Childhood Orthopedics and Trauma Flashcards
1
Q
Subdural hemorrhage
A
- Most common traumatic intracranial injury in children younger than 1 year of age
- Usually associated with skull fracture, usually bilateral, often with associated bilateral retinal hemorrhages
- Seizuers occur in >60% of cases
- Increased ICP is typical (bulging fontanelles)
- May be acute, subacute, or chronic
- While acute and subacute are best visualized by noncontrast CT, for chronic hematomas, MRI is often more effective, as their texture changes over time
- Require non-emergent evacuation, often at a later date
2
Q
Epidural hemorrhage
A
- Occur more frequently than subdural hemorrhage in older children and adults
- Usually associated with skull fracture, usually unilateral, increased ICP
- Adults tend to have arterial injuries, kids tend to have venous injuries
- Seizures do happen, but not as frequently as with subdural hemorrhages, and retinal hemorrhages are uncommon
- Mortality is greater with epidural hemorrhage than subdural hemorrhage, but for the survivors morbidity is less than subdural hemorrhage (since subdural often results in lasting brain damage)
- Require emergent evacuation
3
Q
Concussion
A
Altered mental status immediately after blunt head trauma. No consistent brain abnormality is seen.
Often causes temporary retrograde or anterograde memory loss.
4
Q
Utility of MRI in a known intracranial hematoma already seen on CT
A
Can be used to more accurately age the heomatoma if the exact date of injury is in question
5
Q
Osgood-Schlatter disease aka Osteochondrosis
A
- Condition of painful inflammation of the tibial tubercle, caused by traction apophysitis of the tibial tubercle
- Occurs in active children and adolescents between ages 9 and 17
- Diagnosis may be made clinically
- Treatment consists of decreased activity, ice after exercise, and NSAIDs
- In severe cases, immobilization of the knee and use of crutches may be required
- Symptoms may recur until ossification is complete (~17 years)
- Long-term prognosis is excellent
6
Q
Patellofemoral pain syndrome
A
- Broad term used to describe pain in the front of the knee and around the patella
- Also called “runner’s knee” or “jumper’s knee”
- Characterized by anterior knee pain and stiffness with motion, popping or cracking sound when climbing stairs or standing after a long period of sitting, and tenderness of the inferior patella
7
Q
Slipped capital femoral epiphysis (SCFE)
A
- Occurs in adolescents during the growth spurt. Most common in overweight adolescents. No history of trauma.
- Leads to a limp and groin or thigh pain, however hip pain may be referred to the knee.
- On exam, there is limited hip flexion, internal rotation, and abduction
- Frog leg X-ray reveal widening of the femoral epiphysis and osteopoenia.
- These inviduals are at risk for avascular necrosis of the femoral epiphysis and require orthopedic evaluation
- Treat w/ surgery
8
Q
Iliotibial band friction
A
- Frequent cause of lateral knee pain in runners and bicyclists
9
Q
Etiologies of torticollis
A
- Injury to the sternocleidomastoid
- Anti-dopaminergic side effect (antipsychotics, metoclopramide)
- Congenital vertebral malformations (Kippel-Feil syndrome, etc)
- Trauma
- Inflammatory torticollis (usually following a URI or in association with a pharyngeal abscess or cervical lymphadenitis)
- Connective tissue disease (rheumatoid arthritis)
- Neuropathy (Wilson’s disease, spinal cord or posterior fossa tumors, etc)
- Upper lobe pneumonia
- Benign paroxysmal torticollis
10
Q
Torticollis in a newborn
A
- Typically presents at or soon after birth
- Infants may have experienced birth trauma and usually have a palpable, firm mass within the affected muscle
- Cervical spine radiograph must be taken to rule out vertebral malformation
- After ruling out the above, gentle sternocleidomastoid stretching is the treatment
- If unsuccessful after 1 month of therapy, refer to orthopedics
- Persistent torticollis can lead to facial asymmetry
11
Q
Klippel-Feil syndrome
A
- Congenital syndrome
- May present as torticollis
- Includes:
- Congenital fusion of portions of cervical spine
- Restricted neck movement
- Short neck
- Low hairline
- Sprengel deformity
- Urinary tract abnormalities
12
Q
Sprengel deformity
A
Congenital elevation of the scapula
13
Q
Sandifer syndrome
A
Gastroesophageal reflux with intermittent torticollis
Abnormal head positioning is though to be in response to pain or to protect the airway rather than neuropathological in origin
14
Q
Hair-tourniquet syndrome
A
- When a hair strangulates distal extremity, often a hair stuck in a sock strangling a toe
- Cuts off venous and arterial supply and causes swelling
15
Q
A fracture to ___ or ___ is highly likely to be abuse
A
A fracture to the skull or femur is highly likely to be abuse
21
Q
Legg-Calve-Perthes disease
A
- Age ~6 years old
- Insidious onset of antalgic gate, unable to bear weight on foot
- Avascular necrosis of femoral head in acetabulum
- Diagnose w/ x-ray
- Treat w/ cast
23
Q
Kocher score for septic joint
A
26
Q
Osteosarcoma
A
- Distal femur is typical presentation
- Associated w/ pRB mutation, may have had retinoblastoma
- “Sunburst” pattern on x-ray, confirm with MRI, then biopsy
- Focal, atraumatic bone pain
- Treatment is resection
