Low Yield Flashcards
What fracture pattern in a pediatric patient is pathognomonic for osteopenia imperfecta?
Olecranon fracture
Pediatric elbow dislocations are a/w with what condition(s)?
1) Pediatric abuse
2) Medial epicondyle fractures
Salter Harris fractures occur at what portion of the physis?
Zone of provisional calcification within the hypertrophic zone
What age group is Nursemaid’s elbow most common?
2-5yo
How are Nursemaid elbow’s reduced?
performed by manually supinating the forearm and flexing the elbow past 90 degrees of flexion; during this maneuver the physician’s thumb applies pressure over the radial head and a palpable click is often heard with reduction of the radial head.
alternative technique includes hyperpronation of the forearm while in the flexed position
What must be examined in a suspected isolated radial head dislocation in pediatric patient?
must examine for plastic deformation of the ulna if there is a presumed isolated radial head dislocation
What is indicated in pediatric patients with an unreducible radial head in a Monteggia fracture?
Ulnar osteotomy +/- open reduction of radial head
What nerve palsy is common in acute Monteggia fractures?
PIN; 10% in acute injuries
What is a common radiographic finding in the sequelae of pediatric hip dislocation?
Coxa magna (20%)
Under or overgrowth of the greater trochanter apophysis due to trauma can result in what deformities?
Undergrowth- coxa valga
Overgrowth- coxa vara
What is the treatment of pediatric femoral neck fractures?
1) Open reduction and capsulotomy within 24hrs
2) CRPP with k-wires for very young pts, cannulated screws for older
3) Stop short of physis in younger pts
4) cross physis if need to for stability, cross physis if >12yo
5) avoid anterolateral quadrant of epiphysis and posterior perforation of femoral neck to prevent injury to vasculature
What is the most common complication of pediatric femoral neck fracture?
AVN; almost 100% in Delbet IB (subcapital with dislocaiton of epiphysis); most susceptible age for AVN is 3-8 years
Second most common is coxa vara
Pediatric proximal tibia metaphyseal fractures can develop what late deformity?
Valgus; known as a Cozen deformity
Try to prevent with varus mold in cast, most spontaneously resolve in 12-24 months; affected tibia is often longer (average 9mm)
What is the treatment for a patellar sleeve avulsion fracture?
Cylinder cast if displaced less than 2cm; ORIF with tension band if >2cm displacment (can also use suture tunnels)
Toddler’s fracture usually affects what area of the tibia as opposed to fractures due to abuse?
Toddler’s-distal tibia
Abuse- proximal tibia
What is the treatment of most Toddler’s fracture?
Closed reduction and long leg cast if reduction acceptable
50% apposition
What is a congenital condition of a hypoplastic, undescended scapula?
Sprengel’s deformity; a/w Klippel-Feil syndrome
What shoulder motion is most limited in Sprengel’s deformity?
abduction
What are the associate manefestations of proximal femoral focal deficiencies?
fibular hemimelia (50%) ACL deficiency coxa vara knee contractures
Anterolateral bowing of the tibia is a/w what pediatric condition?
Congenital pseudoarthrosis, commonly a/w neurofibromatosus; posteromedial is physiologic, anteromedial is a/w fibula hemimelia
What is the treatment for tibial deficiency?
1) Complete absence of tibia w/o knee extension- knee disarticulation
2) Proximal tibia present w/ intact knee extension- tib/fib synostosis with Syme amputation
What foot deformity often accompanies posteromedial bowing of the tibia?
Calcaneovalgus foot
What is the cause of posteromedial bowing of the tibia?
Intrauterine positioning
What is the most common sequelae of posteromedial bowing?
Leg length discrepancy of 3-4cm
What is the treatment of posteromedial bowing?
Observation; most resolve by age 5-7yo; may need growth modulation d/t development of LLD
What is the most common cause of in-toeing gait?
Internal tibial torsion
What are causes of in-toeing?
1) Internal tibial torsion (most common)
2) Femoral anteversion
3) Metatarsus adductus
At which point is surgery indicated in patients with internal tibial torsion?
> than 8yo with thigh-foot angle >15 degrees; perform derotational supramalleolar osteotomy
What is the normal femoral anteversion at birth?
30-40 deg
What physical exam finding is indicative of increased femoral anteversion?
Decreased external rotation of the hip
What patients with external tibial torsion are candidates for supranalleolar osteotomy?
Age >8 and rotation >2 SD above the norm (>40 deg)
What is the cause of metatarsus adductus?
Packaging disorder
Metatarsus adductus is associated with what gait abnormality?
in-toeing
What is the treatment for metatarsus adductus?
Non-operative:
Stretching for flexible deformities, rigid deformities serial casting
Operative:
Lateral column shortening, medial column opening wedge osteotomy
Cavovarus foot is described as?
