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FALL15 N833 Adv Pedi Probs > Ortho > Flashcards

Ortho Flashcards

1
Q

What to suspect if kids fracture in odd places?

A

osteosarcoma

(or abuse)

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2
Q

What to worry about if injury at fingertip, e.g., slammed in car door?

A

Tuft fracture, risk of osteomyelitis

Get Xray

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3
Q

Imaging for finger dislocation?

A

yes! X-ray to r/o fracture

generally have a low threshold for x-rays/suspicion of fracture in kids

(will need digital block to reset dislocated finger)

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4
Q

How are children different, in terms of ortho?

A
  • anatomy & physiology
    • more bones
    • physeal and metaphyseal regions
    • bones are often weaker than ligaments
      • Fracture before sprain
        • Always X-ray!
    • born mostly cartilage - “x-ray of foot is mostly nothing”
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5
Q

Parts of the growing bone

A
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6
Q

Adult vs kid’s elbow

A

Adult: 3 bones

Child: 3 bones w/more pieces. Ossification centers can be mistaken for fractures. 11-12yo elbow pictured

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7
Q

Which regions of bone tend to break more in kids?

A

metaphyseal (darker on imaging, less dense)

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8
Q

What are the Salter Harris fracture types?

A
  1. Through growth plate: most common, best prognosis.
    • can be displaced or non-displaced. Nondisplaced looks nl radiographically
    • Usually return in 1 week to see if growth reaction - definitevely fracture
  2. metaphysis and physis
  3. Epiphysis and physis
  4. All
  5. obliterates the growth plate: least common, worst prognosisM

MNEMONIC in relation to physis (growth plate): Separation, Above, Lower, Through, Reduction

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9
Q

What is FOOSH?

A

Fall On Outstretched Hand

axial and lateral force

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10
Q

What should you think if tenderness over growth plate?

A

Even w/o radiographic evidence of fracture, consider Salter Harris type I or V

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11
Q

What should you consider if joint effusion associated w/trauma?

A

occult fracture

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12
Q

Mechanism for cervical spine fractures?

A

Fall, diving accident, MVA

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13
Q

Signs of a cervical spine fracture?

A

tenderness, any neuro deficits

risk factors - see “mechanism”

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14
Q
A
  • CT
  • can see C2 b/c of dens (“funky piece sticking up”)
  • C1 is fractures - this was d/t axial loading to top of head, fell down stairs
  • Risk: SCI d/t bleeding - no invasion in this pic; risk for vertebral artery dissection (circle at left)
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15
Q
A

15yow

Can see C1 (a ring) - Dens process of C2 sticking up past C1 = fracture through dens.

She became left hemiplegic d/t vertebral artery dissection

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16
Q

Mechanism for compression fracture of thoracolumbar spine

A

MVA, sports injury

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17
Q

Signs of compression fracture of thoracolumbar spine

A

point tenderness, loss of function

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18
Q
A

L4 vertebra is “squished”

This child was properly restrained in back seat, but tucked shoulder belt behind him, hit head forward

Will not be paralyzed - spinal cord ends around L1, thus will have chronic back pain but no neuro sx

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19
Q

Most commonly fractured bone?

A

clavicle!

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20
Q

Common injuries to shoulder/clavicle?

A

anterior dislocation

clavicular fracture

*it takes a lot of force to dislocate shoulder - this force would likely fracture before growth plates close)

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21
Q
A

Shoulder dislocation

No growth plates! 18yo.

If you see GPs - think fracture first.

22
Q

Nursemaid’s elbow: what happens?

A
  • Lecture:
    • Bicep tendon gets caught between radial head and distal humerus (capitellum). Should feel tendon pop out when reduce. Must have hand on top of humerus to feel tendon.
    • Not a dislocation - bill as one and you get paid more ;)
  • UpToDate:
    • portion of the annular ligament slips over the head of the radius and slides into the radiohumeral joint, where it becomes trapped.
    • By the age of five years, the annular ligament has become thick and strong and is unlikely to tear or be displaced.
23
Q

Common injuries to arm/elbow

A

nursemaid’s elbow

supracondylar fracture (need assessment of neurovascular status!)

24
Q
A

Supracondylar fracture of humerus!

Urgent - straight to ED!

Blood supply through arm is brachial, runs along humerus. Nerves run alongside - will have white arm d/t artery severed/compressed

25
Q
A
  • Humerus, radius, ulna
  • No obvious fracture. Can move arms.
  • BUT = can see posterior fat pad and anterior sail sign
  • Posterior fat pad: fat pushed away (usually have a swollen elbow) Can also use U/S
26
Q

Scaphoid fracture

A
  • tiny fracture – important d/t blood supply to bone
  • if not pinned, may get avascular necrosis. You will lose significant mobility.
  • PE: tenderness over snuffbox.
  • Even if xray neg, splint and send to ortho.
  • Mechanisms usually FOOSH.
  • Usually happens in older adolescents, not young kids.
27
Q

How common are forearm and wrist injuries?

