Orthopaedics - Paediatric Orthopaedics

Front 1

Name 3 differences between paediatric and adult bone.

Back 1

Thick periosteum (like an internal cast, holds bone in place)

Greater proportion of osteogenic cells (healing times much quicker)

Growth plate still present

Front 2

True or false: in children, you can accept a greater degree of angulation in a fracture, and therefore the threshold for surgical repair is lower.

Back 2

True

Front 3

How does the healing time of children compare to that of adults?

Back 3

Children heal more quickly

Front 4

What region of the bone lies just proximal to the physis?

Back 4

Metaphysis

Front 5

What region of the bone lies just distal to the physis?

Back 5

Epiphysis

Front 6

Where does the metaphysis lie relative to the physis?

Back 6

Proximal

Front 7

Where does the epiphysis lie relative to the physis?

Back 7

Distal

Front 8

What system is used to classify fractures that involve the growth plate?

Back 8

Salter-Harris classification

Front 9

How many types of growth plate fractures are there in the Salter-Harris classification system?

Back 9

5

Front 10

What is a type I Salter-Harris fracture?

Back 10

Complete fracture along growth plate (metaphysis completely separated from epiphysis)

Front 11

What is a type II Salter-Harris fracture?

Back 11

Physeal fracture that extends through the metaphysis

Front 12

What is a type III Salter-Harris fracture?

Back 12

Physeal fracture that extends through the epiphysis

Front 13

What is a type IV Salter-Harris fracture?

Back 13

Physeal fracture plus metaphyseal and epiphyseal fracture

Front 14

What is a type V Salter-Harris fracture?

Back 14

Compression fracture of the growth plate

Front 15

What’s the mnemonic to remember the Salter-Harris system?

Back 15

SALTR
S – separate
A – above
L – low
T – through
R – reduced

Front 16

Which type of Salter-Harris fracture is most common?

Back 16

Type II

Front 17

What is the point of the Salter-Harris classification system?

Back 17

Provide information about possibility/prognosis re: growth disruption

Front 18

What information does the Salter-Harris classification provide about risk of growth disruption?

Back 18

Risk increases as you move up the classification (type V greatest risk, type I lowest)

Front 19

How do you treat a type I or II Salter-Harris fracture?

Back 19

Cast

Front 20

How do you treat a type III, IV, or V Salter-Harris fracture?

Back 20

ORIF

Front 21

A child presents with a limp. What must you have a high index of suspicion for?

Back 21

Abuse

Front 22

What is DDH?

Back 22

Developmental dysplasia of the hip

Front 23

Name three risk factors for DDH.

Back 23

Female

First born

Breech position

Front 24

Which hip is more frequently affected by DDH?

Back 24

Left (70%)

Front 25

Name 4 abnormalities associated with DDH.

Back 25

Foot deformities (club foot, metatarsus adductus)

Torticollis

Neuromuscular disorders

Skeletal dysplasias

Front 26

What is torticollis?

Back 26

Tightening of one side of the sternocleidomastoid

Front 27

Which movement is often restricted in a baby with DDH?

Back 27

Decreased abduction of the thigh at the hip joint

Front 28

What is Galleazi’s sign?

Back 28

Asymmetric knee height

Front 29

Which two physical exam maneuvers are employed to check for DDH?

Back 29

Barlow and Ortolani maneuvers

Front 30

What is the objective of the Barlow maneuver?

Back 30

Dislocate the hip

Front 31

Describe the Barlow maneuver.

Back 31

Adduction of the hip while pushing the thigh posteriorly

Positive test: hip dislocates out of socket

Front 32

What is the point of the Ortolani maneuver?

Back 32

Relocate the dislocated hip

Front 33

Describe the Ortolani maneuver.

Back 33

Abduction of the hip while pulling the thigh anteriorly, contralateral hip must be held still

Positive test: palpable/audible clunk of femoral head moving over posterior rim of acetabulum

Front 34

How do you confirm DDH of the hip?

Back 34

X-ray, ultrasound

Front 35

How do you treat DDH in a newborn?

Back 35

Pavlik harness (splint in abduction) for 16-18 months

Front 36

How do you treat DDH in a 6-18 month old?

Back 36

Closed reduction and hip spica cast

Front 37

How do you treat DDH in a patient 2 years old or older?

Back 37

Open reduction with pelvic osteotomy

Front 38

Name two common complications of DDH.

Back 38

AVN of femoral head
Early osteoarthritis in adulthood

Front 39

What is Perthes disease?

Back 39

Idiopathic AVN of femoral head

Front 40

How does Perthes disease present?

Back 40

Limping child with thigh or knee pain

Front 41

How do you diagnose Perthes disease?

Back 41

X-ray

Front 42

What is clubfoot?

Back 42

• Congenital talipes equinovarus

Front 43

What are the three deformities that characterize clubfoot?

Back 43

• Equinus and varus at ankle joint

• Inversion at subtalar joint

• Adduction at talonavicular joint

Front 44

What is most common and affective treatment for clubfoot?

Back 44

• Ponseti method (serial casting)

Front 45

What are the two types of flatfoot?

Back 45

• Flexible and rigid

Front 46

Which type of flatfoot may need to be corrected?

Back 46

Rigid

Front 47

What abnormality sometimes present in flatfoot requires correction?

Back 47

Coalition (joining of two bones of the foot)

Front 48

What is a greenstick fracture?

Back 48

Fracture in which the bone bends and partially breaks, but only on one side

Front 49

Why do children get greenstick fractures?

Back 49

Thicker periosteum, softer bone

Front 50

What is a supracondylar fracture?

Back 50

Fracture of the distal humerus proximal to the epicondyles

Front 51

Which patient group is most at risk for a supracondylar fracture?

Back 51

Children

Front 52

What is the initial deformity that occurs with a supracondylar fracture?

Back 52

Extension of distal fragment with posterior angulation

Front 53

What is the treatment for an undisplaced supracondylar fracture?

Back 53

Cast with elbow flexed

Front 54

What is the treatment for a displaced supracondylar fracture?

Back 54

ORIF

Front 55

What is the residual deformity that can occur with a supracondylar fracture?

Back 55

“Gunstock deformity” (cubitus varus, which means forearm in varus)

Front 56

What is SCFE?

Back 56

Slipped Capital Femoral Epiphysis

Front 57

What is a slipped capital femoral epiphysis?

Back 57

Type I Salter fracture through the physis of the femoral head

Front 58

Which two conditions are highly associated with SCFE?

Back 58

Obesity

Hypothyroidism

Front 59

What is genus varum?

Back 59

Physical deformity marked by (outward bowing) of the leg in relation to the thigh, giving the appearance of an archer's bow.

In other words, bow-leggedness, or varus deformity at the knee