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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
diagnostics to evaluate radial neck fracture
* xray * AP * lateral * external oblique * clinical if radial head not ossified * ossification begins at age 5
26
managment of radial neck fracture
* immobilize including wrist * sling * NSAID * refer to ortho
27
common cause of nursemaid's elbow
sudden pull on pronated arm
28
what is nursemaid's elbow
dislocation of radial head, typically 1-4 yo
29
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
nursemaid's elbow
30
managment of nursemaid's elbow
* reduction 1. supination, flexion with pressure over radial head 2. hyperpronation with pressure over radial head * lollipop test
31
What is a Monteggia fracture
* ulnar (or radial and ulnar) shaft fx with dislocation of radial head * isolated ulnar shaft fx must be evaluated for this
32
most common wrist fx
* distal radius * metatphysis
33
managment of wrist fx
* splint case * +/- reduction vs surgery * emergent with significant clinical deformity or neurovascular compromise
34
clinical presentation * tender to palpation over anatomic snuffbox
scaphoid fx
35
what are the lateral and medial border of anatomic snuffbox
* lateral * extensor pollicis brevis * abductor pollicis longus * medial * extensor pollicis longus
36
diagnostics to evaluate scaphoid fx
* AP * lateral * scaphoid view * \*may be negative * repeat imaging 10-14 days later for diagnosis
37
managment of scaphoid fx
* thumb spica splint/cast
38
complication of scaphoid fx
avascular necrosis
39
if patient \< 1 yo presents with femur fx, must r/o
child abuse
40
complications of femur fx
* shortening * lengthening * angulation
41
what is the most common patellar fx in kids \< 13 yo
patellar sleeve fx * caused by forced extension with knee in flexion * jumping, kicking
42
management of patellar sleeve fx
* refer to ortho * knee immobilizer, NWB, elevate * NSAIDs
43
what is a toddlers fracture
* fx of tibial shaft * common cause: young child falling while running, often with twisting mechanism
44
diagnostics to evaluate toddlers fracture
* AP * lateral * obliques * often not seen on initial films
45
management of toddlers fracture
* immobilize (splint, wee walker) * refer to ortho * NWB, NSAIDs
46
diagnostics to evaluate ankle fx
* AP * mortise * lateral * internal and external obliques
47
what must you r/o when evaluating ankle fx
* physeal widening (SH 1 fx) * clinical diagnosis: very tender over distal tib or fib physis
48
management of ankle fx
* posterior splint * avoid ACE * elevation * NWB * NSAIDs
49
What is a Triplane ankle fx
* 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
What is a Jones, Psuedo-Jones/Avulsion fx
* fracture to the base of the 5th metatarsal * due to pull of peroneus brevis at its insertion as wall as plantar aponeurosis
51
what is unilateral contraction of the sternocleidomastoid muscle with visible shortening called
torticollis
52
etiology of torticollis
compartment syndrome secondary to venous outflow obstruction
53
treatment of torticollis
* stretching/PT
54
define scoliosis
lateral curve of spine \> 10 degrees
55
adolescent scoliosis is defined as
age \> 10 yo
56
what test is used to evaluate for scoliosis
adams forward flexion exam
57
what imaging is done to evaluate for scoliosis
* Cobb angle * AP/PA standing plain radiograph on long cassette
58
treatment for scoliosis
* TLSO brace * 25 degrees * surgery * 45 degress * internal rod fixation
59
what child presents with thier leg in a flexed and abducted position and refusal to bear weight, what must you rule out?
septic hip vs transient synovitis
60
How can you differentiate between septic hip and transient synovitis
**Kocher criteria** * WBC \> 12,000 * ESR \>40 * Fever \> 101.3 * non weight bearing on affected side 2/4 criteria warrants joint aspiration
61
What is Legg-Calve-Perthes disease
* idiopathic avascular necrosis of the femoral head
62
Legg-Calve-Perthes disease is most common in what patient population
* boys aged 4-8 * typically thin and extremely active
63
clinical presentation * young boy (4-8) * limping at end of day * occasional pain (knee or hip) * limited internal rotation or abduction of hip
Legg-Calve-Perthes disease
64
treatment of Legg-Calve-Perthes disease
* observation * PT to improve ROM * surgery if needed
65
list gradual course of Legg-Calve-Perthes disease
1. necrosis of femoral head 2. fragmentation -\> reabsorption of bone 3. re-ossification 4. remodeling \* younger age at presentation = better outcome
66
What is slipped capital femoral epiphysis (SCFE)
slippage of the femoral epiphysis on the femoral metaphysis "ice cream falling off cone"
67
slipped capital femoral epiphysis (SCFE) is most commonly seen in what patient populations
* obese African american * males * 10-16 yo
68
clinical presentation * obese male 10-16 * limp or NWB * c/o knee pain usually * restricted ROM: abduction and internal rotation
slipped capital femoral epiphysis (SCFE)
69
management of slipped capital femoral epiphysis (SCFE)
* **urgent** surgical consultation for in situ single screw fixation * NWB! * might treat contralateral hip
70
what are the greatest risk factors for developmental dysplasia of hip
1. 1st born 2. female 3. breech 4. FHx
71
what specialized PE can you do to evaluate for developmental dysplasia of hip
* Barlow: checking to see if femoral head will dislocate posteriorly * Ortolani: taking dislocated hip and trying to reduce it * Galeazzi
72
what is Galeazzi test
* tests for developmental dysplasia of hip * affected hip shortened
73
how is developmental dysplasia of hip diagnosed
1. clinical 2. dynamic stress US after 3-4 weeks old 3. radiographs after 4-6 months old
74
management of developmental dysplasia of hip
* **pavlik harness** * monitor with US monthly until normalization and then radiographs after 6 months of age
75
what is osgood-schlatter's disease
inflammation and irritation of patellar tendon insertion on tibial tubercle
76
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
osgood-schlatter's disease
77
What is Sever's disease
* calcaneal apophysitis * irritation, inflammation of calcaneal apophysis * overuse syndrome * pull of achilles tendon
78
Sever's disease most commonly affects what patient population
* children 6-12 yo * common in soccer players and gymansts
79
treatment of Sever's disease
* stretches * ice * NSAIDS
80
risks of clubfoot
* FHx * maternal smoking
81
in clubfoot, Muscles contractures lead to the characteristic deformity that includes (CAVE). What does CAVE acronym stand for
* Cavus * Adductus * Varus * Equinus
82
treatment of clubfoot
Ponseti casting
83
valgus
knock knees, foot goes lateral
84
varus
bow legs, leg retuns to center
85
if you see genu varum, what should be part of DDx
* Blount's disease * Rickets \*vit D deficiency

PEDS II, exam 2 (3 decks)

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