A

Very common!

28
Q

Importance of bowing deformities in forearm/wrist injuries

A

can lead to significant loss of pronation and supination!

U & R need to cross

Cast them and they heal quickly

29
Q

Ulnar fractures are usually associated with…

(+example)

A

radial fractures or dislocations - almost never on own

Montaggia’s fracture – ulna broken and radial head dislocates

30
Q

Common hip problems

A

Developmental dysplasia of the hip

SCFE

AVN (Legg-Calve-Perthes disease)

31
Q

How common are knee injuries in kids?

A

Uncommon!

but fractures + improper healing can cause significant length discrepancies

Evaluate for joint stability!

32
Q

Ankles in kids: sprains vs fracture?

Imaging?

A

Sprains uncommon

multiple different fractures

need 3 views to adequately visualize joint

33
Q

What does knee pain usually indicate?

A

Referred pain from hips

34
Q
A
  • Buckle fracture at distal radius
    • Splint x 2 weeks (or nothing if resource limited). Will heal on its own.
    • optional cast
  • Buckle fracture more common in kids
    • compression fracture on one side of a bone that causes the bone to bend or buckle toward the damaged side
35
Q
A
  • Fooshed – tender over distal radius. Epiphysis of radius is dorsally displaced
  • = displaced salter I – must push on so will line up again. Don’t miss!

normal pictured to contrast - epiphysis squarely on top

36
Q
A
  • Greenstick fracture. Not seen in adults often. One part broken the other not.
  • Must straighten – but also must complete fracture or will only grow back in broken part.
  • (broken part of arm grows longer than nonbroken – one way to add height is to break bones)
37
Q

DDx for nursemaid’s elbow?

A

Clavicle fracture! They hold themselves in the same way!

SO - alway examine clavicle and humerus before trying to reduce

38
Q

12 y/o obese boy w/complaint of BL knee pain, progressively worsening, no hx trauma

You are thinking…

A

Slipped capital femoral epiphysis (SCFE)

  • classic presentation is that of an obese adolescent with a complaint of nonradiating, dull, aching pain in the hip, groin, thigh, or knee and no history of preceding trauma
  • May present before radiographic evidence but proceed to obvious slipping later
39
Q

What is SCFE?

A
  • a chronic salter I fracture
  • Misnomer: actually the proximal femur that is displaced (UpToDate)
40
Q

SCFE: tx

A
  • Fix by putting pin through, opposite side as well since 50% of time is BL!
  • Most serious complication: avascular necrosis (rare and more likely 2/2 pinning) (UpToDate)
41
Q

12 yo gymnastic student w/BL knee pain, beginning of season, no hx acute injuries

Pain at tibial area

A

Osgood Schlatter!

Rx: NSAIDs and rest

(UpToDate: continue activity as tolerate, risk of deconditioning and further injury if stop. Strengthen quads and hamstrings.)

42
Q

Important considerations when ordering radiographs/imaging for kids

A

1 - kids fracture then sprain, so don’t be stingy

2 - comparison views are helpful! Kids tend to be symmetric

43
Q

Treatment for fractured clavicle?

A

Tx: put in a sling and they find each other

44
Q

What is the ACL?

A

one of four major ligaments that stabilize the knee joint during activity

45
Q

When does ACL tear risk increase

A

during adolescent growth spurts, starting at age 12 in girls and age 14 in boys.

46
Q

Recommended approach to ACL tear in teens?

A

Recommended: Early surgery!

But some acute acl tears don’t require surgery: quadriceps and hamstring exercises can helps and also reduce the risks of meniscus tears and osteoarthritis.

47
Q

Risks to ACL surgery

A

surgical techniques may involve drilling into the growth plate, which introduces a risk of complications such as premature closure and limb-length discrepancy.

newer surgeries spare the growth plate

48
Q

Future risks associated w/ACL tear?

A

Up to 10 times more likely to develop degenerative knee osteoarthritis within 10 to 20 years.

Quadriceps and hamstring exercises can help reduce this risk

49
Q

How to reduce risk of acl tear

A

plyometric exercises, like repetitive jumping, to build stronger muscles and stretching and balance training.

50
Q

Why do children often buckle instead of fracturing transversely?

A

bones are soft

51
Q

What is a galeazzi fracture?

A

fracture of the radius with dislocation of the distal radioulnar joint

FALL15 N833 Adv Pedi Probs (10 decks)

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