ORTHO

Question 1

If an infant baby was in a breech position, and has generalized hip laxity – what diagnosis? Who is it most common in?

Answer 1

Developmental dysplasia of the hip Most common in girls & the left hip!

Question 2

When developmental dysplasia often present in children?

Answer 2

Decreased leg length, limp, asymmetry of skin folds, and loss of motion (abduction)

Question 3

What tests do we do for DDH?

Answer 3

Barlow (dislocation) & Ortolani (relocation)

X-Rays & Ultrasound

Question 4

What treatment can you do for DDH?

Answer 4

Brace/Pavlik Harness (under 6 months)

Casting (>6 months)

Surgical (>2 years)

Question 5

If a child under 12 and is thin, wirey, and active and has pain with limping, and radiating groin pain that’s worse with activity and limits their ROM – what diagnosis?

Answer 5

Legg Clave Perthes Disease

Question 6

If a child has hip pain, what must you always look at?

Answer 6

The entire leg

Question 7

What’s occurring in Legg-Calve-Perthes Disease?

Answer 7

Osteonecrosis & femoral head collapses

Question 8

What diagnostics would you do for Legg-Calve-Perthes Disease?


Answer 8

X-ray (look for crescent sign) MRI or CT

Question 9

How would you treat legg-Calve-Perthes disease?

Answer 9

Observation (often re-vascularizes in 12-18 months), NSAIDS, NO activity, and crutches

Question 10

If a 12 year old obese male presents with hip pain with a limp and decreased motion that presents suddenly or gradual – what diagnosis?

Answer 10

Slipped Capital Femoral Epiphysis

Question 11

What diagnostics would you do for SCFE?

Answer 11

X-Ray – fuzzy irregularities (posterior slip with a hook sign)

Question 12

How do you treat SCFE?

Answer 12

Surgical fixation – it WILL progress if left untreated

Question 13

What is a sterile effusion of the hip known as?

Answer 13

Transient synovitis of the hip or Toxic Synovitis

Question 14

How does a transient synovitis of the hip?

Answer 14

2-5-year-old boy who went to bed normally & won’t get out of bed the next morning.
acute onset, limp, pain in groin, and AFEBRILE

Question 15

How do you diagnose transient synovitis of the hip?

Answer 15

Diagnosis of exclusion – x-ray, blood work, and joint aspiration

Question 16

How do you treat transient synovitis of the hip?

Answer 16

Rest, monitor temp, reassurance

Question 17

What would cause intoeing & outtoeing?

Answer 17

Femoral (anteversion/retroversion) or tibial (torsion) rotation

Question 18

What are the sxs of intoeing & outtoeing?

Answer 18

Present by age 2 with walking – rarely painful

Question 19

What are 4 diagnostic tests (rotational profile) that we can do for intoeing & outtoeing?

Answer 19

Foot progression angle, thigh-foot angle, femoral retro/anteversion, foot adductus

Question 20

What type of diagnostic looks at the angle of the foot with walking, negative (intoeing) and positive (out-toeing)?

Answer 20

Foot progression angle

Question 21

What diagnostic test assesses the amount of tibial rotation with the patient prone and knees bent to 90 degrees (looking down on the foot) – looking for rotation of the foot compared to the femur?

Answer 21

Measurement of thigh-foot angle (20-30 degrees of external rotation is normal)

Question 22

What diagnostic test involves swing the lower legs towards/away from each other while prone?

Answer 22

Measure femoral ante/retroversion (40-50 degrees in both directions is normal)

Question 23

What diagnostic test looks at the midline of the foot and that it should bisect the 2nd & 3rd MT?

Answer 23

Assessment of foot adductus

Question 24

How do you treat intoeing or outtoeing?

Answer 24

monitor, reassurance, and referral if no change or improvement

Question 25

If a tall lanky kid presents with pain over the tibial tubercle that’s worse with jumping, running, and kneeling– what diagnosis?

Answer 25

Osgood Schlatter’s

Question 26

How do you treat Osgood Schlatter’s?

Answer 26

Ice, heat, NSAIDs, rest – may take several months

Question 27

What diagnosis involves a medially rotated very flexible forefoot?

Answer 27

Metatarsus Adductus

Question 28

How would you diagnose metatarsus adductus?

Answer 28

Serial weight-bearing photocopies (to measure the amount of deviation)

Question 29

How would you treat metatarsus adductus?

Answer 29

Most spontaneously resolve by 6 months Serial casting (every 2 weeks) starts at 6 months (braces & splints are not helpful!)

Question 30

What are the 4 components of club foot (talipes equinovarus)?

Answer 30

Plantar flexion of ankle Adduction of heel High arch Adduction of forefoot

Question 31

The deformity of club foot is obvious, what must we do on PE?

Answer 31

Assess muscle and nerve function – to r/o spinal etiology NOT reducible

Question 32

How do you treat club foot in the neonate?

Answer 32

immediate casting – prior to leaving the hospital Surgical indication if no results after 4 months

Question 33

At what degree of curvature would diagnose a child with scoliosis?

Answer 33

Lateral curvature >10 degrees

Question 34

What are some of the causes of scoliosis?

Answer 34

Idiopathic (MC), congenital, neuromuscular, and vertebral disease

Question 35

If a child has pain associated with their scoliosis what do you need to think?

Answer 35

Tumor or spinal cord problem – most scoliosis is asymptomatic

Question 36

How do you diagnose scoliosis?

Answer 36

X-rays (AP & LAT) to measure the cobb angle; Adam’s forward bend test

Question 37

At what degree to you brace a child with scoliosis? Surgery?

Answer 37

Brace at 20-40 degrees Surgery at >50 degrees

Question 38

What muscle is involved in torticollis?

Answer 38

Sternocleidomastoid

Question 39

At what age do we see torticollis in? What do we need to r/o in torticollis?

Answer 39

4-6 weeks old R/O a “tumor” in the muscle belly via x-ray and do a thorough neuro exam

Question 40

How do you treat torticollis?

Answer 40

Passive stretching exercises; usually resolves within a year

Question 41

Why should parents not swing their kids by their arms?

Answer 41

They can get a nursemaid’s elbow! AKA subluxation of radial head

Question 42

How would you treat nursemaid’s elbow?

Answer 42

Manipulate with pressure on the radial head and forcefully flex & supinate the forearm

Question 43

What is the name of the fracture that involves the growth plate? How many types?

Answer 43

Salter-Harris fracture & 5 types

Question 44

What type of fracture is through the physis?

Answer 44

Type 1

Question 45

What type of fracture is through the physis into the epiphysis?

Answer 45

Type 3

Question 46

What type of fracture is through the metaphysis, physis & epiphysis?

Answer 46

Type 4

Question 47

When would you do conservative treatment for a salter-harris fracture?

Answer 47

If fracture is non-displaced

Question 48

What type of orthopeadic disorder involves a defect in type 1 collagen and involved multiple reoccurring fractures?

Answer 48

Osteogenesis imperfecta

Question 49

How will the child with Osteogenesis imperfecta present?

Answer 49

Blue eyes, poor dentition, and decreased hearing