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Pediatrics > Ortho > Flashcards

Ortho Flashcards

1
Q

Salter-Harris I

A

Transverse physeal fracture with widening. Seperate.

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2
Q

Salter-Harris II

A

Fracture through the metaphysis and the physis. Most COMMON! Above.

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3
Q

Salter-Harris III

A

Fracture through the Physis and Epiphysis. Lowers

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4
Q

Salter-Harris IV

A

Fracture through all three (metaphysis, physis and epiphysis). Through.

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5
Q

Salter-Harris V

A

Physeal compression or crush fracture. Only seen in high energy injuries. Reduced.

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6
Q

Fat Pad Sign

A

Occult fracture that has released blood into the area.

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7
Q

Supracondylar Fracture Causes

A

Most common peds elbow fracture. Usually occurs during snapping back (falling off monkey bars)

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8
Q

Supracondylar Fracture Xray

A

AP, Lateral and oblique. The anterior humeral line should intersect the capitellum.

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9
Q

Supracondylar Fracture Type I/II Treatment

A

Posterior splint with light overwrap, sling, RICE, Refer to ortho.

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10
Q

Supracondylar Fracture Type III Treatment

A

Emergent ortho consult

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11
Q

Lateral Condylar Fracture of the Distal Humerus Xray

A

AP, Lateral and internal oblique

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12
Q

Lateral Condylar Fracture of the Distal Humerus MRI Indications

A

If needed to differentiate from a transphyseal fracture (Type I).

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13
Q

Lateral Condylar Fracture of the Distal Humerus Treatment

A

Splint, Sling, RICE, refer to ortho. Emergent ortho consult if displacement is greater than 2mm.

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14
Q

Lateral Condylar Fracture of the Distal Humerus Complications

A

Fish tail deformity (common to all distal humerus fractures)

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15
Q

Medial Epicondylar Fracture of the Distal Humerus Causes

A

Common in pitchers and gymnasts. Muscle attachment avulsions (throwing) or elbow dislocations (Need CT to find the medial epicondyle).

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16
Q

Medial Epicondylar Fracture of the Distal Humerus Xray

A

AP, Lateral, and external oblique

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17
Q

Medial Epicondylar Fracture of the Distal Humerus CT

A

To rule out incarceration of the fragment in the joint if you can’t find the piece on xray. Emergent ortho consult.

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18
Q

Medial Epicondylar Fracture of the Distal Humerus Treatment

A

Splint including the wrist. RICE. Refer to Ortho.

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19
Q

Medial Epicondylar Fracture of the Distal Humerus Complications

A

Ulnar nerve palsy, angular deformity, decrased ROM

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20
Q

Radial Neck Fracture Causes

A

Fall on outstretched hand with valgus stress. Elbow dislocation/relocation (persistent pain over radial head after relocation).

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21
Q

Radial Neck Fracture Presentation

A

Tenderness over the radial head. Pain with supination and pronation. Young kids may complain of wrist pain. Can often diagnose clinically in children less than 5.

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22
Q

Radial Neck Fracture Xrays

A

AP, lateral and external oblique

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23
Q

Nursemaid’s Elbow Cause

A

Dislocation of the radial head common in 1-4 yo. Due to sudden pull of a pronated arm.

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24
Q

Nursemaid’s Elbow Presentation

A

Extended or slightly flexed pronated arm, refusal to use arm but able to use fingers, mild pain over the radial head, pain increases with supination.

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25
Q

Nursemaid’s Elbow Treatment

A

Reduction by supinating then flexing the arm with pressure on the radial head. Can also try hyperpronation with pressure on the radial head. Lollipop test.

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26
Q

Monteggia Fracture

A

Ulnar and/or radial shaft fracture with dislocation of the radial head. Suspect in any isolated ulnar shaft fractures.

