus?

A

Forefoot alignment

86
Q

When is flexible flat feet normal?

A

At birth, it diminishes with age, if not uses insoles

87
Q

How is gait analysed?

A

1) Observation:
- Equipment: Eyes and floor
- Limitation: Single aspect, real time

2) Video:
- Equipment: Camera and floor
- Limitation: Single view

3) 3D instrumented:
- Equipment: Labe, force plates, EMG
- Limitation: >5y, walker

88
Q

Gait definition?

A

Series of rhythmical , alternating movements of the trunk & limbs which result in the forward progression of the center of gravity
series of ‘controlled falls’

89
Q

Gait cycle?

A

Gait Cycle =

1) Single sequence of functions by one limb
2) Begins when reference font contacts the ground
3) Ends with subsequent floor contact of the same foot

90
Q

Step length?

A

Distance between corresponding successive points of heel contact of the opposite feet

Right and left should be equal in normal gait

91
Q

Walking base?

A

Walking Base =
> Side-to-side distance between the line of the two feet
> Also known as ‘stride width’

92
Q

Cadence?

A

Cadence =
> Number of steps per unit time
> Normal: 100 – 115 steps/min
> Cultural/social variations

93
Q

Velocity?

A

Velocity =
> Distance covered by the body in unit time
> Usually measured in m/s
> Instantaneous velocity varies during the gait cycle
> Average velocity (m/min) = step length (m) x cadence (steps/min)

94
Q

Comfortable walking speed?

A

> Least energy consumption per unit distance

> Average= 80 m/min (~ 5 km/h , ~ 3 mph)

95
Q

Gait cycles phases?

A

> Stance Phase = reference limb in contact with the floor:

  1. Heel contact: ‘Initial contact’
  2. Foot-flat: ‘Loading response’, initial contact of forefoot w. ground
  3. Midstance: greater trochanter in alignment w. vertical bisector of foot
  4. Heel-off: ‘Terminal stance’
  5. Toe-off: ‘Pre-swing’

> Swing Phase = reference limb not in contact with the floor

  1. Acceleration: ‘Initial swing’
  2. Midswing: swinging limb overtakes the limb in stance
  3. Deceleration: ‘Terminal swing’
96
Q

Single versus double support gait cycle?

A

(1) Single Support: only one foot in contact with the floor

(2) Double Support: both feet in contact with floor

97
Q

Stance versus swing phase time frame?

A 
Stance = 60% of gait cycle
Swing = 40% of gait cycle
98
Q

Single versus double support gait cycle time frame?

A

Single support = 40% of gait cycle

Double support = 20%

99
Q

With increases walking speed what happens to the stance phase of the gait cycle?

A

Decreases

100
Q

With increases walking speed what happens to the swing phase of the gait cycle?

A

Increases

101
Q

With increases walking speed what happens to the double support of the gait cycle?

A

Decreases

102
Q

What is the definition of running?

A

Walking without double support

103
Q

What happens to the stance and swing phases during running?

A

1) Ratio of stance:swing phases reverse

2) Double support disappears. ‘Double swing’ develops

104
Q

Where is the centre of gravity?

A

> Midway between the hips

> Few cm in front of S2

105
Q

Vertical displacement of centre of gravity?

A

Up and down

106
Q

Horizontal displacement of centre of gravity?

A

Side to side

107
Q

Overall displacement of centre of gravity?

A

Sum of vertical & horizontal displacement

108
Q

Forces that influence gait?

A

(1) gravity
(2) muscular contraction
(3) inertia
(4) floor reaction

109
Q

Common gait abnormalities?

A

1) Antalgic Gait
2) Lateral Trunk tilt - Trendelenberg
3) Functional Leg-Length Discrepancy
4) Increased Walking Base
5) Inadequate Dorsiflexion Control
6) Excessive Knee Extension

110
Q

Common gait abnormalities - Antalgic Gait?

A

> Gait pattern in which stance phase on affected side is shortened

> Corresponding increase in stance on unaffected side

111
Q

Common gait abnormalities - Antalgic Gait, common causes?

A

> Splinter in foot
OA
Tendinitis

112
Q

Common gait abnormalities - Lateral Trunk tilt?

A

> Trendelenberg gait
Usually unilateral
Bilateral = waddling gait

113
Q

Common gait abnormalities - Lateral Trunk tilt, common causes?

A 
Common causes:
	A. Painful hip
	B. Hip abductor weakness
	C. Leg-length discrepancy
	D. Abnormal hip joint
114
Q

Common gait abnormalities - Functional Leg-Length Discrepancy?

A

Swing leg: longer than stance leg

115
Q

Common gait abnormalities - Functional Leg-Length Discrepancy, compensations?

A 
4 common compensations:
A. Circumduction
B. Hip hiking
C. Steppage
D. Vaulting
116
Q

What is normal walking base?

