Fractures in Children MCQs

Following are some facts about fractures in children Fractures in children heal faster. Fractures close to the joint heal faster. Sideways displacement will remodel. Angulation in the plane of the adjacent joint is acceptable. Rotational malalignment will never remodel. Physis subjected to compressive forces inhibits growth Reference- Maheshwari 5th /ep. PG NO 59

The treatment of radial head fractures depend on the amount of comminution and the age of the patient. Comminuted fractures in adults is treated by excising the broken fragments. However the radial head excision is contraindicated in Essex Lopresti fracture - Combination of radial head fracture with interosseous membrane rupture and DRUJ subluxation. Displaced fracture in children - Excision of radial head in children will cause cubitus valgus Undisplaced fractures in adults - These can be treated with POP cast. Reference: J. Maheshwari's 5th Edition of Essential Orthopaedics page no. 107

Neuroblastoma is responsible for the most incidence of metastasis in children. Important points: Most common malignancy of bone: Metastasis MC primaries for bone mets: Breast > Prostate> Lung MC primaries for mets in children: Neuroblastoma MC bone involved: Spine> proximal femur MC part of spine involved: Thoracic > Lumbar Reference: Tachdjian's Pediatric Orthopaedics 5th edition page no. 89

Type I collagen is seen in the following skeletal tissues Annulus fibrosus of intervertebral disc Bone Menisci Articular cartilage contain type II collagen Reference: Miler's 8th Edition of Review of Orthopaedics, page no. 98. Reference: Rockwood and Wilkin's Fractures in Children's 8th edition, page no. 609.

The clinical picture points towards ankylosing spondylosis, so the best test to be done in HLA B 27 which will be positive in 80% of cases of ankylosing spondylosis. Reference: J. Maheshwari's 5th Edition of Essential Orthopaedics page no. 291

Prognosis of Pott's paraplegia depends upon the following factors: Age: Children respond to treatment better than adults. Onset: Gradual onset paraplegia has a better prognosis. Duration: Long standing paraplegia has a worse prognosis. Severity: Motor paralysis alone has a good prognosis. Sphincter involvement i.e., urinary or bowel incontinence are bad prognostic indicators. Progress: Sudden progress of the paraplegia has a bad prognosis. Poor prognostic factors in Pott's paraplegia are acute onset, sudden progression and long-standing paraplegia Reference: Maheshwari Essential Orthopedics, 7 th edition, Page no. 192.

The clinical features are consistent with scurvy. Scurvy occurs due to deficiency of vitamin C Vitamin C is a coenzyme in the hydroxylation of proline and lysine. Hydroxyproline and hydroxylysine are the precursors of collagen synthesis. In scurvy, due to vitamin C deficiency, there is reduction in collagen synthesis. So, wherever collagen is required to provide structural integrity, problems occur. E.g. there is weakening of the capillary basement membrane leading to bleeding at sites through out the body. Reference: Miler's 8th Edition of Review of Orthopaedics, page no. 91

The most important biochemical change in renal osteodystrophy is elevated phosphate levels. This is due to the inability of the failing kidney to excrete phosphate, leading to phosphate retention. The biochemical changes in renal osteodystrophy are: Calcium - ↓↓ PTH - ↑ ↑ Serum PO 4 - ↑ ↑ Alkaline Phosphatase (ALP) - ↑ Serum 1, 25 OH Vit D - ↓ Reference: Miler's 8th Edition of Review of Orthopaedics, page no. 75