Ortho Flashcards
SCFE - associated conditions + concerning complication
Associated conditions: Obesity, hypothyroidism, GH deficiency, panhypopituitary, Down’s syndrome, renal osteodystrophy
Complication: Osteonecrosis
Non-painful limp in a toddler (<4 years old) - only x3
- DDH
- Congenital limb deficiencies
- Neuromuscular conditions
Non-painful limp in a child (4-10 years old)
- DDH
- Congenital limb deficiencies
- Neuromuscular conditions
- Leg length discrepancy
- Discoid meniscus
Non-painful limp in an adolescent
Limb length discrepancy
Painful limp in an adolescent
- SCFE
- JIA
- Overuse injuries
- OM
- SA
- Tumors
- Discoid meniscus
- Osteochondritis dissecans
- Trauma
Painful limp in a child (4-10 years old)
- SA
- OM
- Transient synovitis
- Discitis
- JIA
- Trauma
- Perthes
- Overuse injuries
- Osteochrondritis dissecans
- Tumors
Painful limp in a toddler (<4 years old)
- Toddler’s fracture
- OM
- SA
- Transient synovitis
- Reactive arthritis
- JIA
- Tumors
What is a Monteggia fracture dislocation?
Ulna # + radial dislocation
What do you need to consider when evaluating an elbow concern?
CRITOE = ossification centers
Mechanism + treatment for buckle fracture?
- Outstretched hand
- Splint
Mechanism + treatment for greenstick fracture?
- Outstretched hand, lots of force + unstable
- Closed reduction + casting
What is this + treatment for plastic deformation?
- Bending without breaking
- Splint
What bone lesions (x3) do you think about that are central?
- Enchondroma
- Fibrous dysplasia
- Simple bone cyst
- Ewing sarcoma
DDH investigations
- Screening serial physical exams
- Dynamic ultrasounds
- XR = AP/frogleg
What bone lesion is a cortical defect?
Osteoid osteoma
What bone lesions are metaphyseal in location?
Osteochondroma OM Osteosarcoma Non-ossifying fibroma Unicameral bone cyst
How to remember SALTER Harris classification of physeal fractures?
S = straight through A = above L = lower T = through ER = ram
Symptomatic treatment of overuse syndromes?
- NSAIDs
- Rest + activity modification
- PT
- Stretches and training changes
x4 types of scoliosis
- AIS
- Congenital
- Infantile
- Neuromuscular
What x2 important approach questions must you think about for AIS?
- How older are they?
2. How much growth do they have left?
After menarche, how many more years of growth does an individual have?
2 years
Red flags for scoliosis on history + physical?
- History: pain, gait changes, weakness, rapid progression, bowel/bladder symptoms
- Physical: foot deformity, kyphotic thoracic spine, abnormal reflexes, abnormal pattern, signs of dysraphism
What curve characteristics + physiologic age characteristics put AIS at risk for progression?
- Curve: larger, thoracic, double primary curves
- Physiologic age: based on menarche, Risser grade
Rough understanding of Risser grading?
- Helpful for scoliosis
- Grading of ossification at iliac crest apophysis
- 1 = no ossification
- 5 = complete ossification
Low, medium, or high risk curve: Risser 0-1 with presenting curve of <20 deg?
Medium (22% chance of progression)
Low, medium, or high risk curve: Risser 0-1 with presenting curve of >20 deg?
High (68% of progression)
Low, medium, or high risk curve: Risser 2-4 with presenting curve of <20 deg?
Low (1.6% chance of progression)
Low, medium, or high risk curve: Risser 2-4 with presenting curve of >20 deg?
Medium (28% chance of progression)
Imaging investigations for scoliosis
- Standing XR of AP + lateral
- MRI - if unusual curve
When to refer for AIS (x4)?