A

5-10cm

117
Q

Common gait abnormalities - increased walking base, causes?

A

Common causes:
> Deformities
- Abducted hip
- Valgus knee

> Instability

  • Cerebellar ataxia
  • Proprioception deficits
118
Q

Common gait abnormalities - Inadequate Dorsiflexion Control?

A

> In stance phase (Heel contact – Foot flat): Foot slap

> In swing phase (mid-swing): Toe drag

119
Q

Common gait abnormalities - Inadequate Dorsiflexion Control, causes?

A

Causes:
> Weak Tibialis Ant.
> Spastic plantarflexors

120
Q

Common gait abnormalities - Excessive knee extension?

A

> Loss of normal knee flexion during stance phase

> Knee may go into hyperextension

> Genu recurvatum: hyperextension deformity of knee

121
Q

Common gait abnormalities - Excessive knee extension, common causes?

A

Common causes:
> Quadriceps weakness (mid-stance)

> Quadriceps spasticity (mid-stance)

> Knee flexor weakness (end-stance)

122
Q

What are the 5 S’s?

A

Symptoms

Symmetry

Stiffness

Syndromes

Systemic Illness

123
Q

If there is knee pain what should you think?

A

Hip

124
Q

if there is night pain what should you think?

A

Infection or tumour (Until proven otherwise)

125
Q

Children’s fracture principles?

A

1) Children’s fractures are often simple, incomplete & heal quickly
2) Remodel well in plane of joint movement
3) A thick periosteal hinge is (usually) a friend

4) Fractures involving physes can result in progressive deformity:
- Deformity = elbow
- Arrest = Knee, ankle
- Overgrowth = Femur

126
Q

Types of fractures of the forearm in children?

A

1) Shaft fracture
2) Special cases:
- Galeazzi
- Monteggia
3) Distal radial fractures

127
Q

What is a Galeazzi fracture?

A

The Galeazzi fracture is a fracture of the distal third of the radius with dislocation of the distal radioulnar joint.

128
Q

What is a Monteggia fracture?

A

The Monteggia fracture is a fracture of the proximal third of the ulna with dislocation of the proximal head of the radius

129
Q

Low energy leads to which type of fractures?

A

1) Greenstick

2) Buckle

130
Q

High energy leads to which type of fractures?

A

Open, displaced, soft tissue injury

131
Q

Forearm fractures make up what percentage of all paediatric fractures?

A

25-50%

132
Q

Which part of the forearm is usually damaged in children forearm fractures?

A

Distal

133
Q

How is a fracture assessed?

A

1) History – Mechanism
2) Deformity

3) Soft tissues
- Whole limb
- Wounds
- Sensation, Motor fcn
- Vascular status

4) Radiographs

Repeat after intervention

134
Q

Surgical indications in <9 years forearm fractures?

A

> 15 angulation

>45 malrotation

135
Q

Surgical indications in >9 years forearm fractures?

A

1)Proximal:
> 10 angulation
> 30 malrotation

2) Distal:
> 15angulation

136
Q

How many years of growth needs to be remaining to allow flexible nailing?

A

Need 2yrs predicted growth remaining

137
Q

Complications of forearm fractures and repair?

A

1) Compartment syndrome can lead to Volkmann’s contracture due to muscle damage (Ischaemic Necrosis)
2) 5% nonunion or 5% refracture

3) Radioulnar synostosis
- Proximal>distal
- High energy, same level
- Single incision

4) PIN injury
5) Superficial radial nerve injury
6) DRUJ / Radiocapitellar problems

138
Q

In terms of distal radius fractures what are the acceptable ranges?

A 
Acceptable range
> 30 degrees angulation
> 45 degrees rotation
> 10 degrees angulation
> 30 degrees rotation
139
Q

How is a buckle fracture of the distal radius managed?

A

Cast 3-4 weeks

140
Q

How is a greenstick fracture of the distal radius managed?

A

Cast 4-6 weeks

141
Q

Risk for remanipulation in distal radius fractures?

A

Complete fractures
failed anatomic reduction
NOT B/E pop

142
Q

Knee trauma differential?

A 
Infection
Inflammatory arthropathy
Neoplasm
Apophysitis
Hip
Foot
Sickle, Haemophilia
‘Anterior knee pain’
143
Q

Bony injuries of the knee?

A 
Physeal/Metaphyseal
Tibial spine
Tibial tubercle 
Patellar fracture
Sleeve fracture
Patellar dislocation
Referred
144
Q

How many physeal plates within the femur and tibia?

A

2 Femoral: 1 tibial

145
Q

What is the importance of physeal injury?

A

Importance = Blood vessels have high risk of injury and femurs grow rapidly and large

146
Q

Why might there be physeal injury?

A

Why = due to attachment of the ligaments being below the physes in the femur

> Hyperextension – vascular injury
Varus – CPN injury
SH not predictive

147
Q

Average growth of the femur per year?

