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Orthobullets > OITE - Pediatrics > Flashcards

OITE - Pediatrics Flashcards

1
Q

Distal humeral physeal separation, suspicious for what?

A

-Child abuse

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2
Q

Xray finding of distal humeral physeal seperation

A
  • Radius ulna maintain normal relationship
  • radius still lines up with capitellum
  • but distal humerus metaphysis is disconnected from rad+ulna
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3
Q

Define sequestrum

A

Nidus of residual necrotic infected bone

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4
Q

Osteomyelitis organisms, most common?

A
  • Staph aureus (most common)
  • Kingella kingae (culture it longer in CO2 rich medium)
  • GBS in neonates
  • Salmonella (g-ve), in sickle cell, -H influenza (if not vx)
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5
Q

Involucrum?

A

New bone formed by elevated periosteum (in an effort to wall off infection)

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6
Q

How long do xrays remain normal, in context of osteomyelitis

A

Upto first 2 weeks (7-10 days)

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7
Q

What are the 2 lab markers for osteo?

A
  • CRP peaks and normalizes earlier (track short term response)
  • ESR requires 3 weeks to normalize (track long term abx tx)
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8
Q

Clubfoot aka ?

A

Congenital talipes equinovarus

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9
Q

Clubfoot position?

A

Hindfoot - equinovarus
Forefoot - supination, adductus
Midfoot - cavus
CAVE (cavus, adductus, varus, equinus) - order of ponsetti correction

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10
Q

When is achilles tenotomy done in ponseti method?

A

At 6-8 weeks

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11
Q

How long are Denis-Brown bars used for ?

A

2-4 yrs

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12
Q

When is tib ant transfer needed? Prevalence?

A
  • Residual recurrent forefoot supination after 2 years
  • 10 to 30%
  • must have a flexible deformity, and competent tib ant
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13
Q

Late deformities associated with clubfoot surgery?

A

Undercorrection/recurrence - medial spin, intoeing
Overcorrection - flatfoot, hindfoot valgus, calcaneus gait (weak gastroc/soleus)
AVN - (talus), -Dorsal bunion (injury to peroneus longus)

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14
Q

What are length unstable femur fx (in school age children)?

A
  • Comminution

- Large oblique fx pattern

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15
Q

How to tx length unstable femur fx.

A
  • ORIF
  • Submuscular bridge plating
  • Ex fix
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16
Q

What fx pattern is most commonly associated with a pediatric elbow dislocation?

A
  • Medial epicondylar fx (rate of 50%)
  • Due to avulsion of flex-pronator wad
  • ulnar nerve may be entrapped (within joint, after reduction)
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17
Q

What radiographic view will demonstrate max degree of fx displacement, if suspecting lateral condyle fx?

A
  • Internal rotation oblique view

- MRI arthrogram can be useful

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18
Q

What does non-union of lat condyle fx result in?

A

Cubitus valgus –> and ulnar neuropathy

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19
Q

Where should you avoid dissection in ORIF of lat condyle fx

A

Posterolateral dissection should be avoided (can compromise blood supply)

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20
Q

Infantile Blount’s Disease?

A
  • Progressing worsening genu varum
  • Metaphyseal diaphyseal angle > 13 deg
  • Onset prior to 3
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21
Q

Surgical tx for infantile blounts?

A
  • Langenskiold stage 3 or more
  • Failure of bracing
  • Best result if prox tib fib osteotomy done before age of 4
  • Plan for prophylactic fasciotomy
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22
Q

Distal femoral physeal injury is more common than ligamentous knee injury in peds, due to what?

A

Epiphyseal ligament insertions

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23
Q

Rate of physeal arrest in Distal femoral physeal injury?

A

30-50%

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24
Q

How to treat physeal arrest in dist fem physeal fx?

A
  • Partial arrest - bar resection if 2cm growth remaining. (PMMA interposition to occupy space left)
  • If >50% involvement, perform ipsilatearl completion of arrest
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25
Q

How do you ascertain degree of interosseous mold of a cast, in context of DR fx?

