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PEDS II, exam 2 > ortho > Flashcards

ortho Flashcards

1
Q

which salter harris classification is this: transverse physeal fx with widening

A

salter harris I

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2
Q

which salter harris classification is this: fx through metaphysis and physis

A

salter harris II

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3
Q

which salter harris fx is the most common

A

II

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4
Q

which salter harris classification is this: fx through physis and epiphysis

A

salter harris III

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5
Q

which salter harris classification is this: fx through metaphysis, physis and epiphysis

A

salter harris IV

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6
Q

which salter harris classification is this: physeal compression or crush fx

A

salter harris V

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7
Q

what mneumonic can you use to remember salter harris classification

A

SALTR: make sure ephysis is on bottom when using this mneumonic

  • Seperate
  • Above
  • Lower
  • Through
  • Reduced
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8
Q

what is this

A

fat pad sign: blood released; very common in peds injury

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9
Q

what is the most common pediatric elbow fx

A

supracondylar fx

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10
Q

with a supracondylar fx, what diagnostics will you get

A
  • xray
    • AP
    • true lateral
    • oblique
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11
Q

When evaluating an xray for a suprecondylar fx, what are you looking for

A

look to see if anterior humeral line intersects with the capitellum

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12
Q

management for Type I and II suprecondylar fx

A
  • posterior splint with light overwrap (no ACE bandage
  • sling, ibuprofen
  • refer to ortho
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13
Q

management for Type III suprecondylar fx

A

emergent ortho consult

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14
Q

clinical presentation

  • STS concentrated to lateral aspect of elbow
  • TTP over lateral condyle
A

lateral condylar fx of distal humerus

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15
Q

diagnostics for evaulating potential lateral condylar fx of distal humerus

A
  • xray
    • AP
    • lateral
    • internal oblique
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16
Q

managment of lateral condylar fx of distal humerus

A
  • emergent referral if displacement >2mm
  • splint, sling, NSAIDs
  • ortho: casting vs surgery
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17
Q

complication of lateral condylar fx of distal humerus

A
  • fish tail deformity
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18
Q

what are common causes of medial epicondylar fx of distal humerus

A
  • muscle attachment avulsion
    • throwing athletes
  • elbow dislocation
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19
Q

diagnostics when evaluating for medial epicondylar fx of distal humerus

A
  • xray
    • AP
    • lateral
    • external oblique
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20
Q

what do you need to rule out in xray of medial epicondylar fx of distal humerus

A

incarceration of fragment in joint

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21
Q

managment of medial epicondylar fx of distal humerus

A
  • refer to ortho
  • splint including wrist
  • NSAIDs
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22
Q

complications of medial epicondylar fx of distal humerus

A
  • ulnar nerve palsy
  • angular deformity
  • decrease ROM
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23
Q

common causes of radial neck fracture

A
  • FOOSH with valgus stress
  • elbow dislocations
    • during dislocation or relocation
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24
Q

clinical presentation

  • TTP over radial head/neck
  • pain with supination/pronation > flextion/extension
  • young children may complain of wrist pain
A

radial neck fracture

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25
Q

diagnostics to evaluate radial neck fracture

A
  • xray
    • AP
    • lateral
    • external oblique
  • clinical if radial head not ossified
    • ossification begins at age 5
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26
Q

managment of radial neck fracture

A
  • immobilize including wrist
  • sling
  • NSAID
  • refer to ortho
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27
Q

common cause of nursemaid’s elbow

A

sudden pull on pronated arm

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28
Q

what is nursemaid’s elbow

A

dislocation of radial head, typically 1-4 yo

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29
Q

clinical presentation

  • arm either fully extended or slightly flexed and pronated
  • overall refusal to use arm
  • mild pain over radial head (global pain to elbow)
  • pain increases with attempts to supinate
A

nursemaid’s elbow

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30
Q

managment of nursemaid’s elbow

A
  • reduction
    1. supination, flexion with pressure over radial head
    2. hyperpronation with pressure over radial head
  • lollipop test
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31
Q

