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Ortho Flashcards

1
Q

Salter Harris I

A

Through growth plate

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2
Q

Salter Harris II

A

Through growth plate and metaphysis

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3
Q

Salter Harris III

A

Though growth plate and epiphysis

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4
Q

Salter Harris IV

A

Through metaphysics, epiphysis and physis

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5
Q

Salter Harris V

A

Physeal compression (complete obliteration of the growth plate) - High energy trauma

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6
Q

Least common fracture

A

Salter Harris V

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7
Q

Most common fracture

A

Salter Harris II

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8
Q

Elbow fx associated w/ fat pad sign

A

Blood released into area (REFER)

* Ant sail

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9
Q

Most common elbow fracture in kids

A

Supracondylar fracture

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10
Q

Biggest concern about supracondylar fx

A

Neuromuscular fxn (Med Nerve - ant interosseous) = OK sign

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11
Q

Clinical presentation of supracondylar fx

A

Swelling
Pain
Deformity

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12
Q

Dx supracondylar fx

A

AP
Lateral
Oblique

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13
Q

Mechanism of injury for supracondylar fx

A

FOOSH (distal humerus displaces posteriorly)

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14
Q

Type I, II and III supracondylar fxs

A

I- Capitulum aligned w/ ant humeral line
II-Capitulum not aligned
Iii-Cortex separated **

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15
Q

Why aren’t ACE bandages indicated for mgt of supracondylar fxs

A

Can cut off blood flow
I/II- sling and refer, Ibuprofen
III - Emergent ortho consult

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16
Q

Pinpoint tenderness to palpation over the lateral condyle w/ associated localized soft tissue swelling

A

Lateral condylar fx of distal humerus

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17
Q

Dx for lateral condylar fx of distal humerus

A

AP, Lat, oblique

MRI to diff from transphyseal fx

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18
Q

Mgt for lateral condylar fx of distal humerus

A

Emergent referral for disp >2mm

Splint, sling, NSAIDS

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19
Q

complications with lateral condylar fx

A

Fishtail deformity (damages physis)

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20
Q

Classic throwing elbow injury w/ pop

A

Medial epicondylar fx of distal humerus

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21
Q

What imaging do you need if you have elbow dislocation

A

CT- when you cnt find the fractured piece

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22
Q

Dx for epicondylar fx

A

AP, Lat, Oblique grays

R/O incarceration (little chip missing)

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23
Q

Complications of medial condylar fx of distal humerus

A

Ulnar nerve palsy
Angular deformity
decreased ROM

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24
Q

Common cause of Radial neck fracture

A

FOOSH w/ valgus stress (skate boarding)

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25
Q

Tenderness to palpation over radial head w/ pain when sup & pronation > flexion & extension, w/ complaint of wrist pain

A

Radial head fx

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26
Q

Dx of radial neck fracture in chn

A

Clinical (no ossification of radial head)

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27
Q

Tx radial head/neck fx

A

Immobilize wrist (sling older, cast younger)
Sling
NSAIDS (Naproxen)
Refer

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28
Q

Dislocation of radial head, 1-4yo

A

Nursemaid’s elbow

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29
Q

Cause of nursemaid’s elbow

A

sudden pull of pronated arm

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30
Q

Clinical presentation of nursemaid’s elbow

A

Arm fully extended/slightly flexed + pronated

+/- pain, Don’t want to supinate

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31
Q

Do you need imaging for Nursemaid’s elbow

A

NO, clinical dx unless you suspect associated underlying fx

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32
Q

Mgt for nursemaid’s elbow

A

Reduction by:

  • Supination, flexion w/ pressure over radial head
  • Hyperpronation w/ pressure over the radial head
  • Lollipop/popsicle test
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33
Q

Ulnar or radial shaft fx w/ dislocation of radial head

A

Monteggia fx

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34
Q

What should you consider when you see an isolated ulnar fx

A

Monteggia fx

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35
Q

What is the most important thing to do w/ Mlonteggia fx

A

Reducing the radial head or it won’t go back in w/ out surgery

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36
Q

Dx of Monteggia fx

A

Xray, make sure you get imaging of elbow!!

