miscellaneous pediatric

Question 1

key difference between skeletally mature and immature bones ?

Answer 1

presence of physeal plates

Question 2

when should non accidental injuries or child abuse be taken into consideration ?

Answer 2

1- Incoherent history
2- Bilateral fractures
3- Fractures in different stages of healing
4- Bruises and or burns in highly suggestive areas
5- Fractures in very young age
(below 18 months – pre ambulatory)
6- Spiral fracture pattern

Question 3

what classification is used in paediatric fractures (distal bones ) ?

Answer 3

salter harris classification

Question 4

what is the most common paediatric fracture ?

Answer 4

supracondylar humeral fracture

Question 5

what is the mechanism of injury of supracondylar humerus fracture ?

Answer 5

fall on outstretched hand ( extension )
direct fall on elbow ( flexion )

Question 6

what nerve is affected in supracondylar humerus fracture ?

Answer 6

anterior interosseous nerve

Question 7

what does anterior interosseous nerve affection present with ?

Answer 7

inability to flex thumb and index finger

Question 8

what is the management of supracondylar humerus fractures ?

Answer 8

non-displaced : conservative in a back splint with close follow up
displaced : closed vs open reduction and k wire fixation

Question 9

what are the non operative management options for femoral shaft fracture ?

Answer 9

hip spica

Question 10

what operative modality is not preferred in children above 49 kg suffering from femoral shaft fracture ?

Answer 10

elastic intramedullary nails - nancy nails

Question 11

what are the treatment modalities of femoral shaft fracture for each age group ?

Answer 11

less than 6 months :
pavlik harness
hip sica

7 months to 5 years :
hip spica
external fixator
ORIF
flexible nails

6-11 years :
ORIF
external fixator
flexible nail

> 11 years :
ORIF
Flexible nail
IM nail

Question 12

what is Talipus-Equino varus ?

Answer 12

congenital club foot

Question 13

what other congenital abnormalities are associated with Talipus-Equino varus?

Answer 13

spina bifida
UT anomalies
GIT anomalies

Question 14

what is the patho-anatomy of Talipus-Equino varus?

Answer 14

CAVE
cavus - contracture of plantar fascia
adductus - of forefoot
varus - of heel
equinus - achilles tendon shortening

Question 15

what is the management of congenital club foot ?

Answer 15

serial casting - ponseti technique
soft tissue procedures

Question 16

what is thee other name for flat foot ?

Answer 16

pees planus

Question 17

what are the two forms of pes planus ?

Answer 17

flexible - most common
rigid

Question 18

what is the difference between the rigid and flexible form of pes planus ?

Answer 18

flexible - arch reconstitutes with tip toeing , does not with rigid
but both show a decrease in the medial longitudinal arch

Question 19

what are the causes of rigid flat foot ?

Answer 19

accessory navicular
tarsal coalition - abnormal connection of 2 or more bones in thee foot
congenital vertical talus

Question 20

what are the two forms of tarsal coalition ?

Answer 20

calcaneo - navicular
talo-calcaneal

Question 21

what is the presentation of pes planus ?

Answer 21

May have arch pain or pretibial pain
In flexible form – foot is flat on weight bearing only
In rigid form – foot is flat regardless of weight bearing

Question 22

what is osggood-scchlatter ?

Answer 22

self-limited condition characterized by inflammation and stress-induced injury of the tibial tuberosity at the insertion point of the patellar tendon

Question 23

what is the typical age of presentation ?

Answer 23

10-15 years old

Question 24

what is the clinical picture of osgood schlatter ?

Answer 24

1- Anterior knee pain, often described as localized to the tibial tubercle
2- Pain often exacerbated by activities such as running, jumping, or kneeling, and relieved with rest

Question 25

what is the salter harris classification ?

Answer 25

SALTER
Straight across growth plate - seperated growth plate
Above growth plate
lower growth plate
through or two growth plate
erasure of Growth plate