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Royal Super 4th Year Brain > Ortho > Flashcards

Ortho Flashcards

1
Q

SCFE - associated conditions + concerning complication

A

Associated conditions: Obesity, hypothyroidism, GH deficiency, panhypopituitary, Down’s syndrome, renal osteodystrophy
Complication: Osteonecrosis

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2
Q

Non-painful limp in a toddler (<4 years old) - only x3

A
  • DDH
  • Congenital limb deficiencies
  • Neuromuscular conditions
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3
Q

Non-painful limp in a child (4-10 years old)

A
  • DDH
  • Congenital limb deficiencies
  • Neuromuscular conditions
  • Leg length discrepancy
  • Discoid meniscus
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4
Q

Non-painful limp in an adolescent

A

Limb length discrepancy

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5
Q

Painful limp in an adolescent

A
  • SCFE
  • JIA
  • Overuse injuries
  • OM
  • SA
  • Tumors
  • Discoid meniscus
  • Osteochondritis dissecans
  • Trauma
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6
Q

Painful limp in a child (4-10 years old)

A
  • SA
  • OM
  • Transient synovitis
  • Discitis
  • JIA
  • Trauma
  • Perthes
  • Overuse injuries
  • Osteochrondritis dissecans
  • Tumors
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7
Q

Painful limp in a toddler (<4 years old)

A
  • Toddler’s fracture
  • OM
  • SA
  • Transient synovitis
  • Reactive arthritis
  • JIA
  • Tumors
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8
Q

What is a Monteggia fracture dislocation?

A

Ulna # + radial dislocation

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9
Q

What do you need to consider when evaluating an elbow concern?

A

CRITOE = ossification centers

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10
Q

Mechanism + treatment for buckle fracture?

A
  • Outstretched hand

- Splint

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11
Q

Mechanism + treatment for greenstick fracture?

A
  • Outstretched hand, lots of force + unstable

- Closed reduction + casting

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12
Q

What is this + treatment for plastic deformation?

A
  • Bending without breaking

- Splint

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13
Q

What bone lesions (x3) do you think about that are central?

A
  • Enchondroma
  • Fibrous dysplasia
  • Simple bone cyst
  • Ewing sarcoma
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14
Q

DDH investigations

A
  • Screening serial physical exams
  • Dynamic ultrasounds
  • XR = AP/frogleg
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15
Q

What bone lesion is a cortical defect?

A

Osteoid osteoma

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16
Q

What bone lesions are metaphyseal in location?

A 
Osteochondroma
OM
Osteosarcoma
Non-ossifying fibroma
Unicameral bone cyst
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17
Q

How to remember SALTER Harris classification of physeal fractures?

A 
S = straight through
A = above
L = lower
T = through
ER = ram
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18
Q

Symptomatic treatment of overuse syndromes?

A
  • NSAIDs
  • Rest + activity modification
  • PT
  • Stretches and training changes
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19
Q

x4 types of scoliosis

A
  • AIS
  • Congenital
  • Infantile
  • Neuromuscular
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20
Q

What x2 important approach questions must you think about for AIS?

A
  1. How older are they?

2. How much growth do they have left?

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21
Q

After menarche, how many more years of growth does an individual have?

A

2 years

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22
Q

Red flags for scoliosis on history + physical?

A
  • History: pain, gait changes, weakness, rapid progression, bowel/bladder symptoms
  • Physical: foot deformity, kyphotic thoracic spine, abnormal reflexes, abnormal pattern, signs of dysraphism
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23
Q

What curve characteristics + physiologic age characteristics put AIS at risk for progression?

A
  • Curve: larger, thoracic, double primary curves

- Physiologic age: based on menarche, Risser grade

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24
Q

Rough understanding of Risser grading?

A
  • Helpful for scoliosis
  • Grading of ossification at iliac crest apophysis
  • 1 = no ossification
  • 5 = complete ossification
25
Low, medium, or high risk curve: Risser 0-1 with presenting curve of <20 deg?
Medium (22% chance of progression)
26
Low, medium, or high risk curve: Risser 0-1 with presenting curve of >20 deg?
High (68% of progression)
27
Low, medium, or high risk curve: Risser 2-4 with presenting curve of <20 deg?
Low (1.6% chance of progression)
28
Low, medium, or high risk curve: Risser 2-4 with presenting curve of >20 deg?
Medium (28% chance of progression)
29
Imaging investigations for scoliosis
- Standing XR of AP + lateral | - MRI - if unusual curve
30
When to refer for AIS (x4)?
- Atypical curve (L side) - Skeletally mature, >45 deg - Skeletally immature, >20 deg or progressive curve - Rapid progression + pain
31
When to rpt XR, refer (Y/N), and tx - if curve 10-19 deg, risser 0-1?
- q6 months - No - Observe
32
When to rpt XR, refer (Y/N), and tx - if curve 10-19 deg, risser 2-4?
- q6 months - No - Observe
33
When to rpt XR, refer (Y/N), and tx - if curve 20-29 deg, risser 0-1?
- q6 months - Yes - Brace if >25 deg
34
When to rpt XR, refer (Y/N), and tx - if curve 20-29 deg, risser 2-4?
- q6 months - Yes - Observation or brace
35
When to rpt XR, refer (Y/N), and tx - if curve 29-40 deg, risser 0-1?
- Yes | - Brace
36
When to rpt XR, refer (Y/N), and tx - if curve 29-40 deg, risser 2-4?
- Yes | - Brace
37
When to rpt XR, refer (Y/N), and tx - if curve >40 deg, risser 0-4?
- Yes | - Surgery
38
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
39
Medical term for clubfoot
Talipes Equinovarus
40
x4 aspects of deformity for clubfeet
CAVE - Cavus - Adductus - Varus - Equinus (limited ROM/inflexible)
41
Treatment for clubfeet
Ponseti method
42
What should you worry about if there is a unilateral congenital foot deformity?
-Spinal pathology
43
What x2 etiologies do you think about for congenital vertical talus (aka rocker bottom feet)?
- Neuro disorders | - Syndromes
44
What is spondylolysis and what is the sport most commonly associated with this?
=stress # of the pars interarticularis | -gymnastics/dance
45
Kocher criteria (+what does it tell you)
- Fever - WBC count >12 - Inability to bear weight - ESR >40 =Makes you think more about septic arthritis
46
What imaging modalities may show early detection of Perthes prior to XR?
- Bone scan | - MRI
47
What is the chance for AVN secondary to SCFE that is unstable?
50%
48
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
49
Where would the pain be on examination palpation for achilles tendonitis?
2cm proximal to the insertion on the calcaneous
50
Suspicious findings on exam for scoliosis
- Back pain - CALM, sacral dimple, midline cutaneous findings - Unilateral foot deformity - Atypical curve pattern
51
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
52
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
53
What is genu varum?
Physiological bowing of the lower extremities in children less than 2 years of age
54
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
55
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
56
Who is more at risk for Blount disease?
- African Americans | - Overweight toddlers
57
What bone tumor is associated with a periosteal reaction?
-Ewing
58
What bone tumor is associated with long + flat bones (e.g., ribs)?
-Eqwing
59
Age range for Perthes
4-9 years old

Royal Super 4th Year Brain (25 decks)

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