A

Look at Cast Index = (sag width / coronal width)

Want CI

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26
Q

Name 7 characteristic UE deformities in cerebral palsy

A
  • Shoulder IR, Elbow flexion, Forearm pronation
  • Wrist flexion, wrist ulnar deviation
  • Thumb in palm
  • Finger swan neck
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27
Q

Name 2 reasons to tx UE CP contracture

A

1-hygeine (antecubital fossa, wrist + hand)

2- improve function

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28
Q

When would you consider PSF for scoliosis of Duchenne Muscular Dystrophy

A

PSF for curves progressing > 25 to 30

Operate early, as it is better tolerated

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29
Q

Hallmarks of DMD ?

A
  • Decreased motor skills
  • Gower’s sign (proximal muscle weakness, from sit to stand)
  • Calf pseudohypertrophy
  • Markedly Elevated CPK
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30
Q

Distal humeral physeal seperation

A
  • Posteromedial displacement of rad/ulna shafts to distal humerus
  • difficult to diagnose (arthrogram), -children
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31
Q

Flexible flatfoot (pes planovalgus)?

A
  • Low medial arch, valgus heel, and forefoot abduction

- NORMAL subtalar motion, no heel cord contracture

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32
Q

Surgical tx for flexible pes planovalgus?

A
  • Calcaneal neck lengthening osteotomy (most common)
  • Lengthen achilles tendon
  • possible Medial cuneiform osteotomy
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33
Q

Acceptable angulation and rotation in BBFA?

A

10 angulation 10, rotation 30 (shaft)

Dorsal angulation 30 deg (10 yo)

34
Q

Legg-Calve-Perthes Disease (coxa plana)?

A

Boys 4:1
Lateral pillar classification has significant prognostic value
-early fragmentation phase (best time)
-approx 6 months onset of symptoms

35
Q

What is the lateral pillar classification for Legg-Calv-Perthes?

A

A - none
B - 50% loss of height
C - >50% loss of height

36
Q

Sprengel’s deformity?

A
  • Failure of scapular descent (high small scapula)
  • Assoc with Klippel feil
  • Diminished ABDUCTION is most affected function
37
Q

Posteromedial tibial bowing can be associated with what other manifestation?

A
  • assoc with calcaneovalgus foot
  • often resolves spontaneously
  • 2-5cm LLD at maturity
38
Q

Lysosomal storage diseases, all have an increased risk for what?

A

Carpal tunnel syndrome

39
Q

Vertical talus other names ?

A

Talipes equinovalgus
Congenital convex pes valgus
-p/w rocker bottom feet

40
Q

Xray findings on lateral plantar flexion view, for vertical talus?

A
  • Talus not in line with metatarsals

- Navicular dorsally dislocated

41
Q

What is the genetic cause of dwarfism characterized by hitch-hikers thumb, cauliflower ears, and severe clubfeet?

A 
Diastrophic dysplasia (ARecessive, twisted dwarf)
-Sulfate transport protein
42
Q

Marfan’s is an AD disorder with defective gene encoding?

A

Fibrillin

43
Q

Most common cause of peroneal spastic flatfoot?

A
  • Calcaneonavicular coalition

- commonly presents as recurrent ankle sprains

44
Q

Tarsal coalition surgical tx?

A

50% joint involvement – Arthrodesis

45
Q

Initial tx of spastic flat foot?

A

Casting

46
Q

In Monteggia fx, want to close reduce and immobilize how?

A
  • Hyperflexion (110 deg) and supination

- relaxes biceps and TIGHTENS IOM

47
Q

When would you order an endocrine workup for SCFE

A

If child less than 10 years old

Pin bilateral if there is endocrine etiology

48
Q

SCFE has a fx through what zone?

A

Hypertrophic zone

49
Q

What position is the neck displaced in SCFE?

A

Neck displaced anteriorly

Neck externally rotated

50
Q

What measure is used to determine radiographic severity of the epiphyseal slip, in order to guide treatment?

A

Southwick Severity Angle (epiphyseal-shaft angle difference)

Mild 50

51
Q

Which 2 lines are used to divide hip into 4 quadrants, in DDH?

A

Hilgenreiner and Perkins

head is above H, and lateral to P

52
Q

When does proximal femur ossific nucleus appear on xray?

A

6 months of age

53
Q

Neurofibromatosis is associated with all of the following what?

