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What is a common condition that can lead to multiple fractures in infancy?
What is a common condition that can lead to multiple fractures in infancy?
Which factor increases the likelihood of a child sustaining bony injuries?
Which factor increases the likelihood of a child sustaining bony injuries?
What should be prioritized when assessing a child with a suspected non-accidental injury?
What should be prioritized when assessing a child with a suspected non-accidental injury?
Which condition complicates the assessment for non-accidental injury due to being an independent risk factor?
Which condition complicates the assessment for non-accidental injury due to being an independent risk factor?
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Why must doctors maintain a high-index of suspicion regarding traumatic injuries in children?
Why must doctors maintain a high-index of suspicion regarding traumatic injuries in children?
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What is a recommended action when identifying unusual injury patterns in children?
What is a recommended action when identifying unusual injury patterns in children?
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Which of these can be a potential sign of non-accidental injury?
Which of these can be a potential sign of non-accidental injury?
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What is a typical response from caring parents when NAI investigations are initiated?
What is a typical response from caring parents when NAI investigations are initiated?
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What percentage of non-accidental injuries (NAI) cases involve children younger than 18 months suffering head or facial injuries?
What percentage of non-accidental injuries (NAI) cases involve children younger than 18 months suffering head or facial injuries?
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Which type of bitemark requires full investigation due to the risk of abuse?
Which type of bitemark requires full investigation due to the risk of abuse?
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Which burn is specifically mentioned as a result of neglect?
Which burn is specifically mentioned as a result of neglect?
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What is a characteristic sign of force feeding in children?
What is a characteristic sign of force feeding in children?
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Which pattern of bruising can suggest non-accidental injury (NAI)?
Which pattern of bruising can suggest non-accidental injury (NAI)?
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What common misunderstanding might lead individuals to misidentify bitemarks on children?
What common misunderstanding might lead individuals to misidentify bitemarks on children?
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What might petechial bruising indicate after a slap?
What might petechial bruising indicate after a slap?
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In cases of corporal punishment, which bruising pattern is typically observed?
In cases of corporal punishment, which bruising pattern is typically observed?
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What is the primary reason for the increased potential for remodelling in young individuals?
What is the primary reason for the increased potential for remodelling in young individuals?
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How does the location of a fracture influence remodelling potential?
How does the location of a fracture influence remodelling potential?
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What does Wolff's law state regarding bone remodelling?
What does Wolff's law state regarding bone remodelling?
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During the remodelling process after a fracture, where is bone primarily deposited?
During the remodelling process after a fracture, where is bone primarily deposited?
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What happens to rotational deformities in bone after a fracture?
What happens to rotational deformities in bone after a fracture?
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What is the expected outcome of an angular deformity over time if remodelling occurs?
What is the expected outcome of an angular deformity over time if remodelling occurs?
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What type of fracture is shown in the examples of paediatric bones?
What type of fracture is shown in the examples of paediatric bones?
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What factors affect the potential for remodelling after a fracture, aside from age?
What factors affect the potential for remodelling after a fracture, aside from age?
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What is a key factor that differentiates pediatric fractures from adult fractures?
What is a key factor that differentiates pediatric fractures from adult fractures?
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At what age do the growth plates typically fuse in females?
At what age do the growth plates typically fuse in females?
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What potential problem arises from intra-articular fractures in children?
What potential problem arises from intra-articular fractures in children?
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What was observed in the healing process of a completely displaced distal radius fracture in children?
What was observed in the healing process of a completely displaced distal radius fracture in children?
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Why is it important to address steps in the articular surface after a fracture?
Why is it important to address steps in the articular surface after a fracture?
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After how many months was the pediatric femoral fracture observed to be well on its way to remodeling?
After how many months was the pediatric femoral fracture observed to be well on its way to remodeling?
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What complication can arise from growth plate injuries in children?
What complication can arise from growth plate injuries in children?
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Which of these fractures is characterized as 100% displaced and healed completely over a specific period?
Which of these fractures is characterized as 100% displaced and healed completely over a specific period?
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What is the main utility of the Salter Harris classification system?
What is the main utility of the Salter Harris classification system?
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Type 1 Salter Harris fractures primarily affect which part of the bone?
Type 1 Salter Harris fractures primarily affect which part of the bone?
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What is the likelihood of growth abnormalities associated with Type 1 Salter Harris fractures?
What is the likelihood of growth abnormalities associated with Type 1 Salter Harris fractures?
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What is the most common management approach for undiagnosed Type 1 fractures?
What is the most common management approach for undiagnosed Type 1 fractures?
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Which type of Salter Harris fracture accounts for approximately 70% of cases?
Which type of Salter Harris fracture accounts for approximately 70% of cases?
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In Type 2 Salter Harris fractures, how does the fracture line exit?
In Type 2 Salter Harris fractures, how does the fracture line exit?
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What aspect of Type 2 fractures contributes to their classification as Salter Harris fractures?
What aspect of Type 2 fractures contributes to their classification as Salter Harris fractures?
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What is indicated if a Type 1 fracture cannot be reduced through closed means?
What is indicated if a Type 1 fracture cannot be reduced through closed means?
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What type of ossification involves osteoid being laid down within a fibrous membrane?
What type of ossification involves osteoid being laid down within a fibrous membrane?
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What is the primary role of the physis in long bones?
What is the primary role of the physis in long bones?
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Which factor does NOT contribute to the cessation of skeletal growth?
Which factor does NOT contribute to the cessation of skeletal growth?
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What is the incidence of developmental dysplasia of the hip (DDH) in newborns?
What is the incidence of developmental dysplasia of the hip (DDH) in newborns?
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What is the most common age range for Perthes disease?
What is the most common age range for Perthes disease?
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Which clinical sign is NOT associated with Slipped Upper Femoral Epiphysis (SUFE)?
Which clinical sign is NOT associated with Slipped Upper Femoral Epiphysis (SUFE)?
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What is a characteristic feature of plasticity in paediatric bones?
What is a characteristic feature of plasticity in paediatric bones?
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Which of the following is a red flag for septic arthritis/infection in children?
Which of the following is a red flag for septic arthritis/infection in children?
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Which of the following treatments is NOT applicable for Developmental Dysplasia of the Hip (DDH)?
Which of the following treatments is NOT applicable for Developmental Dysplasia of the Hip (DDH)?
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What does Wolf's law state regarding bone remodeling?
What does Wolf's law state regarding bone remodeling?
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What type of fracture is most commonly associated with compression forces in children?
What type of fracture is most commonly associated with compression forces in children?
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Which of the following conditions has an increased risk associated with lower social class?
Which of the following conditions has an increased risk associated with lower social class?
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Which of the following is NOT a factor influencing skeletal growth?
Which of the following is NOT a factor influencing skeletal growth?
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What is the appropriate age range for assessing for SUFE in females?
What is the appropriate age range for assessing for SUFE in females?
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Study Notes
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.
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