What is a Monteggia fracture

A
  • ulnar (or radial and ulnar) shaft fx with dislocation of radial head
    • isolated ulnar shaft fx must be evaluated for this
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32
Q

most common wrist fx

A
  • distal radius
  • metatphysis
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33
Q

managment of wrist fx

A
  • splint case
  • +/- reduction vs surgery
  • emergent with significant clinical deformity or neurovascular compromise
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34
Q

clinical presentation

  • tender to palpation over anatomic snuffbox
A

scaphoid fx

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35
Q

what are the lateral and medial border of anatomic snuffbox

A
  • lateral
    • extensor pollicis brevis
    • abductor pollicis longus
  • medial
    • extensor pollicis longus
36
Q

diagnostics to evaluate scaphoid fx

A
  • AP
  • lateral
  • scaphoid view
  • *may be negative
    • repeat imaging 10-14 days later for diagnosis
37
Q

managment of scaphoid fx

A
  • thumb spica splint/cast
38
Q

complication of scaphoid fx

A

avascular necrosis

39
Q

if patient < 1 yo presents with femur fx, must r/o

A

child abuse

40
Q

complications of femur fx

A
  • shortening
  • lengthening
  • angulation
41
Q

what is the most common patellar fx in kids < 13 yo

A

patellar sleeve fx

  • caused by forced extension with knee in flexion
    • jumping, kicking
42
Q

management of patellar sleeve fx

A
  • refer to ortho
  • knee immobilizer, NWB, elevate
  • NSAIDs
43
Q

what is a toddlers fracture

A
  • fx of tibial shaft
  • common cause: young child falling while running, often with twisting mechanism
44
Q

diagnostics to evaluate toddlers fracture

A
  • AP
  • lateral
  • obliques
  • often not seen on initial films
45
Q

management of toddlers fracture

A
  • immobilize (splint, wee walker)
  • refer to ortho
  • NWB, NSAIDs
46
Q

diagnostics to evaluate ankle fx

A
  • AP
  • mortise
  • lateral
  • internal and external obliques
47
Q

what must you r/o when evaluating ankle fx

A
  • physeal widening (SH 1 fx)
    • clinical diagnosis: very tender over distal tib or fib physis
48
Q

management of ankle fx

A
  • posterior splint
    • avoid ACE
  • elevation
  • NWB
  • NSAIDs
49
Q

What is a Triplane ankle fx

A
  • MOI: external rotation
  • SH III on AP view; SH II on lateral view
  • must get CT to assess displacement
  • may require surgical fixation vs closed reduction
50
Q

What is a Jones, Psuedo-Jones/Avulsion fx

A
  • fracture to the base of the 5th metatarsal
  • due to pull of peroneus brevis at its insertion as wall as plantar aponeurosis
51
Q

what is unilateral contraction of the sternocleidomastoid muscle with visible shortening called

A

torticollis

52
Q

etiology of torticollis

A

compartment syndrome secondary to venous outflow obstruction

53
Q

treatment of torticollis

A
  • stretching/PT
54
Q

define scoliosis

A

lateral curve of spine > 10 degrees

55
Q

adolescent scoliosis is defined as

A

age > 10 yo

56
Q

what test is used to evaluate for scoliosis

A

adams forward flexion exam

57
Q

what imaging is done to evaluate for scoliosis

A
  • Cobb angle
  • AP/PA standing plain radiograph on long cassette
58
Q

treatment for scoliosis

A
  • TLSO brace
    • 25 degrees
  • surgery
    • 45 degress
    • internal rod fixation
59
Q

what child presents with thier leg in a flexed and abducted position and refusal to bear weight, what must you rule out?

