MRC Peds Notes Flashcards
What growth plate zone do physeal fractures occur through?
ZPC in the zone of hypertrophy
What is the 1st and 2nd most common causes of death in children?
1st: accidental injury
2nd: NAT
Blocks to closed reduction of of proximal humerus fractures in children
biceps tendon, deltoid, periosteum
Acceptable reduction of proximal humerus fracture in kids
< 5 yo: 70 degrees and 100% displaced
5-12 yo: 40-70 degrees
> 12 yo: 40 degrees and 50% displacement
Can you treat type II SCH fx on outpatient basis?
yes, safe and effective to do at ASC
What is a risk factor for infection in SCH fx?
younger age
What injuries result in cubitus varus and valgus?
SCH: cubitus varus
lateral condyle fx: cubitus valgus
what XR view is best for viewing lateral condyle fractures?
internal oblique
What injury should be assessed for on a distal humeral axial view?
medial epicondyle
What injury is associated with elbow dislocations?
medial epicondyle fracture
What is the direction of displacement of a transphyseal distal humerus fracture?
posteromedial
Late complications from transphyseal distal humerus fracture?
cubitus varus and medial condyle AVN
Reduce a radial head fracture if…
its more than 30 degrees angulated.
Traction, varus in supination and then extend, flex and pronate.
Complications with ORIF of radial head fractures
Loss of ROM
AVN
Synostosis
Acceptable alignment forearm fracture younger than 9
15 degrees angulation
45 degrees of rotation
Acceptable alignment forearm fracture older than 9
10 degrees angulation proximal
15 degrees angulation distal
30 degrees of rotation
Assessing rotation on an AP XR
radial styloid and biceps tuberosity at 180 degrees
Assessing rotation on a lateral XR
ulnar styloid and coronid 180 degrees
Submuscular plating of pediatric femur fractures can lead to…
genu valgum.
Tibial tubercle fx can have entrapped…
lateral meniscus.
Tibial eminence fx can have entrapped…
medial meniscus.
Considerations for ORIF tibial shaft fracture
> 5 degrees of posterior angulation
>5-10 degrees varus/valgus
Triplane fracture
SH II on the lateral and SH III on the AP = a SH IV fracture
Distal tibial physeal closure
central –> medial –> lateral
Atlantooccipital dissocation
dens-basion distance > 12 mm
The dentocentral synchondrosis fuses at…
age 6.
Most common cervical fracture in kids is…
odontoid fracture (usually through the synchondrosis.
Treat with CR/Halo.
Involcrum
new bone formed by active periosteum around old, dead bone
Sequestrum
necrotic bone that is avascular and can be a nidus for infection
Best predictors of septic hip in order
- T > 101.3
- CRP > 2
- ESR > 40
- NWB
- WBC > 12K
Chronic Recurrent Multifocal Osteomyelitis
multiple sites, pathology and cx negative, associated with palmar and plantar pustules
- *Treat with NSAIDs
- *can cause LLD
Brain MRI of CP will show…
periventricular leukomalacia.
Botox MOA
inhibits presynaptic release of ACh
Dorsal rhizotomy can be considered for..
ambulatory diplegic patients.
What region of a CP hip is deficient?
posterior acetabulum
What femoral deformity is associated with CP?
valgus and anteversion
CP Equinovalgus foot
due to spastic peroneal
Tx: TAL, PB lengthening, lateral column lengthening, calc osteotomy
CP Equinovarus foot
**Most common in spastic hemi
Overpull of PT
Treatment of CP foot w/ flexible varus and weak peroneals
SPTT to peroneals
Treatment of CP foot w/ flexible varus and overactive tib ant
SATT to cuboid
Arthrogryposis is associated with…
decrease in anterior horn cells.
Fascioscapulohmeural muscular dystrophy
- AD
- scapular winging
- weakness of facial muscles (inability to whistle) and proximal UE
Treatment of polymyositis and dermatomyositis
anti-TNF meds
Freidrich Ataxia
- AR
- spinocerebellar degeneration (posterior columns of cord)
- Frataxin gene (GAA repeat)
- wide-based gait
- cardiomyopathy
- cavus foot
- scoliosis
