7 Ortho

Question 1

Peds ortho injuries:

what is the general rule if you suspect possible fx, and xrays show open physis but no fracture

Answer 1

If hx and exam suggestive, assume salter harris 1. Splint and ortho f/u

Question 2

salter harris

when to consult ortho

Answer 2

4 and 5 for sure, probably 3 given the articular involvement

Question 3

Triplane ankle fx

-do what, what dispo

Answer 3

• very serious in a growing kid. salter harris 3/4 in ankle with open physes present
• call ortho now, OBTAIN CT SCAN

Question 4

supracondylar fx

-classifications, and tx/dispo

Answer 4

1: no displacement: splint in 90 degrees, ortho f/u
2. displaced, intact posterior cortex
3. displaced, no cortical contact
- ortho consult if displaced

Question 5

FOOSH and you see bowing of forearm

-tx, dispo

Answer 5

this is a bowing fx. XR other side if unsure

Serious. splint, ortho f/u

Question 6

Radial neck fx:

what is acceptable reduction, when to consult ortho

Answer 6

(per hippo em:)

Todder:

<10 degree neck angulation will correct naturally

>30 degree = closed reduction or percutaneous pin

Age>10y:

>30 degree angulation or translocation >3mm = call ortho

unable to reduce angulation <45 degrees = call ortho

unable to pronate/supinate >60degree = call ortho

Question 7

peds elbow fx

mnnemonic

Answer 7

CRITOE

1,3,5,7,9,11. order never changes although age can

capitellum (lateral side, articulates with radial head)

radius

internal

trochlea

olecranon

external

Question 8

toddler presents with limp and cannot walk, after hx of trauma/fall

-you don’t see fx on XR, do what

Answer 8

Think Toddler’s fx. Fx line easily missed on day 1

splint, assume a salter harris 1 fx anyway, ortho f/u

Question 9

Sever’s disease

Answer 9

calcaneal apophysitis. think osgood shlatter of the achilles

boys 8, girls 6, usually b/l

NSAIDs, orthotic shoes support