Exam 2 Flashcards
3 fused bones of pelvis
pubic bone, ilium, ischium
iliopectineal line
from ilium to pubic bone
ilioischial line
from ilium to ischium
Shenton’s line
from femoral neck to obturator ring
best way to evaluate SI joint
CT or Judet view
what do the arcuate lines on the sacrum represent
foramina where sacral spinal nerves exit
best way to evaluate sacrum
CT (obscured by gas and stool)
what type of joint is pubic symphysis
synchondrosis
what attaches to ASIS
sartorius
what attaches to AIIS
rectus femoris
3 locations for femoral neck fractures
subcapital, transcervical, basicervical
what inserts on greater trochanter
gluteus medius, gluteis minimus
what inserts on lesser trochanter
iliopsoas
what is the most common location for proximal femur fractures
intertrochanteric region
what occurs at the metaphysis in peds
growing bone matures into adult bone
what increases risk for femoral head AVN
the closer the fracture is to the femoral head
rotation in femur fractures
distal fragment tends to externally rotate
what does white areas around bone indicate
sclerotic, bone is healing
insufficiency fracture
normal stress on abnormal bone
what group more commonly experiences avulsion fractures and why
pediatrics; tendons are stronger than bone
what is a diastasis
pubic symphysis and SI joints are pulled apart
when does pelvic diastasis occur
vertical shear injury
why are pelvic diastasis life-threatening
blood loss
most common hip dislocation
posterior
what is a common cause of hip dislocation
MVC
what injury is commonly associated with hip dislocation
acetabular fracture
what causes an anterior or inferior hip dislocation
externally rotated hip with force along femur
common pelvis avulsion sites for peds
ASIS, AIIS
pediatric hip on x-ray
lucency around iliac crest and ischia
what is an apophysis
a growth plate in an area that doesn’t articulate with anything (greater trochanter)
best way to view ilium in pediatrics
false profile (60 degree rotation)
pathological process of osteoarthritis
damage to cartilage leads to damage to bone (microfractures) allowing synovial fluid to leak in (subchondral cysts) and osteophytes as bone tries to repair itself
hallmarks of osteoarthritis on imaging
osteophytes, asymmetric joint space loss, subchondral cysts, subchondral sclerosis
pathological process of inflammatory arthritis
inflammatory reaction in synovium leads to erosions that start at the edge of the bone and uniform thinning of cartilage. Increased bloodflow leads to increased osteoclast activity and osteoporosis
hallmarks of inflammatory arthritis on imaging
erosions, concentric/symmetric joint space loss, soft tissue swelling, osteoporosis
coxa profunda
femoral head pushes into acetabulum and pelvis, causing loss of iliopectineal line. Seen in inflammatory arthritis
causes of sacroiliitis
ankylosing spondylitis, IBD, septic joint, RA, psoriatic arthritis, reactive arthritis
where does ankylosing spondylitis start
SI joints
signs of sacroiliitis on imaging
sclerosis and symmetric SI joint widening
most common pediatric fracture
distal forearm
SH 1
through the growth plate, can look normal if nondisplaced
SH 2
through the growth plate and metaphysis
SH 3
through physis, epiphysis, and into joint
SH 4
metaphysis, physis, epiphysis
SH 5
crush injury to growth plate
most common SH fracture
type II
treatment for SH fracture
splinting, then casting, usually heals without complications
when to call ortho for SH fracture
type 3 and above
seq of SH 3
angular deformity due to premature closure of growth plate on one side
seq of SH 4
can cause angular deformity or cupping
seq of SH 5
premature growth plate closure causing limb length discrepancy
Tillaux fracture
ligamentous avulsion of tibia (pediatric version of ankle sprain)
what type of SH fracture is a Tillaux
3
how to image peds ankle fractures
CT
what is a toddler fracture
spiral fracture of tibia from learning to walk
what type of SH fracture is a SCFE
displaced type 1
imaging for SCFE
AP pelvis frog leg
ischium insertion
hamstrings
avulsion fracture of lesser trochanter
kickers
risk factor for developmental dysplasia of the hip
breech presentation
fractures seen in child abuse
metaphyseal corner fractures (avulsion fracture due to flailing limbs), rib fractures, skull fractures
how much angulation can a pediatric wrist fx have without needing surgery
45 degrees
phase 1 of fracture healing timeline
hematoma, 1 week
phase 2 of fracture healing timeline
soft callus (2-3 weeks)
phase 3 of fracture healing timeline
hard callus (4-16 weeks)
phase 4 fracture healing timeline
remodelling (17 weeks)
signs of SCFE
pain to groin, knee, thigh, antalgic gait, external rotation of the foot/hip and shortening
osgood schlatter aka
tibial tubercle apophysitis
osgood schlatter cause
stress to extensor mechanism (jumping)
osgood schlatter presentation
pain to tibial tubercle, worse with activity, pain with extension against resistance, enlarged tibial tubercle
osgood schlatter workup
AP/lateral knee radiographs
osgood schlatter treatment
NSAIDs, rest, ice, activity modification, sleeves PRN. Or 6 weeks in extension cylinder cast OR ossicle excision
common LCP population
males age 4-8
LCP presentation
insidious onset of painless limp with intermittent hip/knee/groin/thigh pain
LCP imaging
AP lateral pelvis frog leg
LCP radiograph findings
medial joint space widening, crescent sign, sclerotic appearance
LCP treatment, nonoperative
limit weight-bearing, activity restriction, maintain femoral head until ossification
LCP treatment, operative