A

Cafe au lait spots (smooth borders)
Hemihypertrophy
Scoliosis
Pseudoarthrosis (anterolateral bowing)

54
Q

What lesion is hallmark and pathognmemonic for neurofibromatosis?

A

Plexiform neurofibromas

55
Q

What is the most common skeletal dysplasia?

A

Achondroplasia

FGFR-3

56
Q

Features of Dwarfism?

A

Rhizomelic limb shortening
Frontal bossing
Spinal stenosis
Champagne pelvis

57
Q

Osteogenesis imperfecta associated with residue substitution?

A

Glycine substitution in procollagen molecule

58
Q

Charcot Marie Tooth Disease, aka?

A

Peroneal muscular atrophy

59
Q

Charcot Marie Tooth Disease, is AD. What are its features?

A

Cavus feet
Hammer toes
Motor deficits (tib ant, peron brevis, intrinsics foot and hand)

60
Q

Myelodysplasia (myelomeningocele, spina bifida). What is the most common level involved? Results most often in what dislocation?

A

L3/L4
Hip dislocations (tx if L4 or L5 level)
–L3 levels and higher have poor results with recon maneuvers

61
Q

Osteopetrosis?

A
  • AR
  • Failure of osteoclast to remodel (carbonic anhydrase dysfuncn)
  • High mortality rate (tx with bone marrow transplant)
62
Q

Arithmetic method about LE growth?

A

Prox femur 3mm / yr
Distal femux 10mm / yr
Prox tibia 6mm / yr
Distal tibia 5mm / yr

63
Q

According to arithmetic method, when is growth cessation in boys and girls?

A

Boys 16 yo

Girls 14 yo

64
Q

Accessory navicular first line tx?

A
  • Non op

- Excision after 6 mo of non-op attempts

65
Q

In tibial tubercle fx, injury to what artery most likely causes compartment syndrome?

A

Anterior tibial recurrent artery

66
Q

What is cavocarus foot?

A
  • Elevation of medial arch from relative forefoot equinus

- Spasticity of contracted plantar fascia + weak Tib Ant

67
Q

In in toe-ing, what are the 4 measurements for rotational profile?

A
  • FPA (foot progression angle)
  • Hip rotation (for femoral anteversion)
  • Thigh foot angle and transmalleolar axis (tibial torsion
  • Heel bisector (measure for metatarsus adductus)
68
Q

Another name for Toddler’s fracture of the tibia?

A

CAST - childhood accidental spiral tibial fx

69
Q

Best predictors of septic hip, in order, are what?

A
  • Fever > 101.3
  • CRP >2.0 -ESR > 40
  • Inability to bear weight
  • WBC > 12,000
70
Q

Which joints have an intra-articular metaphysis (and are therefore more at risk for osteomyelitis)?

A

hip, shoulder, elbow, ankle

71
Q

Most common cause of septic arthritis in adolesecents?

A

N. gonorrhea

72
Q

Prognosis for spont recovery for involved arm after obstetrical brachial plexopathy? After Horner’s?

A

90% will resolve

Horner’s

73
Q

Erb’s palsy?

A

C5-6

74
Q

Klumpkes palsy?

A

C8-T1

75
Q

When is early surgery in obstetric brachial plexopathy indicated?

A

Early sgx - complete flail arm or Horners

Later sgx - Tendon transfer or osteotomy

76
Q

How do you treat radial neck fx.

A

less than 30 deg angulation - immobilize
>30 deg angulation - Closed reduction
>30-60 – open reduction

77
Q

Bone growth in humerus ratio?

A

80/20 prox/distal

78
Q

Order of appearance of elbow growth centres?

A

CRITOE

1 -3 - 5 - 7 - 9 -11

79
Q

Order of closure of elbow growth centres?

A

CTE -R-O-I

12,12,12 - 15-15-17

80
Q

Ortho manifestation of sickle cell disease?

A
  • Osteomyelitis, septic arthritis
  • Dactylitis (acute hand and foot swelling)
  • Osteonecrosis, bone infracts
  • Growth retardation
81
Q

What injuries and fx pattern are suspicious for child abuse?

A
  • Corner fx
  • Fx in non-walker (long bone)
  • multiple fx in various stages of healing
  • bruises of different ages

Orthobullets (6 decks)

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