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37
Q

Common cause of wrist fx

A 
FOOSH
Direct trauma (Hit by sting)
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38
Q

Dinner fork deformity

A

Wrist fx

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39
Q

Common locations of wrist fx

A

Distal radius

Metaphysis

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40
Q

Clinical presentation of wrist fracture

A

Point tenderness, swelling, ecchymosis

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41
Q

torus/buckle fx

A

Fx thru bone

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42
Q

Mgt of wrist fx

A

Splint, cast, reduction

Emergent referral w/ significant deformity or neuromuscular compromise

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43
Q

Most common carpal fx

A

Scaphoid

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44
Q

Dx of scaphoid fx

A

Clinical; TTP over anatomic snuff box
Xrays: may be -ve, repeat in 10-14 days
MRI; consider in elite athletes

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45
Q

Tx for scaphoid fx

A

Thumb spica splint

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46
Q

Major complication of wrist fracture

A

Avascular necrosis

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47
Q

What do you need to consider if child

A

Child abuse

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48
Q

clinical presentation of femur fracture

A 
Hx of trauma
Pain in groin or buttock
Non-weight bearing
Slight adduction w/ ext rotation
\+/- limb shortening
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49
Q

Dx femur fx

A

Xray entire length of femur

50
Q

Tx femur fx

A

Hip spica cast vs surgery

51
Q

Complications of femur fx

A

Shortening - displacement w/ overlap
Lengthening - remodeling w/ extra bone
Angulation

52
Q

Fx special to kids

A

Patellar sleeve fx

53
Q

Most common patellar fx in Kids

A

Patellar sleeve fx

54
Q

Cause of patellar sleeve fx

A

Forced ext w/ knee flexion (patella riding high on X-ray)

55
Q

Tx patella sleeve fx

56
Q

Location of toddler’s fx

A

Tibial shaft

57
Q

Common cause of toddler’s fx

A

falling while running w/ twisting mech

58
Q

Sign of toddler’s fx

A

Limping (Clinical Dx)

Xray: +/- visualized, spiral fx

59
Q

Tx toddler’s fx

A

Immobilize (splint/wee walker)

REFER

60
Q

Cause of ankle fx

A

Rolling the ankle

61
Q

Clinical presentation of ankle fx

A

TTP, localized swelling, ecchymosis

62
Q

Dx ankle fx

A

Clinical (Exquisitely TTP over distal tibia and fib physis)

63
Q

What do you need to rule out w/ ankle fx

A

Physeal widening (SH I)

64
Q

Mgt ankle fx

A

Post splint (avoid ACE bandage)
Elevate
NSAIDS
Non-weight bearing

65
Q

Triplane fx mechanism

A

External rotation = EMERGENT- need surgery

66
Q

How do you assess displacement in triplane fx

67
Q

What do you see on X-ray w/ triplane fx

A

SH III on AP view

SH II on lat view

68
Q

Jones/ pseudo-jones, avulsion fx

A

Fx to base of 5th Metatarsal

69
Q

Unilateral contraction of sternocleidomastoid w head tilt to shortened muscle and chin rotation to contralateral side

A

Torticollis

70
Q

Etiology of torticollis

A

Compartment syndrome SCM 2˚ to venous outflow obstruction

71
Q

What is torticollis strongly associated with

A

plagiocephaly

72
Q

Tx for torticollis

A

Stretching/PT

Positioning educ

73
Q

Lateral curve >10˚ w/ rotational component

74
Q

Etiology of scoliosis

A

Idiopathic, F>M, genetic component

75
Q

Infantile/congenital scoliosis

A

zero to three yrs old

76
Q

Juvenile scoliosis

A

four to nine yrs old

77
Q

Adolescent scoliosis

A

older than ten years old

78
Q

PE findings for adolescent idiopathic scoliosis

A

Shoulder/pelvic obliquity
Assymentry of scapulae
Adam’s forward flexion exam (paraspinal prominences)
Abdominal reflexes

79
Q

Clinical presentation of scoliosis

A

Asymptomatic
+/- pain
obstructive lung (severe)

80
Q

Dx scoliosis

A

Imaging: Cobb angle

AP/PA standing radiographs on LONG cassette

81
Q

Tx scoliosis

A

TLSO brace - 25˚ (Boston Milwaukee Charleston bending)

Surgery - 45˚

82
Q

Clinical presentation that makes you suspect of septic hip or transient synovitis