femoral osteotomy until old enough for hip replacement
nursemaids elbow mechanism
sudden longitudinal traction applied to hand with elbow extended and forearm pronated
nursemaids elbow pathophys
annular ligament becomes trapped between radial head and capitellum
nursemaids elbow presentation
child holding arm flexed and pronated, heard pop, pain over lateral aspect of elbow with supination
nursemaids elbow x-ray findings
radius is not in line with capitellum
nursemaids elbow reduction
hold arm supinated and apply pressure over radial head and maximally flex arm
clubfoot aka
congenital talipes equinovarus
most common musculoskeletal birth defect
clubfoot
clubfoot CAVE
cavus, adductus, varus, equinus
treatment of clubfoot
Ponseti serial casting, new cast q 1-2 weeks
causes of acute onset limp in peds
fracture, soft tissue injury, foreign body
causes of insidious onset limp in peds
osgood-schlatter, stress fracture, chondromalacia patella, chondritis dessicans
diagnosis for osteomyelitis
MRI
diagnosis for bone malignancy
MRI
symptoms of bone malignancy
pain at night, palpable mass
signs of leukemia
neutropenia, decreased platelet count, anemia, night pain
x-ray findings for leukemia
moth-ridden bone
SI joint infection sign
positive FABER (flexion, abduction, external rotation)
classic sign for septic arthritis
won’t bear weight
septic arthritis diagnosis
ultrasound and joint aspiration
SI joint infection diagnosis
MRI
psoas abscess sign
psoas sign (pain with hip flexion)
Barlow
adduct the hip while applying posterior force
Ortolani
abduct the hip while applying anterior force
sign of hip joint effusion
hip flexed, abducted, externally rotated
when does bone malignancy occur
peds over 10
3 types of femoroacetabular impingement
pincer, cam, combined
pincer impingement
extra bone grows over the normal rim of the acetabulum, so the labrum gets crushed under the more prominent acetabulum. More common in middle-aged women
cam impingement
femoral head isn’t round and doesn’t rotate well within the acetabulum and grinds the cartilage. young, athletic men
mechanism of hip impingement
repeated overloading of structures, labral degeneration, osteoarthritis
symptoms of hip impingement
groin pain worsened by hip flexion, difficulty sitting, limping, mechanical symptoms, gluteal or trochanteric pain
test for hip impingement
Fadir test (flex the hip and internally rotate)
treatment for hip impingement
activity modification, NSAIDs, PT, hip replacement
trochanteric bursitis presentation
lateral hip/thigh pain, point tenderness over bursa over greater trochanter with bogginess, erythema, crepitus
trochanteric bursitis mechanism
tight IT band, overexertion, trauma
trochanteric bursitis treatment
NSAIDs, IT band stretching, PT, injections
IT band syndrome presentation
pain over greater trochanter distal to lateral knee
IT band syndrome mechanism
repetitive use
IT band syndrome treatment
RICE, PT, massage, injections
test for IT Band syndrome
Obers test (put leg behind off side of bed)
AVN symptoms
asymptomatic, deep groin pain, eventual joint collapse
AVN treatment pre-collapse
core decompression, vascularized fibular graft
femoral neck stress fracture mechanism
repetitive loading of bone with microfractures and no opportunity to heal
femoral neck stress fracture symptoms
insidious onset, improves with rest, benign physical exam
radiograph findings of femoral neck stress fracture
may find linear lucency if late
imaging for femoral neck stress fracture
MRI
treatment for femoral neck stress fracture
NWB or percutaneous screw fixation if severe
Maisonneuve fracture
fracture of fibula with ankle sprain
fracture with highest risk of femoral head AVN
femoral neck, closer to the femoral head
artery compromised in femoral neck fracture
medial circumflex
artery potentially compromised in intertrochanteric fracture
lateral circumflex
anterior dislocation of knee causes what
possible popliteal artery compromise
bones of ankle
tibia, fibula, talus
achilles tendon attachment
calcaneus
talus articulates with
navicular
calcaneus articulates with
cuboid
navicular articulates with
cuneiforms
what fracture is associated with inversion
lateral talus
attachment of peroneus tendon
base of 5th metatarsal
extensor complex components
quad muscles/tendon, patella, patellar tendon, tibia
acl
prevents tibia from sliding anteriorly relative to the femur
test for acl injury
lachman, anterior drawer
pcl
prevents tibia from sliding posteriorly relative to femur
pcl injury mechanism
direct impact to tibia or forced hyperextension
test for LCL injury
varus
test for MCL injury
valgus
what is attached to MCL
medial meniscus
treatment for MCL
hinge knee brace
terrible triad
ACL, MCL, medial meniscus
test for meniscus
McMurray
knee tendon rupture sign
cannot extend knee against gravity and cannot resist flexion
treatment for knee tendon rupture
urgent surgical repair, NWB, immobilize knee in extension
quad tendon rupture mechanism
sudden heavy load on partially flexed knee
patella dislocation mechanism
rapid change of direction, usually displaces laterally
patella dislocation treatment
PT, RICE, NSAIDs, braces, possible MPFL reconstruction
patella dislocation test
patellar apprehension sign, J tracking
when is surgery indicated for tibial plateau fractures
more than 3 mm displacement
knee dislocation meaning
femur and tibia have dislocated
ottawa ankle rules
pain near malleoli AND age over 55, unable walk 4 steps, bone tenderness at posterior edge of either malleolus
when to get ankle-brachial index
knee dislocations
