Musculoskeletal

Question 1

when they first independently ambulate, generally walk with a wide base of support, taking short,
sometimes asymmetric steps, with occasional foot slapping
as they pick up speed. Arm motion is nonreciprocal with
their legs and they fall frequently because of poor balance
and immature motor planning

Answer 1

Toddlers

Question 2

At what age do children walk with more fluid and symmetric strides,
reciprocal arm motion, and improved overall coordination
of movement

Answer 2

3 –5 years old

Question 3

By what age do most children walk with a coordination pattern similar to adults, including longer
stride lengths and a decreased step cadence

Answer 3

By age 7

Question 4

hip pain, knee pain or ankle pain cause a shortened stance phase on
the affected side called ‘

Answer 4

Antalgic gait

Question 5

is the time that the limb is in
contact with the ground supporting the weight of the body.

Answer 5

Stance phase

Question 6

Examples of nonantalgic limp

Answer 6

toe-walking, which
may be the result of a tight heel cord; recurrent or untreated
clubfoot; limb-length discrepancy; or a neurologic disability
such as cerebral palsy

Question 7

Trendelenburg gait

Answer 7

has the appearance of the child shifting his or her body weight over
the affected hip during the stance phase. This shift reduces
the force exerted on the weak abductors. The distinction
between Trendelenburg and antalgic gaits can be seen in the
stance phase wherein the Trendelenburg stance phase is not
shortened because the Trendelenburg gait is not caused by
pain.

Question 8

Leg length discrepancy

Answer 8

causes gait disturbances. The difference on the shorter limb is characterized by walking on the toes. The difference is seen on the
longer side with walking and standing with the hip and/or
knee in flexion to actively equalize leg lengths

Question 9

symptom of a wide variety of acute lower extremity musculoskeletal injuries, including ligament sprains,
muscle strains, contusions, and fractures

Answer 9

Limping

Question 10

The diagnoses in pediatric trauma that must not be
missed

Answer 10

neurovascular compromise, open fractures, and impending compartment syndrome.

Question 11

occurs when swelling or bleeding into
muscle compartments of the upper or lower extremities inhibits adequate blood supply into or out of the compartments

Answer 11

compartment syndrome

Question 12

the generally accepted
best indicators of an evolving compartment syndrome in
children are the so-called “three As”

Answer 12

increasing Analgesia
needs to control pain, Anxiety, and Agitation

Question 13

In children,
compartment syndrome most commonly develops after

Answer 13

fractures of the tibial shaft, supracondylar humerus, and forearm

Question 14

When to send child immediately to the ED for Ortho evaluation

Answer 14

A child who presents with limping or inability to bear weight because
of severe pain after a traumatic injury or surgery, especially
one who has been asking for increasing amounts of pain
medication, is inconsolable, or is especially anxious from
pain

Question 15

lower extremity fractures in a child who is not yet ambulating, Metaphyseal corner fractures, epiphyseal separations, and
multiple fractures at different stages of healing should

Answer 15

increase suspicion for nonaccidental trauma and child abuse

Question 16

Spiral or oblique fracture–common cause of limping in
the young child that is not easily identified without a high
index of suspicion. The injury typically presents with limping after a minor twisting injury or fall. Often families do not
recall an inciting injury or event. Typically, physical examination reveals no swelling or limb deformity

Answer 16

Toddler fracture

Question 17

a fracture on the tension side
of the bone and plastic deformation of the bone cortex on
the opposite side

Answer 17

greenstick fracture

Question 18

the toddler who limps after
minor trauma and has essentially normal findings on
physical examination and negative radiographs is presumed to have this injury and is casted for 4 weeks. Casting is provided for comfort and to prevent worsening of the bone
injury

Answer 18

greenstick fracture

Question 19

Bacterial infections of the lower extremities are common
and have a wide range of clinical manifestations. Musculoskeletal infections include local cellulitis, fasciitis, myositis,
septic arthritis, osteomyelitis, and especially in the era of
MRSA, extensive infections that involve soft tissues, bone,
and joints simultaneously

Answer 19

Septic arthritis of the hip is the mist critical diagnosis. It cannot be missed because acutely damage to hip cartilage and the blood supply to
the femoral head begins within 6 to 12 hours of infection
onset and may be irreversible after 1 to 2 days.

Question 20

local swelling and tenderness, erythema, joint effusions of the knee or ankle and limited joint motion are physical findings of what condition

Answer 20

musculoskeletal infections except septic hip arthritis

Question 21

child holds the affected hip in
a position of flexion with slight abduction and external
rotation and resists passive hip movement because of pain is a sign of

Answer 21

septic hip arrthritis

Question 22

a self-limited virus-related synovitis of the hip that presents
similarly to septic arthritis but generally with less acute
symptoms and milder elevations of inflammatory markers.

Answer 22

Toxic synovitis

Question 23

Temperature greater than 101.3
wbc >12k
ESR> 40
inability to bear weight

Answer 23

Kocher criteria. The higher the number of positive findings the more likely the diagnosis of septic hip arthritis vs toxic synovitis

Question 24

may present with fever and limping that worsens slowly over 1 to 3 days.

Answer 24

Osteomyelitis and deep soft-tissue infections of the lower
extremities

Question 25

atraumatic hip pain and limping
Seen in the 3 to 8 years age group, hip symptoms are most
commonly preceded by a viral infection (2 weeks to 1 month
prior), typically of the upper respiratory tract. Clinical findings vary but typically are low-grade fever, limping, and
some limitation of hip motion

Answer 25

toxic synovitis

Question 26

an autoimmune disease diagnosed in children younger than 16 years of age that is characterized by joint pain, swelling without a large effusion, and stiffness that persists
longer than 6 weeks and has no detectable cause.

Answer 26

Juvenile idiopathic arthritis

Question 27

a spectrum of hip conditions ranging from abnormalities of the formation (dysplasia) of the acetabulum and femoral head to hip instability and dislocation.
a child who presents for evaluation of a painless “limp” or “abnormal gait” noticed by the parents
or a leg-length discrepancy

Answer 27

Developmental dysplasia of the hip (DDH)