Ortho

Question 1

what is treatment of hip dysplasia w/ children < 6 mo

Answer 1

pavlik harness - keep hips abducted/flexed

Question 2

metatarsus adductus

Answer 2

int-oeing of the forefoot

unrestricted ankle joint range

Question 3

talipes equinovarus / club foot

Answer 3

medial rotation of the tibia, fixed plantar flexion of the ankle, heel inversion, forefoot adduction

Question 4

legg-clave-perthes disease

Answer 4

avascular necrosis of the femoral head

ischemic bone resorbed & reossified w/in 2-5 yrs

Question 5

slipped capital femoral epiphysis (SCFE)

Answer 5

gradual/acute separation of the proximal femoral growth plate
-femur head slipping off the femoral neck & rotating into an inferior/posterior position

Question 6

risk factors for the slipped capital femoral epiphysis

Answer 6

-happens during puberty + assoc. w/ obesity

Question 7

eval of SCFE

Answer 7

radiographs in frog-leg lateral
look at epiphyseal displacement: physeal plate widening, dec. epiphyseal heigh, Klein line (line along the femoral neck) w/o lateral epiphysis intersection

Question 8

osgood schlatter disease

Answer 8

• swelling, pain, tenderness over the tibial tuberosity
• repetitive stress to the distal insertion of the patellar tendon attachment to the proximal tibia
• 10-15 yrs of age

Question 9

osgood schlatter disease management + natural hx

Answer 9

irregularities of the tubercle ossification center + soft tissue swelling

• mild & resolve w/ activity modification / stretching
• casting 6wks+
• long-term morbidity low

Question 10

treatment of scoliosis

Answer 10

25-30* in growing children: bracing to limit progression for curves
over 45-50: surgical treatment - risk of late progression in adulthood
90-100: significant cardiopulm compromise

Question 11

achondroplasia

Answer 11

AD inheritance\
long bones
incr. susceptibility to pulm complications, abnormally small foramen mgnum –> brainstem compression in homozygotes

Question 12

children’s common fractures

Answer 12

incomplete buckle / greenstick fractures
flexibility / thicker periosteum around the bones
ligament/tendons stronger = more fractures than sprains

Question 13

osteomyelitis evaluation

Answer 13

xrays - periosteal elevation / radiolucent necrotic tissue - 2-3 wks
bone scans positive w/in 24-72 hrs of symptom onset
gadolinium-enhanced MRI-subperiosteal intraosseous abscess/necrotic bone
-elevated CRP, ESR takes a longer amount of time to become elevated

Question 14

treatment of osteomyelitis

Answer 14

broad spectrum a/b (cefazolin, nafcillin, oxacillin for 4-6 wks
neonates - GBS / gram-neg bacilli coverage
sickle cell = 3rd gen cephalosporin for salmonella coverage