A

septic hip vs transient synovitis

60
Q

How can you differentiate between septic hip and transient synovitis

A

Kocher criteria

  • WBC > 12,000
  • ESR >40
  • Fever > 101.3
  • non weight bearing on affected side

2/4 criteria warrants joint aspiration

61
Q

What is Legg-Calve-Perthes disease

A
  • idiopathic avascular necrosis of the femoral head
62
Q

Legg-Calve-Perthes disease is most common in what patient population

A
  • boys aged 4-8
  • typically thin and extremely active
63
Q

clinical presentation

  • young boy (4-8)
  • limping at end of day
  • occasional pain (knee or hip)
  • limited internal rotation or abduction of hip
A

Legg-Calve-Perthes disease

64
Q

treatment of Legg-Calve-Perthes disease

A
  • observation
  • PT to improve ROM
  • surgery if needed
65
Q

list gradual course of Legg-Calve-Perthes disease

A
  1. necrosis of femoral head
  2. fragmentation -> reabsorption of bone
  3. re-ossification
  4. remodeling

* younger age at presentation = better outcome

66
Q

What is slipped capital femoral epiphysis (SCFE)

A

slippage of the femoral epiphysis on the femoral metaphysis “ice cream falling off cone”

67
Q

slipped capital femoral epiphysis (SCFE) is most commonly seen in what patient populations

A
  • obese African american
  • males
  • 10-16 yo
68
Q

clinical presentation

  • obese male 10-16
  • limp or NWB
  • c/o knee pain usually
  • restricted ROM: abduction and internal rotation
A

slipped capital femoral epiphysis (SCFE)

69
Q

management of slipped capital femoral epiphysis (SCFE)

A
  • urgent surgical consultation for in situ single screw fixation
    • NWB!
    • might treat contralateral hip
70
Q

what are the greatest risk factors for developmental dysplasia of hip

A
  1. 1st born
  2. female
  3. breech
  4. FHx
71
Q

what specialized PE can you do to evaluate for developmental dysplasia of hip

A
  • Barlow: checking to see if femoral head will dislocate posteriorly
  • Ortolani: taking dislocated hip and trying to reduce it
  • Galeazzi
72
Q

what is Galeazzi test

A
  • tests for developmental dysplasia of hip
  • affected hip shortened
73
Q

how is developmental dysplasia of hip diagnosed

A
  1. clinical
  2. dynamic stress US after 3-4 weeks old
  3. radiographs after 4-6 months old
74
Q

management of developmental dysplasia of hip

A
  • pavlik harness
  • monitor with US monthly until normalization and then radiographs after 6 months of age
75
Q

what is osgood-schlatter’s disease

A

inflammation and irritation of patellar tendon insertion on tibial tubercle

76
Q

clinical presentation

  • focal tenderness to tibial tubercle
  • enlargment or bony protrusion of tibial tubercle
  • pain flares around time of rapid growth
    • girls: 10-11
    • boys: 13-14
A

osgood-schlatter’s disease

77
Q

What is Sever’s disease

A
  • calcaneal apophysitis
  • irritation, inflammation of calcaneal apophysis
    • overuse syndrome
    • pull of achilles tendon
78
Q

Sever’s disease most commonly affects what patient population

A
  • children 6-12 yo
  • common in soccer players and gymansts
79
Q

treatment of Sever’s disease

A
  • stretches
  • ice
  • NSAIDS
80
Q

risks of clubfoot

A
  • FHx
  • maternal smoking
81
Q

in clubfoot, Muscles contractures lead to the characteristic deformity that includes (CAVE). What does CAVE acronym stand for

A
  • Cavus
  • Adductus
  • Varus
  • Equinus
82
Q

treatment of clubfoot

A

Ponseti casting

83
Q

valgus

A

knock knees, foot goes lateral

84
Q

varus

A

bow legs, leg retuns to center

85
Q

if you see genu varum, what should be part of DDx

A
  • Blount’s disease
  • Rickets *vit D deficiency

PEDS II, exam 2 (3 decks)

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