Knott - Peds Flashcards
approach to peds ortho
- age
- context
- hx
- pe
- imaging → xray, US, CT, MRI
- referral → ED/ortho
what are 3 types of ortho infxns
- transient (toxic) synovitis
- septic arthritis
- osteomyelitis
mc location for transient synovitis
hip
what do you think when you see a non toxic, post viral infxn pediatric pt w. an antalgic gait and his hip abducted and externally rotated
transient synovitis
a pt w. septic arthritis will appear
ill
fever
irritable
septic arthritis is almost always caused by
staph
osteomyelitis commonly affects the
long (tubular) bones
what do you think when you see periosteum elevation of a long bone
osteomyelitis
mc place for osteoid osteoma
le → proximal femur
benign bone lesions progress
slowly
what are the benign bone lesions
- osteoid osteoma
- osteoblastoma
- osteochondroma
malignant bone lesions are characterized by
lots of pain → kids waking up screaming at night
an osteoma is a
non malignant bone lesion
what do you think when you see small radiolucent nidus
< 1 - 1.5 cm
osteoid osteoma
what is the mc place for an osteoblastoma
posterior column of the spine
what do you think when you see non-malignant bone lesion larger than osteoid osteoma
osteoblastoma
what are the 3 mc place for osteochondroma
distal femur
around knee
proximal humerus
what do you think when you see a cartilage-capped bony spur on the external surface of a bone
osteochondroma
what creates a cauliflower appearance on xray
osteochondroma
what are the malignant bone lesions
- osteosarcoma
- ewing’s sarcoma
what is the mc location for osteosarcomas
femur
what is the mc primary malignant bone lesion in kids
osteosarcoma
osteosarcoma often occurs
post trauma
what do you think when you see a pt w. localized pain for several months that waxes and wanes with normal labs except for elevated alk phos and LDH
osteosarcoma
what does this xray make you think - sunburst, codman’s triangle
osteosarcoma
what is the mc location for ewing’s sarcoma
long bones of extremities →
- femur
- tib/fib
- humerus
what does this xray make you think - moth eaten, permeative appearance; codman’s triangle; onion peel; periosteal elevation
ewing’s sarcoma
what are 6 considerations in evaluation of pediatric fx
- age
- MOI
- anatomic location
- soft tissue involvement → open vs closed
- key PE
- xrays
what is the most metabolically active portion of the bone
metaphysis
what portion of the bone is the most prone to fx
metaphysis
be able to label this pic
4 types of peds fx
- buckle
- plastic deformation → bowing
- greenstick
- physeal
what is the mc pediatric fx
buckle
buckle fx is caused by what type of injury
FOOSH
mc location for buckle fx
ulna/radius
what is the mc location for a bowing fx
ulna
radius
what is this fx called
bowing fx
what is this fx
greenstick → bone is bent w. fx line, but fx does not extend completely thru bone
salter harris fx’s involve the
growth plate → physeal fx
salter harris types III-V usually require __
dt risk of __
ortho referral
stunted growth
what might you be concerned about w. a toddler fx
child abuse
what is the mc location for a toddler fx
femur
tib/fib
what is the mc elbow injury/elbow fx in kids
supracondylar fx
supracondylar is a ___ injury
do not miss!
what do you think when you see a pt w. elbow pain and guarding and no ROM
supracondylar fx
what does the fat pad sign on a peds elbow xray make you think of
supracondylar fx
what peds pt population usually has clavicle fx
adolescents
athletes
where do boxers fx occur
fx of head/neck of 5th metacarpal
what is a nat
non accidental trauma
what are 6 nat injuries that might make you suspicious for child abuse if the hx is inconsistent w. injury
- long bone fx in non ambulatory pt
- rib fx
- sternum, scapula, spinous process, vertebral body fx
- multiple fx in various stages of healing
- digital fx in < 3 yo
- complex skull fx in < 18 months
when does the posterior fontanelle close
2 months
when does the anterior lateral fontanelle close
3 months
when does the posterior lateral fontanelle close
one year
when does the anterior fontanelle close
2 years
what is the etiology of torticollis
sternocleidomastoid m
in what pt population is back pain concerning
young kids
what is the mc scoliosis location
thoracic region →
r thoracic
l lumbar
what are 2 values to evaluate scoliosis
cobb angle
risser score
what does the risser score measure
iliac ossification/skeletal maturity
older kids have a lower risk for progression of
scoliosis
what pt population do you think of with spondylolysis and spondylolisthesis
gymnasts
divers
fx of posterior arch in lower lumbar spine and scotty dog sign on xray should make you think of
spondylolysis and spondylisthesis
asymmetric thigh folds and a positive barlow and ortolani should make you think of
developmental hip dysplasia
what is the imaging choice for hip dysplasia dx in kids 4-6 weeks old
US
what is the diagnostic imaging of choice for developmental hip dysplasia f kids are > 4-6 weeks old
xray
what do you think of when you see an overweight AA middle schooler w. pain and no hx of trauma
slipper capital femoral epiphysis
what is this xray showing - widened epiphyseal plate, bloomberg’s sign, off-centered Klein’s sign
slipped capital femoral epiphysis
what LE condition might affect a skinny younger kid after trauma or infxn
legg-calve-perthes dz
what is legg-calve-perthes dz
osteonecrosis of femoral head
babies are born with with leg formation
fenuvarus → bow legged
what are indications for referral with genu valgum
- >8 cm btw medial malleoli
- progressive knock-knees after 4-5 yo
- unilateral or assymetric
- associated w. short stature
- hx metabolic dz or joint swelling/infxn
what are indications for referral with genu varus
- >6 cm btw femoral condyles
- progressive bowing
- persistent bowing >3yo
- unilateral or asymmetric
- short stature
- hx of concern
when would you measure thigh-foot angle
tibial torsion
what is the mc congenital foot deformity
metatarsus adductus
what is the tx for clubfoot (talipes equinovarus)
early serial casting
what is the mc reason for bone pain in adolescents
sever’s apophysitis → osgood schlatter’s of the ankle
what is the most common location for osteochondrosis dessicans (OCD) -
complication of osgood schlatter’s
knee
what condition might you see in little leaguers
lateral epicondylitis
how many times should you try to reduce a nursemaid’s elbow before xraying
2
how do you reduce a nursemaid’s elbow
supinate and flex
