SM_251a-252a: Peds MSK, Peds / Adult Sports Med Flashcards Preview

MSK/Derm > SM_251a-252a: Peds MSK, Peds / Adult Sports Med > Flashcards

Flashcards in SM_251a-252a: Peds MSK, Peds / Adult Sports Med Deck (45)
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1

Describe structural differences in pediatric bones

Structural differences in pediatric bones

  • More porous and pliable: unique fracture patterns, incomplete fractures
  • Ligaments stronger than bone: more likely to fracture, less likely to sprain
  • Periosteum: holds fracture fragments in alignment
  • Extensive remodeling: corrects large degrees of angulation and displacement, nonunion is rare

2

Describe the anatomy of a growing bone

Growing bone

  • Diaphysis: shaft
  • Metaphysis: tapering part
  • Physis: growth plate
  • Epiphysis: end of bone

3

In growing bone, there are ____ on the epiphyseal side and cells ____ on the metaphyseal side

In growing bone, there are  germinal on the epiphyseal side and cells calcify on the metaphyseal side

4

Describe the Salter-Harris classification

Salter-Harris classification

  • Salter I: separation through physis usually through areas of hypertrophic and degenerating cartilage cell counts
  • Salter II: fracture through a portion of the physis that extends through the metaphysies
  • Salter III: fracture through portion of the physis that extends through the epiphysis and into the joint
  • Salter IV: fracture across metaphysis, physis, and epiphysis
  • Sater V: crush injury to the physis

5

Describe growth plate injury in the Salter-Harris classification

Growth plate injury in the Salter-Harris classification

  • Salter I: initially normal or subtle widening radiograph, diagnosis based on hx of trauma and symptoms, repeat XR shows healing callus, growth rarely affected
  • Salter II: most common growth plate fracture pattern, growth rarely affecte
  • Salter III and V: may interference growth, involves articular surface and may affect joint
  • Salter V: crush injury of growth plate, from severe axial loading, worst prognosis with possible growth arrest

6

Salter-Harris I fracture is ____

Salter-Harris I fracture is separation through the physis, usually throughb areas of hypertrophic and degenerating cartilage cell columns

7

Salter-Harris II fracture is ____

Salter-Harris II fracture is fracture through a portion of the physis that extends through the metaphyses

8

Salter-Harris III fracture is ____

Salter-Harris III fracture is fracture through a portion of the physis that extends through the epiphysis and into the joint 

9

Salter-Harris IV fracture is ____

Salter-Harris IV fracture is fracture across metaphysis, physis, and epiphysis

10

Salter-Harris V fracture is ____

Salter-Harris V fracture is crush injury to the physis

11

Transverse fracture occurs ____ to the long axis, is caused by ____ or ____, and involves ____ force

Transverse fracture occurs perpendicular to the long axis, is caused by direct blow or bending force, and involves higher force

12

Comminuted fracture involves ____ force mechanism, is rare in ____, and often necessitates ____ because it is difficult to reduce

Comminuted fracture involves high force mechanism, is rare in children, and often necessitates operative intervention/fusion because it is difficult to reduce

13

Oblique fracture is ____ to long axis, involves ____ or ____ mechanism, and can lead to ____ 

Oblique fracture is oblique to long axis, involves twisting force or compression/bending mechanism, and can lead to be difficult to maintain alignment due to significant displacement

14

Spiral fracture is caused by a ____ mechanism and often takes ____ force than a transverse fracture

Spiral fracture is caused by a twisting mechanism and often takes less force than a transverse fracture

15

Describe fracture displacement

Fracture displacement

  • Fracture fragment is moved out of normal bony alignment
  • Translation: lateral movement, describe as percentage
  • Angulation: in degrees, measure through mid-axial line
  • Rotation: may be difficult to tell

16

Describe buckle/torus fracture

Buckle/torus fracture

  • Result of compression force on bone: FOOSH injury
  • Common forearm fracture in children: junction of metaphysis and diaphysis of distal forearm
  • Stable fracture
  • Heals well with simple immobilization: premade splint for 3-4 weeks, rapid return to function

17

Describe nursemaid's elbow (radial head subluxation)

Nursemaid's elbow (radial head subluxation)

  • Typical history: traction to arm, pain initially / comfortable at rest, will not use arm
  • Physical exam: no swelling, deformity, or bony tenderness; pain with movement of elbow
  • Most common elbow injury at 2-5 years old
  • Traction to radius pulls radial head distally and annular ligament (which attaches radius to ulna) gets trapped in joint space
  • Treat with supination and flexion or with hyperpronation

