Untitled Quiz

Introduction to Pediatric Musculoskeletal (MSK) System

• Focuses on the growing skeleton, pediatric MSK, and sports injuries in children.

Mechanisms of Bone Formation

• Intramembranous ossification: Osteoid laid down by osteoblasts within a fibrous membrane.
• Endochondral ossification: Osteoid deposited on cartilage scaffolds.

Secondary Centre of Ossification

• Bone growth is characterized by primary and secondary ossification centers.
• The process involves continuous growth and development of the bone structure in children.
• Development of the bone is shown over time, 4 months, 4 years, and 16 years.
• Artery and vein supply nutrients to the bone.

Cessation of Skeletal Growth

• Skeletal growth is affected by genetics, altering factors, systemic disease, nutrition, endocrine factors, and trauma.
• A table/graph shows the approximate age of skeletal maturation in girls and boys.
• The data covers the chronological age of the individuals.

What is a Physis

• Hyaline cartilage plates at the ends of long bones are responsible for growth.
• Physis longitudinal
• Perichondrium
• Endochondral ossification

Microscopic Structure of the Physis

• Resting zone
• Proliferative zone
• Hypertrophic zone
• Metaphyseal bone

Paeds MSK

• Limping child – Age Distribution: Shows the prevalence of different conditions (DDH, Transient Synovitis, Perthes, SUFE, Tumours/Septic Arthritis, and Neurosmuscular conditions) across different age groups in children.
• Limping child – Exclude Sepsis: Diagnostic procedures like full blood count, ESR, CRP, X-rays (AP & frog lateral), Ultrasound, MRI, and bone scan are used to rule out or confirm septic arthritis in a limping child.
• Developmental dysplasia (DDH): Prevalence is 1-5/1000 births, predominantly affects females (F:M ratio 5:1). Risk factors include first-born status, breech presentation, family history, and oligohydramnios.
• DDH Examination: Barlow's and Ortolani’s maneuvers are utilized to examine for hip dysplasia, along with assessment for skin crease asymmetry, leg length discrepancy, and reduced abduction.
• DDH Radiographs: Imaging techniques utilized to examine the child's hip joint conditions.

Perthes Disease

• Osteonecrosis of the femoral epiphysis, with unclear etiology, but likely non-genetic factors.
• Males are more affected than females, (4:1 ratio)
• Common age range is 4-8 years old
• Lower socioeconomic background may exhibit an increased risk for the condition

Slipped Upper Femoral Epiphysis (SUFE)

• Affects adolescent Males (3:1), younger females (not post-menarche).
• Often found in obese or tall/slender children.
• Associated with rapid growth.
• 7% risk of occurrence in second-degree relative.

SUFE - Clinical

• Typically manifested as pain in the groin, thigh, and knee.
• Associated with a limp, antalgic gait, limb adduction, and external rotation.

Red Flags (General)

• Neonate with painful arm/leg
• Spinal/limb asymmetry
• School-aged child with limp
• Adolescent with knee pain
• Back pain

NAI (Non-Accidental Injury) - High Index of Suspicion

• Suspicious features include injury inconsistent with history, delayed care-seeking, multiple fractures without a known cause, retinal hemorrhage, torn frenulum, and household falls resulting in fracture.

Pediatric MSK Trauma

• Plasticity/Elasticity: Children's bones are less rigid than adult bones, allowing for greater plasticity and deformity without complete fractures (green stick, buckle/torus).

Remodeling

• The greatest potential for remodeling happens during childhood.
• Remodeling is higher when in vicinity of a joint.
• The plane of the deformity and the fracture should be considered for prognosis.
• The presence of wolf's law is critical for effective remodeling in pediatric fracture treatment.

Physeal Considerations

• Growth plates allow longitudinal growth, fusing around 14-16 years of age.
• Fractures in these areas can cause significant growth problems.

Salter-Harris Classification

• A system for classifying fractures within the growth plate, providing guidance for treatment plans dependent on injury location and severity. Type 1 fractures are straightforward, whereas 5 is the most serious, involving complete destruction of the physis and significant threat of growth abnormalities.

Growth Deformities

• Fractures in growth plates can lead to deformities, particularly in areas close to joints, especially if left untreated. Early identification and treatment are essential to prevent future issues.

Paediatric Fractures

• Treatment differs significantly from adults due to factors like periosteal thickness, and the ability for bone remodeling and faster healing time.

Manipulation under Anaesthesia

• Surgical technique, used in cases where closed reduction is unsuccessful for various reasons, such as severe displacement or instability.

Fracture Reduction and Maintenance

• Understanding the mechanical principles involved in fracture reduction(s).

K-wires and Flexible Nails

• Methods of internal fixation used to maintain proper alignment in the early treatment of fractured bones.

Sports Injuries

• Common types of injuries include acute traumatic (bruising, cuts, abrasions, head injury, cartilage/meniscal injuries, muscle/tendon/ligament injuries, dislocations) and chronic overuse (tendonitis, stress fractures, back pain, instability injuries to bone and surrounding tissue).
• Prevention strategies include improving fitness, gradual training intensity increases, proper warm-up and cool-down routines, appropriate equipment, and avoiding overuse.

Tutorial Content

• Includes the following topics: Gait in children, Transient synovitis, Developmental dysplasia of the hip, Perthes' disease, Slipped capital femoral epiphysis, Red flags, Infection, Discitis, Malignancy.