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N283B/C Patho > Ortho > Flashcards

Ortho Flashcards

1
Q

Are fractures in children more common than in adults? Why?

A

Yes - Different fracture patterns due to elasticity of pediatric bone

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2
Q

4 main types of pediatric fracture patterns

A

Buckle/torus
greenstick
plastic deformation
complete

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3
Q

which pediatric fracture pattern?

  • most common in distal radius of wrist but can also seen in any long bone like ankle
  • Stable fractures that heal well with a few weeks of mobilization
A

Buckle/torus

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4
Q

which pediatric fracture pattern?

  • tension side of the bone starts to crack but concave side still intact (crack goes through one side of the bone but not the other)
  • either careful manipulation or have to complete the fracture to put it back in position
A

Greenstick

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5
Q

which pediatric fracture pattern?

  • no clear fracture line but it’s bent, so still needs to be fixed (can cause functional and cosmetic deformities)
  • often need to complete the fracture
A

Plastic deformation

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6
Q

which pediatric fracture pattern?

  • goes through all sides of the bone
  • Different types: Transverse, Oblique, Spiral
A

complete

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7
Q

Which classification would this be on Salter-Harris physical injury classification?

goes through the growth plate - oftentimes x ray is completely negative, would be based on clinical assessment

A

I

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8
Q

What’s the most commonly seen classification of injury per the Salter-Harris physical injury classification?

A

II

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9
Q

Growth disturbance can happen in ___ type of physeal injury

A

any

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10
Q

If fracture goes through the growth plate, it can stop growth which can cause what 3 main problems?

A

joint incongruity, deformity, limb length discrepancy → can lead to long-term arthritis, joint pain

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11
Q

Which classification would this be on Salter-Harris physical injury classification?

complete crush injury - looks like it’s completely disappeared in the x-ray

A

V

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12
Q

The closer the break is to the growth plate, the ____ the healing

A

faster

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13
Q

True or false: Fractures that would require surgical correction in adults often don’t need surgery or reduction in kids

A

true

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14
Q

High alert for non-accidental trauma with fractures in ____ children

A

non-ambulatory

Femur fracture, healing fractures in different stages of healing

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15
Q

What fracture tx has strongest protection? When would you use?

A

Cast

for anything that’s unstable or has been reduced

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16
Q

Which is faster, splint or cast? What would you use splint for

A

splint

allow for swelling - good for acute injury that you know it’s going to swell, splint for 1st week to prevent compartment syndrome

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17
Q

What type of fracture would you use the Brace or Cam boot with?

A

buckle fracture or something more stable - can take off to shower/sleep

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18
Q

Sprain vs strain? What’s the immediate tx

A

Sprain: Injury to ligament that attaches bone to bone (ex. ACL)

Strain: Injury to muscle/tendon (ex. Patellar or achilles tendon)

Immediate treatment: PRICE (Protect, Ice, Rest, Compression, Elevation)

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19
Q

What’s the most common dislocation location in adolescents?

A

patellar dislocation (kneecap) - lateral dislocation that happens with twisting injury - also football helmet vs. knee injury

20
Q

____ dislocation is uncommon under age 10, more common in age 10-20

What would this be in the under 10 population?

A

Shoulder

Under 10, this same injury would actually cause a humerus fracture

21
Q

Osgood Schlatter, Jumper’s Knee (Sinding-Larsen-Johansson Syndrome), Severs Disease, and Little League Elbow are all types of

A

Apophysitis

inflammation of connection of secondary growth center to the bone

22
Q

What type of Apophysitis?

  • jumping sports, basketball - where patellar tendon attaches to tibia
  • Might see bump on front of knee
A

Osgood Schlatter

23
Q

Jumper’s Knee (Sinding-Larsen-Johansson Syndrome) is similar to Osgood Schlatter except at the ___ attachment

A

proximal

24
Q

What type of Apophysitis when the area where achilles tendon attaches to heel bone is affected?

A

Severs Disease

25
Q

Apophysitis and stress reaction/fractures are both types of ____ sports injuries

A

overuse

26
Q

Curve < 10 degrees would be called

A

spinal asymmetry

27
Q

Scoliosis definition

A

3-dimensional deformity (as spine bends, vertebrae curve and bring the ribs with them) measured by Cobb Angle, greater than 10 degree

28
Q

What’s the most common type of scoliosis?

A

Idiopathic

29
Q

Scoliosis not due to bony deformity but like tethered spinal cord or other malformation, or secondary to trauma (congenital heart disease+surgery, injury) would be classified as

A

secondary

30
Q

Scoliosis seen with CP, Marfan’s etc would be classified as

A

Neuromuscular/syndromic

31
Q

What populations have genetic predisposition with idiopathic scoliosis

A

identical twins and daughters of mom’s with scoliosis (10-20%)

32
Q

Left or right thoracic curve most typical with idiopathic scoliosis?

A

right (90%)

33
Q

___:___ female to male ratio for curves > 30 degrees

A

10:1

34
Q

Imaging for scoliosis

A

PA/lateral standing scoliosis film

35
Q

line from top endplate of most prominent vertebrae to bottom endplate of most prominent vertebrae

A

cobb angle

36
Q

4 main types of scoliosis

A

idiopathic
secondary
congenital
NM/syndromic

37
Q

Adam’s bend forward test

A

Hands together, knees straight, bend forward

  • Rib rise secondary to elevated rib cage
  • Loin rise from prominent unilateral lumbar paraspinal muscles
38
Q

Younger age of onset of scoliosis has ___ likelihood of progression

A

increased

39
Q

the bigger the curve the ____ the risk of progression

A

greater

40
Q

4 ways to assess spine growth remaining

A
  • Chronological age (girls grow until 14 approx)
  • Menarche (Girls normally grow for about another 2 years after onset of menses
  • Bone age (x-ray of hand to determine how old skeleton is)
  • Riser sign which appears when puberty begins: I-V degree of ossification of illiac crest (once they’ve reached Riser IV then spine growth is pretty close to finished)
41
Q

How to manage mild scoliosis (10-24 degrees) if skeletally mature and not skeletally mature

A

Skeletal mature: FU as needed.

Immature: FU Q4-6 months until maturity

42
Q

How to manage moderate scoliosis (25-49 degrees) if skeletally mature and not skeletally mature

A

Skeletal mature: FU Q5 years to assess progression.

N: Consider bracing, FU Q 4-8 months

43
Q

How to manage severe scoliosis (curve over 50)

A

consider surgery

100% chance of progression of curve over 50 degrees

44
Q

Gold standard for bracing

A

Boston

45
Q

Which is more effective, nighttime or daytime bracing

A

daytime/all the time (18 hours/day)

46
Q

Goal of bracing? Best for what curvature?

A

Goal is to halt progression, NOT correction – can decrease risk of progression in patients listed below up to 80% when worn 16-18 hours/day

25-49 degrees in skeletally immature patients with idiopathic scoliosis

N283B/C Patho (3 decks)

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