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27
Q

Monteggia Fracture treatment

A

Needs emergent reduction

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28
Q

Wrist Fracture Causes

A

Most common peds fracture. Caused by a direct fall (FOOSH). Fall from monkey bars, bed, soccer. Or direct trauma. Usually in the distal radius or the metaphysis.

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29
Q

Wrist Fracture Presentation

A

point tenderness, swelling and ecchymosis

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30
Q

Wrist Fracture Xrays

A

AP, lateral +/- oblique. Needed to diagnose SH type I.

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31
Q

Wrist Fracture Treatment

A

Emergent ortho consult for any displacement of the growth plate or neurovascular compromise. Splint or cast, +/- reduction/surgery.

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32
Q

Scaphoid Wrist Fracture Presentation

A

Tender anatomical snuffbox. Often diagnosed clinically.

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33
Q

Scaphoid Wrist Fracture Xray

A

AP, lateral and scaphoid view (AP with 30 degrees of ulnar deviation). Often Xray is negative so repeat in 10-14 days.

34
Q

Scaphoid Wrist Fracture Treatment

A

Thumb spica splint. Refer if there is displacement or continued pain.

35
Q

Scaphoid Wrist Fracture Complications

A

Avascular necrosis

36
Q

Femur Fractures Presentation

A

NWB, limb shortening, pain in groin or buttock. Proximal fractures will be held slightly adducted with external rotation. Suspect abuse in children less than 1 yo.

37
Q

Femur Fractures Treatment

A

Hip spica cast and/or surgery

38
Q

Femur Fractures Complications

A

Shortening or lengthening. Angulation.

39
Q

Patellar sleeve fracture Cause

A

Forced extension with the knee in flexion. Jumping, kicking, etc. Unique to kids especially less than 13 yo. Can be at superior or inferior pole of the patella.

40
Q

Patellar sleeve fracture Treatment

A

Knee immobilization, NWB, RICE. Refer to ortho.

41
Q

Toddler’s Fracture Cause

A

Tibial shaft fracture caused by child falling while running, often with a twisting mechanism.

42
Q

Toddler’s Fracture Xray

A

AP, lateral, oblique. Often missed on initial films.

43
Q

Toddler’s Fracture Treatment

A

RICE, NWB, refer to ortho.

44
Q

Ankle Fracture Presentation

A

tender to palpation (physeal injury if exquisetley tender of the physis), localized swelling and bruising, +/- weight bearing.

45
Q

Ankle Fracture Xray

A

AP, mortise, lateral, internal/external oblique

46
Q

Ankle Fracture Treatment

A

Posterior splint, RICE

47
Q

Triplane Fractue Cause

A

External rotation. Common in teens.

48
Q

Triplane Xray findings

A

SH III on AP and SH II on lateral. Need CT to assess displacement.

49
Q

Triplane Treatment

A

Usually surgery

50
Q

Jones, Pseudo-Jones/Avulsion Fracture Cause

A

Fracture to the base of the fifth metatarsal due to the pull of the peroneus brevis or plantar aponeurosis at their insertion site. Common in traction injuries.

51
Q

Torticollis Definition

A

Unilateral contraction of the SCM with visible shortening. Due to compartment syndrome. Head is tilted with the chin rotated to contralateral side. Must evaluate for plagiocephaly.

52
Q

Torticollis Treatment

A

Stretching/PT with positioning education.

53
Q

Scoliosis Definition

A

Idiopathic curvature of greater than 10 degrees with a rotational component. More common in females. Congenital (0-3 yo) and juvenile (4-9) all need to be referred to ortho.

54
Q

Scoliosis Presentation

A

usually asymptomatic, +/- pain, obsturctive lung symptoms if severe.

55
Q

Scoliosis Physical exam

A

shoulder/pelvic obliquity, asymmetry of scapulae, adam’s forward flexion exam (paraspinal prominences), abdominal reflexes.

56
Q

Scoliosis Xray

A

AP/PA standing with a long cassette (may need special facility). Measure the cob angle (greater than 10 degrees).

