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Royal Super 4th Year Brain > Ortho > Flashcards

Ortho Flashcards

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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
Q

Low, medium, or high risk curve: Risser 0-1 with presenting curve of <20 deg?

A

Medium (22% chance of progression)

26
Q

Low, medium, or high risk curve: Risser 0-1 with presenting curve of >20 deg?

A

High (68% of progression)

27
Q

Low, medium, or high risk curve: Risser 2-4 with presenting curve of <20 deg?

A

Low (1.6% chance of progression)

28
Q

Low, medium, or high risk curve: Risser 2-4 with presenting curve of >20 deg?

A

Medium (28% chance of progression)

29
Q

Imaging investigations for scoliosis

A
  • Standing XR of AP + lateral

- MRI - if unusual curve

30
Q

When to refer for AIS (x4)?

A
  • Atypical curve (L side)
  • Skeletally mature, >45 deg
  • Skeletally immature, >20 deg or progressive curve
  • Rapid progression + pain
31
Q

When to rpt XR, refer (Y/N), and tx - if curve 10-19 deg, risser 0-1?

A
  • q6 months
  • No
  • Observe
32
Q

When to rpt XR, refer (Y/N), and tx - if curve 10-19 deg, risser 2-4?

A
  • q6 months
  • No
  • Observe
33
Q

When to rpt XR, refer (Y/N), and tx - if curve 20-29 deg, risser 0-1?

A
  • q6 months
  • Yes
  • Brace if >25 deg
34
Q

When to rpt XR, refer (Y/N), and tx - if curve 20-29 deg, risser 2-4?

A
  • q6 months
  • Yes
  • Observation or brace
35
Q

When to rpt XR, refer (Y/N), and tx - if curve 29-40 deg, risser 0-1?

A
  • Yes

- Brace

36
Q

When to rpt XR, refer (Y/N), and tx - if curve 29-40 deg, risser 2-4?

A
  • Yes

- Brace

37
Q

When to rpt XR, refer (Y/N), and tx - if curve >40 deg, risser 0-4?

A
  • Yes

- Surgery

38
Q

What are the thresholds for spinal curvature with (a) dx of scoliosis, (b) brace, and (c) surgery?

A

(a) 10 deg
(b) 25 deg
(c) 40-45 deg

39
Q

Medical term for clubfoot

A

Talipes Equinovarus

40
Q

x4 aspects of deformity for clubfeet

A

CAVE

  • Cavus
  • Adductus
  • Varus
  • Equinus (limited ROM/inflexible)
41
Q

Treatment for clubfeet

A

Ponseti method

42
Q

What should you worry about if there is a unilateral congenital foot deformity?

A

-Spinal pathology

43
Q

What x2 etiologies do you think about for congenital vertical talus (aka rocker bottom feet)?

A
  • Neuro disorders

- Syndromes

44
Q

What is spondylolysis and what is the sport most commonly associated with this?

A

=stress # of the pars interarticularis

-gymnastics/dance

45
Q

Kocher criteria (+what does it tell you)

A
  • Fever
  • WBC count >12
  • Inability to bear weight
  • ESR >40

=Makes you think more about septic arthritis

46
Q

What imaging modalities may show early detection of Perthes prior to XR?

A
  • Bone scan

- MRI

47
Q

What is the chance for AVN secondary to SCFE that is unstable?

A

50%

48
Q

What is calcaneal apophysitis, how to dx, what sports are more commonly associated, and tx?

A
  • 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
Q

Where would the pain be on examination palpation for achilles tendonitis?

A

2cm proximal to the insertion on the calcaneous

50
Q

Suspicious findings on exam for scoliosis

A
  • Back pain
  • CALM, sacral dimple, midline cutaneous findings
  • Unilateral foot deformity
  • Atypical curve pattern
51
Q

What features would make you do an XR in an ankle injury?

A
  • Not able to bear weight BOTH at site + in ED

- Pain to posterior aspect of malleoli

52
Q

What features would make you do an XR in a foot injury?

A
  • Not able to bear weight BOTH at site + in ED
  • Tender at navicular bone
  • Tender at base of 5th metatarsal
53
Q

What is genu varum?

A

Physiological bowing of the lower extremities in children less than 2 years of age

54
Q

Causes of pathologic bowing?

A
  • 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
Q

What is Blount disease (plus other name) + how to diagnosis?

A

=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
Q

Who is more at risk for Blount disease?

A
  • African Americans

- Overweight toddlers

57
Q

What bone tumor is associated with a periosteal reaction?

A

-Ewing

58
Q

What bone tumor is associated with long + flat bones (e.g., ribs)?

A

-Eqwing

59
Q

Age range for Perthes

A

4-9 years old

Royal Super 4th Year Brain (25 decks)

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