18

Describe greenstick fracture

Greenstick fracture

  • Compression or bending force
  • Bone on convex side fails
  • Fracture does not propagate to other side (incomplete)
  • Plastic deformity of concave side
  • If reduction is needed, need to make break complete to maintain alignment

19

Describe toddler's fracture

Toddler's fracture

  • Oblique, non-displaced fracture of distal tibia
  • Child must be walking and < 5 years old
  • MechanismL twist while running or falling and trying to free leg
  • Clinical picture: limp or refusal to bear wright, minimal to no swelling, fracture line may be subtle on x-ray
  • Treatment: cast, no weight bearing

20

Describe slipped capital femoral epiphysis

Slipped capital femoral epiphysis

  • Occurs in adolescents (10-16 years)
  • Growth plate instability during periods of rapid growth
  • Salter I fracture w/ slippage of epiphysis: slips inferior and posterior
  • Risk factors: male, obesity, endocrine disorders
  • History: often sub-acute or chronic, acute worsening, vague pain to groin / thigh / knee, limp
  • Physical exam: pain and limitation with flexion and internal rotation, gait is limp w/ leg externally rotated at hip
  • Radiograph: widening growth plate, ice cream falling off cone
  • Treatment: immediaten surgical fixation to prevent further slippage
  • Complications: avascular necrosis of hip
  • Watch for SCFE of other hip

21

Slipped capital femoral epiphysis is described as ____ on radiograph, is treated with ____, may be complicated by ____, and should cause clinician to watch for ____

Slipped capital femoral epiphysis is described as "ice cream falling off the cone" on radiograph, is treated with immediate surgical fixation, may be complication by avascular necrosis of hip, and should cause clinician to watch for SCFE of other hip

22

This is a ____ fracture of the ____

This is a Salter-Harris II fracture of the distal radius

23

Describe bone formation

Bone formation

  • Cartilage skeleton is transformed to a bony skeleton
  • Endochondral ossification: process of bone formation from cartilage in long bones
  • Primary ossification center: calcification starts in long bone shaft
  • Secondary ossification center: at ends of bone in the epiphyses
  • Physis: growth plate (between ossification centers)
  • Apophysis: accessory growth plate, where muscles attach

24

Children typically injure ____ and ____, while adults typically injure ____ and ____

Children typically injure physis and apophysis while adults typically injure tendons and ligaments

25

Describe advantages and disadvantages of open physes

Advantages and disadvantages of open physes

  • Advantages: tremendous potential for bone healing and remodeling, fractures are often easier to heal
  • Disadvantages: can fracture through the physes (risk of growth arrest / angulation), irritation of physis or apophysis (juvenile epiphyseolysis or apophysitis)

26

Sinding-Largen-Johansson syndrome is ____

Sinding-Largen-Johansson syndrome is inferior patella apophysitis

  • Irritation of accessory growth area (apophysis) of inferior patella
  • Age 11-12 most common b/c infrapatellar apophysis is active
  • Clinical diagnosis
  • Symptomatic treatment
  • Stretching 
  • Patellar strap

27

Osgood-Schlatter syndrome is ____

Osgood-Schlatter syndrome is inflammation of patellar ligament at tibial tuberosity (apophysitis)

 

  • Boys 12-15 yo, girls 10-13 yo
  • Adolescents participating in sports
  • Bilateral sometimes
  • Aggravated by running, jumping, kneeling
  • Treatment: activity modification, icing, NSAIDs, patellar strap, PT (but avoid quadriceps strengthening), consider immobilization
  • Waxing/waning symptoms for 1-2 years - 10% with persistent symptoms

28

Sever disease is ____

Sever disease is calcaneal apophysitis

 

  • Age 8-11
  • Often children have mild weakness w/ ankle dorsiflexion and tight calf muscles
  • Clinical diagnosis
  • Differential includes stress fracture and infection
  • Childhood version of Achilles tendinopathy / plantar fasciitis

29

Anterior superior iliac spine apophysis avulsion fracture is ___

Anterior superior iliac spine apophysis avulsion fracture is when bone is pulled away from apophysis at anterior superior iliac spine

 

  • Treatment: rest, slow progression of PT (RICE, gentle ROM, resistance exercise, stretching / strengthening, sports-specific drills), return to sports 6 weeks - 4 months, surgery is rarely indicated

30

Little League Elbow is ____ and is primarily treated with ____

Little League Elbow is medial epicondyle apophysitis and is treated primarily with rest

 

  • Also use physical therapy / biochemical analysis
  • Prevent with proper pitch progression, pitch counts, and proper rest

(medial epicondylitis / golfer's elbow is seen in adults) 

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