57
Q

Scoliosis Treatment

A

Refer at 20 degrees, ILSO brace at 25 degrees, Surgery at 45 degrees.

58
Q

Septic Hip Presentation

A

Holds leg in flexion and abduction. Refuses to bear weight or limps.

59
Q

Septic Hip Diagnosis

A

Kocher Criteria (2/4 warrants aspiration): WBC greater than 12,000, ESR greater than 40, Fever greater than 101.3 degrees, NWB.

60
Q

Septic Hip Treatment

A

Admit to the hospital with an emergent ortho referral. Joint aspiration or surgical identification is diagnostic. Positive cultures only 50-60% of the time.

61
Q

Transient Synovitis

A

Diagnosis of exclusion. Treat with NSAIDs and if it responds then it isn’t septic hip.

62
Q

Leg-Calve-Perthes Disease Definition

A

Idiopathic avascualr necrosis of the femoral head. Boys 4-8 yo. Typically thin and overactive.

63
Q

Leg-Calve-Perthes Disease Presentation

A

Limp towards the end of the day. Occasional hip/knee pain. Limited internal rotation and/or abduction of the hip.

64
Q

Leg-Calve-Perthes Disease Treatment

A

Observation, PT, surgery if realignment is needed. The younger the better outcome.

65
Q

Slipped Capital Femoral Epiphysis Definition

A

Slippage of the femoral epiphysis on the metaphysis. “ice cream falling off the cone” Common in obese black males 10-16 yo.

66
Q

Slipped Capital Femoral Epiphysis Presentation

A

Limp or NWB. Knee pain, restricted abduction and internal rotation.

67
Q

Slipped Capital Femoral Epiphysis Xray

A

AP of pelvis and frog lateral.

68
Q

Slipped Capital Femoral Epiphysis Treatment

A

Urgent surgical consultation for single screw fixation (maybe of both hips) NWB and get to the hospital fast.

69
Q

Dysplasia of the Hip Risk Factors

A

First born, female, breech, FH.

70
Q

Dysplasia of the Hip Diagnosis

A

Postive Barlow’s (push back) and/or Orlanti (make an “O”). Galeazzi test to check limb length.

71
Q

Dysplasia of the Hip Imaging

A

Ultrasound from 3-4 weeks, radiographs after 4-6 mo.

72
Q

Dysplasia of the Hip Treatment

A

Pavlik Harness. Avoid swaddling and tight clothes. Monitor with monthly ultrasounds or Xray (6 mo) until 8 yo.

73
Q

Osgood- Schlatter’s Disease Definition

A

Inflammation/irritation of the patellar tendon insertion site. Common in jumpers. Usually flares during growth spurts: females 10-11 and males 13-14.

74
Q

Osgood- Schlatter’s Disease Presentation

A

Focal tenderness and enlargement of the tibial tubercle.

75
Q

Osgood- Schlatter’s Disease Xrays

A

Lateral to rule out avulsion

76
Q

Osgood- Schlatter’s Disease Treatment

A

RICE, quad exercises, hamstring stretches, Chopat strap.

77
Q

Calcaneal Apophysitis (Sever’s Disease) Definition

A

Irritaion/inflammation of the calcaneal apophysis. Overuse syndrome due to the pull of the achiles. Common in gymnasts and soccer players ages 6-12.

78
Q

Calcaneal Apophysitis (Sever’s Disease) Treatment

A

RICE, NSAIDs and stretching

79
Q

Clubfoot Definition

A

Fixed deformity. Often diagnosed on fetal ultrasound. Increased risk with FH and maternal smoking. CAVE: Cavus, Adductus, Varus, Equinus (dorsiflexion). Affected limb will have a smaller foot and calf with a shortened tibia.

80
Q

Blounts Disease

A

Unilateral Varus (bow leg)

81
Q

Physiologic progression of leg shape

A

Varus to valgus to straight

Pediatrics (8 decks)

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