A

Hold leg in flexion and abducion

NWB / walk w/ limp

83
Q

Kocher criteria

A

Diagnostic for septic hip (2/4)

  • WBC >12000
  • ESR >40
  • Fever >101.3
  • Non weight bearing
84
Q

How to distinguish btn septic hip and transient synovitis

A

Admin of high dose NSAIDS resolves transient synovitis temporarily otherwise its septic hip

85
Q

Mgt of septic hip vs transient synovitis

A

Admiit

Emergent ortho referral (joint aspiration/surgical identification = diagnostic)

86
Q

What do you need to image is s’one complains about knee pain

87
Q

Thin extremely active male 4-8yo idiopathic AVn of femoral head complaining of hip pain

A

Legg calve perthes

88
Q

Clinical presentation of legg calve perthes

A
  • limp at the end of the day
  • Occasional pain in hip / knee region
  • Ltd ROM
89
Q

Dx of legg calve perthes

A

Clinical

Xrays

90
Q

Tx legg calve perthes

A

Observe, PT for ROM

Surgery to realign

91
Q

Gradual course of perthes

A

Necrosis
Fragmentation
re-ossificatin
Remodelling

92
Q

What is the determinant of prognosis for perthes

A

Age of onset; younger = better

93
Q

Slippage of femoral epiphysis “ice-cream falling off the cone)

A

Slipped capital femoral epiphysis

94
Q

population affected by SCFE

A

obese african america male 10-16yo

95
Q

Clinical presentation of SCFE

A

limp
NWB
Knee pain
Ltd ROM

96
Q

Tx SCFE

A

urgent surgical consult (legal issue) - single screw fixation

97
Q

What does evaluation of well child check for regarding Developmental dysplasia of the hip

A

Laxity
Subluxation
Dislocation

98
Q

Risk factors of DDH

A

1st born female , BREECH POSITION, Family Hx, twin gestation

99
Q

Dx DDH

A

Clinical: + Barlow +/- Ortolani = Ortho referal
Galeazzi- hip shortening
US - no X-ray use no ossification centers (-ve ortolani/barlow w/ risk factors)

100
Q

at what age can you do radiographs for DDH

A

4-6mos ( four to six months)

101
Q

DDH Tx

A

Pavlik harness
Avoid swaddling
Monitor w/ US until normal
Radiograph after 6mos (six months)

102
Q

Complication of DDH

A

Avascular necrosis - legal liability

103
Q

Inflammation and irritation of patellar tendon insertion on tibial tubercle

A

Osgood Schlatter Dz

104
Q

Clinical prestneaton

A

Focal tenderness of tibial tubercle w/ enlargement of tibial tubercle

105
Q

Dx Osgood schlatter

A

Clinical

Xrays to rule out avulsion

106
Q

Mgt osgood schlatter

A

Rest, ibuprofen, quad exercises, hamstring stretches, chopat strap
Pain flares during rapid growth
G: 10-11
B: 13-14

107
Q

Inflammation and irritation of calcanea apophysis

A

Calcaneal apophysisits - Sever’s dz

108
Q

Cause of calcanea apophysisits

A

Overuse

Pull of achilles tendon (6-12yo)

109
Q

Clinical presentation of calcaneal apophysitis

A

pain at calcaneal apophysis

110
Q

Tx calcaneal apophysitis

A

Stretches and ice, NSAIDS

111
Q

Risk factors of club foot

A

FHX, maternal smoking

112
Q

Fixed deformity

A

Club foot (bilat/unilat)

113
Q

What is the earliest club foot can be diagnosed

114
Q

What makes up club foot

A 
CAVE
C-Cavus (hooking of the foot)
A-Adductus (curving foot)
V-Varus
E-Equinus (pointing down)
115
Q

Tx Club foot

A

Ponseti casting 4-6wks

116
Q

Genu varum and genu valgum

A

bow legged (Blount’s dz, Rickets) vs knock kneed

117
Q

What should you be concerned about with a non-reducing nurse maid’s elbow

A

Entrapment of annular ligament - Refer

118
Q

Goal of pre sports physical

A

Rule out life threatening conditions

identify conditions the require treatment plan

119
Q

Do you need routine labs for pre sports physical

120
Q

How many people are disqualified from play with pre-sports physical

A

1% (one percent)

Peds (11 decks)

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