Elevated longitudinal arch with fixed plantarflexed forefoot
Tibialis anterior is overpowered by the peroneus longus
What muscle imbalance is responsible for cavovarus foot?
Tibialis anterior is overpowered by the peroneus longus a/w : Charcot-Marie-Tooth Freidreich's ataxia Cerebral palsy Polio spinal cord lesions
Coleman block testing assesses what?
Flexible hindfoot in a cavovarus deformity
Placed under the lateral column which removes the contribution of a plantarflexed first ray; if does not correct then is rigid hindfoot
What is the treatment for cavovarus foot?
Mild and flexible: medial rigid insole with lateral wedge
Flexible: plantar fascia release, post tib transfer, TAL, 1st MT dorsiflexion osteotomy
Rigid: Calcaneal valgus osteotomy
Severe rigid: triple arthrodesis
Lack of frataxin gene is characteristic of what disease?
Friedreich’s ataxia; due to GAA repeat on Ch 9q13
What is the most common cause of death in Friedreich’s ataxia?
Cardiopulmonary compromise; usually by age 50.
Wheelchair bound by age 30
What is the treatment of Friedreich’s ataxia?
Treat associated disorders:
Scoliosis- observe/brace if less than 40deg, PSF if >60deg
Cavovarus foot- transfers and osteotomies, possible triple arthrodesis
What is Kohler’s disease?
Idiopathic AVN of the navicular;
Ages 4-7yo
80% occur in boys
Why is the treatment for Kohler’s disease?
NSAIDs and short leg walking cast
What is the treatment for accessory navicular?
Activity and shoe modification
Casting if refractory
Surgical excision in chronic refractory cases
What technical trick helps prevent recurrence in excision of accessory navicular?
Recurrence of symptoms MC d/t inadequate bone resection
Respect flush with the medial cuneiform
What is the treatment for congenital curly toe?
Observation; most go away on their own, taping does not help; surgical release of severe toe or nail deformity in kid >3yo
Describe flexible pea plants in pediatric patients?
Physiologic variant consisting of a decrease in the medial longitudinal arch and a valgus hindfoot and forefoot abduction with weightbearing;
Corrects with Coleman block testing (tarsal coalition flatfoot does not)
What is the treatment of flexible pes planus in children?
Observation; arch redevelops by maturity and orthotics don’t change the course of the disease
Surgery (Evans calcaneus osteotomy and TAL or Strayer) is rarely indicated
What proteins are a/w Larsen’s syndrome?
AD (autosomal dominant) form gene codes for filamin B
AR form is carbohydrate sulfotransferase 3 deficiency
What is Larsen’s syndrome?
rare genetic disorder with characteristic findings of ligamentous hyperlaxity, abnormal facial features, and multiple joint dislocations
a/w cervical kyphosis that presents with myelopathy (posterior cervical fusion at 18mths of life)
What is arthrogryposis?
Nonprogressive congenital disorder involving multiple rigid joints (usually symmetric) leading to severe limitation in motion; normal cognition
What mutation causes spinal muscular atrophy?
Mutation of SMN-I present in all SMA pts; severity determined by number of functional copies of SMN-II; causes progressive loss of alpha-motor neurons in anterior horn of spinal cord
What is the mutation involved with Ehlers-Danlos?
COL5A1 or COL5A2; gene for type V collagen
important in proper assembly of skin matrix collagen fibrils and basement membrane
What is the physical exam scoring system for joint hypermobility?
Beighton-Horan scale: (5 or more pts)
1) passive hyperextension of each small finger >90° (1 point each)
2) passive abduction of each thumb to the surface of forearm (1 point each)
3) hyperextension of each knee >10° (1 point each)
4) hyperextension of each elbow >10° (1 point each)
5) forward flexion of trunk with palms on floor and knees fully extended (1 point)
Define juvenile idiopathic arthritis?
A persistent autoimmune inflammatory arthritis lasting > 6 weeks in a patient younger than 16 years of age; HLA markers DR4 associated with polyarticular
DR8, DR5, DR2.1 associated with pauciarticular
RF- seropositive in
What condition a/w juvenile idiopathic arthritis requires outside consultation?
Anterior uveitis: consists of iridocyclitis frequently indolent and requires immediate ophthalmologic evaluation for slit lamp examination; indolent and can lead to blindness if overlooked
Which type of juvenile idiopathic arthritis has the best prognosis?
Pauciarticular; less than 5 joints involved, typically presents with painful limp that improves throughout the day
Pauciarticular>polyarticular>systemic
Polyarticular typically involves hand/wrist
Systemic (Still’s disease) fever, rash, splenomegaly
What lysosomal storage disease is common in Ashkenazi Jews?
Gaucher’s; leads to accumulation of sphingolipids
What is the deficiency in Gaucher’s disease?
B-glucocerebrosidase