A

11mm

148
Q

Average growth of the tibia per year?

A

6mm

149
Q

How to manage physeal injury?

A

> Cast immobilise
Percutaneous fix
ORIF articular displacement
ROM early <6/52

150
Q

How to monitor physeal?

A

Harris lines, angulation & length

151
Q

How to manage physic arrest?

A

> Resect Bar
Complete epiphysiodesis
Contralateral epiphysiodesis
Corrective osteotomy

152
Q

How is hinged tibial spine classified by Meyers & McKeever?

A

Group II

153
Q

How is displaced tibial spine classified by Meyers & McKeever?

A

Group III

154
Q

How is undisplaced tibial spine classified by Meyers & McKeever?

A

Group I

155
Q

How are Group I/II Meyers & McKeever classification of tibial spine managed?

A

Long leg cast

156
Q

How are Group II/III Meyers & McKeever classification of tibial spine managed?

A

ORIF/AxIF

157
Q

How are tibial spine classified?

A

Meyers & McKeever classification

158
Q

How are tibial tubercle classified?

A

Ogden classification

159
Q

Group I Ogden classification - Tibial tubercle?

A

Distal avulsion

160
Q

Group II Ogden classification - Tibial tubercle?

A

To prox tibial physis (not joint)

161
Q

Group III Ogden classification - Tibial tubercle?

A

To prox tibial physis (into joint)

162
Q

How to manage an undisplaced patellar fracture?

A

Cylinder cast

163
Q

How to manage an displaced patellar fracture?

A

ORIF

164
Q

Risk factors for patella dislocation?

A

Risk factors

  • Laxity,
  • Poor VMO,
  • Q angle,
  • Femoral anteversion,
  • Tibial ext rotation
  • Patella alta
165
Q

How to image osteochondral lesions?

A 
Plain films (Tunnel view) 
\+/- MRI
166
Q

How to manage type I osteochondral lesions?

A

Type I (cartilage intact) - immobilise

167
Q

How to manage type II and III osteochondral lesions?

A

Type II (flap) & III (fragment) - drilling/fix

168
Q

Why is the risk of growth arrest in ankle fractures of children?

A

As physis is weaker than ligaments so high risk of physis fracture and injury

169
Q

Ankle fracture classification - Mechanistic ?

A

Lauge-Hansen, Dias-Tachdjian

  • Helpful with reduction
  • Poor interobserver reliability
170
Q

Ankle fracture classification - Anatomical?

A

> Salter-Harris

  • Good reproducibility
  • Prognostic value

> Vahvanen & Aalto

171
Q

Assessment of an ankle fracture?

A

> History – Mechanism
Deformity
Soft tissues
AP & lateral radiographs – Ottawa rules

172
Q

Assessment of an ankle fracture?

A

> History – Mechanism
Deformity
Soft tissues
AP & lateral radiographs – Ottawa rules

173
Q

Management of ankle SH1?

A

> Displaced <3mm – POP 6

> Displaced >3mm – MUA,POP 6

174
Q

Management of ankle SH2?

A

> Displaced <3mm – POP 4+2

> Displaced >3mm – MUA,POP

> Persistent displacement - Open reduction

175
Q

Management of ankle SH3?

A

> Undisplaced – POP 6

> Displaced – (Open) red’n
& interfrag screw

176
Q

Management of ankle SH4?

A

> ORIF

> Monitor for growth arrest

177
Q

Ankle - Transitional Fractures - Tillaux?

A

> External rotation

> Anterior tibiofib lig avulsion

> SH3

> Closed/Open reduction

178
Q

Ankle - Transitional Fractures– Triplane?

A

> External rotation

> SH3 on AP + SH2 on lat = SH4

> 2 - 3 - 4 part

> CT, ORIF

179
Q

Pros and cons of physis in children?

A

Pro = Remodelling

Con = Slip, arrest, overgrowth

180
Q

Pros and cons of bone in children?

A

Pro = Simple fractures, Quick heal

Con = Plastic deformity

181
Q

Pros and cons of periosteum in children?

A

Pro = Hinge

Con = Block red’n

182
Q

Pros and cons of ligaments in children?

A

Pro = Protect joint

Con = Physis fracture

183
Q

Pros and cons of cartilage in children?

A

Pro = Resilient

Con = Imaging

184
Q

Overuse injuries in children?

A

1) Osgood-Schlatter’s Disease

2) Sever’s Disease = Growth plate inflammation on the calcaneus

185
Q

What are the warning signs of non-accidental injury?

A

> Incongruent hx

> Bruising – pattern

> Burns

> Multiple fractures, multiple stages of healing

> Metaphyseal #, Humeral shaft #

> Rib #s

> Non-ambulant #

Year 3 - Musculoskeletal (30 decks)

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