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12 Cards in this Set

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What are the 5 types of epiphyseal plate injuries in the Salter and Harris classification?
1 Straight through/separation - whole epiphysis separated from shaft N.B this may be occult, or complete off ending of the epiphysis from the shaft may be seen (without accompanying fracture)
2 Above physis - metaphyseal fragment (above refers to e.g. distal epiphysis of tibia)
3 Lower than physis - part of epiphysis separated
4 Through physis - part of epiphysis separated and also a metaphyseal fragment
5 Ruined/rammed - crushing part or all of epiphysis
Regarding Salter Harris classification
1. Which type is most common?
2. Which two types may be occult?
3. What is the order of severity?
4. Slipped upper femoral epiphysis represents which type of SH injury?
1 - Type 2 represents 75% of injuries
2 - 1, 5
3 - severity ordering is the same as type e.g. 1 is least severe, 5 is most severe; this is because in most bones the blood supply to the physis (growth plate) is through the epiphysis, and in the higher numbered 'types' epiphysis disruption occurs
4 - 1
What is the importance of the classification and recognising these injuries?
Growth arrest of part of the plate may lead to angulatory deformity, and of the whole plate shortening of the bone and in paired bones (e.g. radius/ulnar) joint deformity
Elbow injuries - what does the CRITOE mneumonic stand for and why is it helpful?
C - Capitellum R - radial head I - 'internal' (medial) epicondyle T - trochlea O - olecranon E - 'external' (lateral) epicondyle

Timing of ossification of centres of elbows. Girls 1, 3, 5, 7, 9, 11 boys 2, 4, 6, 8, 10, 12

Helps to distinguish - is this bony fragment an ossification centre or a fracture...e.g. if an ossification centre shouldn't have appeared there yet, then it is more likely a fracture from the visible bone
Regarding lateral XR of elbow which is incorrect
1) a posterior fat pad can be normal but an anterior is always pathologic
2) anterior humeral line should pass through middle third of capitellum
3) radiocapitellar line is through the centre of the radius and should bisect the capitellum
4) the most inferior structure is the olecranon
1) incorrect - opposite is true
Regarding supracondylar fractures - true or false
1. the olecranon and medial and lateral epicondyles preserve their normal equilateral triangular relationship
2. type I only an anterior fat pad may be seen
3. type II shows anterior fat pad but posterior cortext remains intact
4. type III both cortices broken, possible displacement
1. T - unlike in elbow dislocation
2. F - POSTERIOR fat pad; long arm splint and ortho referral; may be angulated so check anterior humeral line and radiocapitellar line; if significant will operate
3. T
What are the potential complications of type III supracondylar fracture?
Posterolateral displacement can compromise brachial artery and radial nerve, compartment syndrome may develop, Volkmann's ischaemic contracture may result
Nursemaid's elbow/radial head subluxation - which is incorrect?
1 displacement of the annular ligament has occurred
2 child may present with the arm adducted and flexed
3 commonly occurs between 3-5y
4 two methods of reduction are hyperpronation of the wrist OR supination with hyperflexion
3 incorrect, 1-3 years is commonest

4 correct, with thumb over radial head
Regarding Osgood Schlatter disease which is incorrect
1 risk factors include excess weight and overuse
2 sudden or repeated quadriceps contraction at onset of pubertal growth spurt may be responsible
3 traction apophysitis of tibial tuberosity
4 spontaneous resolution is rare and excision of
a detached fragment commonly required
4 incorrect - UNCOMMON to require surgery; acute episodes may warrant 2/52 immobilisation however spontaneous resolution is the rule. Severe persistent sx may merit excision of the detached fragment
Regarding Perthe's disease which is incorrect
1. age range is 5-10 years with a female:male ratio of 5:1
2. commonly bilateral
3. is due to segmental avascular necrosis of the femoral head
4. presentation may be with intermittent limp and pain of hip, groin or knee
1. INCORRECT - MALE:female ratio 5:1
2. 15-20% bilateral

Examination may demonstrate reduced ROM, internal rotation and extension painful, unequal leg lengths. Early radiological findings subtle. Requires femoral osteotomy or bracing, healing takes years
Regarding slipped capital femoral epiphysis which is incorrect
1. usually occurs later than Perthe's disease and has a similar male predominance
2. unlike Perthe's, is associated with obesity
3. in younger children may be associated with hypothyroidism, arthritis, renal failure, radiation or chemo
4. a line drawn along superior aspect of femoral neck to superior ascetabulum fails to transect the medial quarter of the femoral head (Klein's line)
1. true - Perthe's 5-10,SLFE 10-15 (female 11-13, male 14-16)
4. false - the LATERAL quarter

MRI indicated if normal films, high clinical suspicion. May lead to avascular necrosis. Tends NOT to cause growth arrest due to timing later in puberty. May present with externally rotated foot. Lateral films diagnositic
Transient synovitis which is incorrect
1. boys affected twice as often as girls
2. viral inflammation and hypertrophy of synovium of hip joint
3. may present with night crying and limp
4. most common cause acute hip pain children age 3-10
2. incorrect - though may follow viral URTI (50% cases) inflammation is 'nonspecific'

Mild restiction in motion, mild fever (if any).
Log roll test is most sensitive, patient lies supine and examiner gently rolls limb from side to side (involuntary mm guarding comparing one side to another may be present). WCC/ESR mild (this is a MILD disease!!) elevation. US - effusion. Hip aspiration may be needed to exclude other causes