- Atypical curve (L side)
- Skeletally mature, >45 deg
- Skeletally immature, >20 deg or progressive curve
- Rapid progression + pain
When to rpt XR, refer (Y/N), and tx - if curve 10-19 deg, risser 0-1?
- q6 months
- No
- Observe
When to rpt XR, refer (Y/N), and tx - if curve 10-19 deg, risser 2-4?
- q6 months
- No
- Observe
When to rpt XR, refer (Y/N), and tx - if curve 20-29 deg, risser 0-1?
- q6 months
- Yes
- Brace if >25 deg
When to rpt XR, refer (Y/N), and tx - if curve 20-29 deg, risser 2-4?
- q6 months
- Yes
- Observation or brace
When to rpt XR, refer (Y/N), and tx - if curve 29-40 deg, risser 0-1?
- Yes
- Brace
When to rpt XR, refer (Y/N), and tx - if curve 29-40 deg, risser 2-4?
- Yes
- Brace
When to rpt XR, refer (Y/N), and tx - if curve >40 deg, risser 0-4?
- Yes
- Surgery
What are the thresholds for spinal curvature with (a) dx of scoliosis, (b) brace, and (c) surgery?
(a) 10 deg
(b) 25 deg
(c) 40-45 deg
Medical term for clubfoot
Talipes Equinovarus
x4 aspects of deformity for clubfeet
CAVE
- Cavus
- Adductus
- Varus
- Equinus (limited ROM/inflexible)
Treatment for clubfeet
Ponseti method
What should you worry about if there is a unilateral congenital foot deformity?
-Spinal pathology
What x2 etiologies do you think about for congenital vertical talus (aka rocker bottom feet)?
- Neuro disorders
- Syndromes
What is spondylolysis and what is the sport most commonly associated with this?
=stress # of the pars interarticularis
-gymnastics/dance
Kocher criteria (+what does it tell you)
- Fever
- WBC count >12
- Inability to bear weight
- ESR >40
=Makes you think more about septic arthritis
What imaging modalities may show early detection of Perthes prior to XR?
- Bone scan
- MRI
What is the chance for AVN secondary to SCFE that is unstable?
50%
What is calcaneal apophysitis, how to dx, what sports are more commonly associated, and tx?
- Equivalent to osgood-schlatter
- One of the most common causes of heel pain
- From jumping sports that may have an abnormal heel strike (dance, gymnastics, soccer)
- Heel pain with squeeze test
- Tx = bilateral heel cup, rest, NSAIDs, ice
Where would the pain be on examination palpation for achilles tendonitis?
2cm proximal to the insertion on the calcaneous
Suspicious findings on exam for scoliosis
- Back pain
- CALM, sacral dimple, midline cutaneous findings
- Unilateral foot deformity
- Atypical curve pattern
What features would make you do an XR in an ankle injury?
- Not able to bear weight BOTH at site + in ED
- Pain to posterior aspect of malleoli
What features would make you do an XR in a foot injury?
- Not able to bear weight BOTH at site + in ED
- Tender at navicular bone
- Tender at base of 5th metatarsal
What is genu varum?
Physiological bowing of the lower extremities in children less than 2 years of age
Causes of pathologic bowing?
- Neuromuscular disorders
- Metabolic bone disease: vit D deficiency, rickets, hypoPO4
- Asymmetric growth arrest: Blount disease, trauma, infection, tumor
- Bone dysplasia: dwarfism, metaphyseal dysplasia, achondroplasia
What is Blount disease (plus other name) + how to diagnosis?
=Tibia verum
- developmental deformity resulting from abnormal endochondral ossification of the medial aspect of the proximal tibial physes –> varus angulation + medial rotation of the tibia
- clinical + standing AP XR for M-D angle
Who is more at risk for Blount disease?
- African Americans
- Overweight toddlers
What bone tumor is associated with a periosteal reaction?
-Ewing
What bone tumor is associated with long + flat bones (e.g., ribs)?
-Eqwing
Age range for Perthes
4-9 years old
