Paeds: MSK trauma, infective & inflammatory

Paediatric Fracture/Trauma

1. Greenstick fracture
   • Incomplete fracture -> bending of bone
   • Usually mid diaphysial
2. Bowing fractures
   • Incomplete fracture
   • Usually found with transverse or greenstick fracture of paired bone (eg. radial greenstick & ulna bowing fracture)
3. Salter-Harris fractures
   • Straight through - good prognosis
   • Above - good prognosis, mot common 
   • Lower - poorer prognosis 
   • Through - poor prognosis
   • Rammed - worst prognosis
4. Torus fracture = circumferential buckle fracture
5. Monteggia fracture/dislocation
   • Proximal ulna fracture and radial head dislocation
   • GRIMUS
     • Galeazzi = Radius Inferior (distal)
     • Monteggia = Ulnar Superior (proximal)
6. Apophyseal avulsion
   • Pelvis/hip: ASIS, AIIS, ischial tuberosity
   • 5th metatarsal
7. Toddler fracture
   • Undisplaced spiral tibia fracture

NAI

• Metaphyseal fractures (corner fractures) -> pathagnomic
• Rib fractures (posterior)
• Skull fractures
• Scapular & sternal fractures
• Spiral femur fractures in non-weightbearing children

Bone Infarcts

• Osteonecrosis of metaphysics or diaphysis
• XR: sheet like central lucency surrounded by shell-like sclerosis with serpiginous border
• MRI: central signal isointense to marrow -> marrow not replaced, T1 serpiginous low signal, T2 high

Brodie Abscess = intraosseous abscess

• Lytic lesion in oval configuration with thick sclerotic rim fading into surrounding bone 

Transient Synovitis

• Clinical diagnosis
• Cause of hip pain and limp in young children

Juvenile Idiopathic Arthritis

• 13/100,000
• Oligoarticular or polyarticular
• May have systemic onset (Still disease) with spiking fevers and rash