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PEDS 2- clinical disciplines > Ortho > Flashcards

Ortho Flashcards

1
Q

Valgus abnormality?

A

knock knees

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2
Q

Varus abnormality?

A

bow legs

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3
Q

How are kids bones dif. from adults?

A

metabolically more active

thicker and more durable

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4
Q

What is an occult fx?

A

fracture not initially evident on plain xrays

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5
Q

Salter Harris I fx?

A

transverse physeal fx w/ widening

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6
Q

Salter Harris II fx?

A

fx through metaphysis and physis

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7
Q

Salter Harris III fx?

A

fx through physis and epiphysis

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8
Q

Salter harris IV fx?

A

fx through metaphysis, physis, and epiphysis

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9
Q

Salter harris V fx?

A

physeal compression or crush fx

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10
Q

What is the MC pediatric elbow fx?

A

supracondylar fx

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11
Q

Presentation of supracondylar fx?

A

FOOSH injury from height, typically w/ hyperextension

swelling, pain +/- deformity

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12
Q

What x-ray view will you best see a supracondylar fracture?

A

lateral

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13
Q

Tx of distal humerus supracondylar fx?

A

Type I/II: posterior splint w/ light overwrap, Ibuprofen, elevation, refer to ortho

Type III or NV concerns: emergent ortho consult

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14
Q

presentation of lateral condylar fx?

A

soft tissue swelling concentrated to lateral aspect of elbow

ttp over lateral condyle

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15
Q

Management of lateral condylar fx of distal humerus?

A

emergent referral if displacement >2mm

splint, sling, NSAIDs

ortho: casting v. surg

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16
Q

What are some complications of lateral condylar fx of distal humerus?

A

nonunion

fishtail deformity

cubitus valgus/varus deformities

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17
Q

Common causes of medial epicondylar fx

A

muscle attachement avulsion-throwing athletes

may be assoc. w/ elbow dislocation

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18
Q

Management of medial epicondylar fx?

A

emergenct if entrapped fragment

splint: wrist & sling

NSAIDs

ortho: short term immobilization v. open fixation

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19
Q

comps of medial epicondylar fx?

A

ulnar nerve palsy
nonunion
angular deformity
decreased ROM

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20
Q

Common causes of radial neck fx?

A

FOOSH w/ valgus stress

elbow dislocations: during dislocation or relocation

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21
Q

Presentation of radial neck fx?

A

TTP over radial head/neck

pain w/ supination/pronation > flexion/extension

young children may complain of wrist pain

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22
Q

Management of radial neck fx?

A

immobilize (including wrist)

sling, NSAIDs, ortho

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23
Q

comps of radial neck fx?

A

premature physeal closure

loss of ROM

nonunion

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24
Q

MC age range for nursemaid’s elbow?

A

1-3y/o

common cause is sudden pull of pronated arm

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25
Q

Presentation of nursemaid’s elbow?

A

arm either fully extended or slightly flexed and pronated

overall refusal to use arm (may still use fingers)

mild pain over radial head, pain increase w/ attempts to supinate

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26
Q

What are the 2 ways that you can reduce a nursemaid’s elbow?

A
  1. hyperpronation w/ pressure over the radial head
  2. supination, flexion w/ pressure over radial head

then lollipop test

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27
Q

epidemiology of capitellar osteochondrosis “panner disease”

A

Males 5-10yos

dominant (throwing) arm

baseball, gymnastics, handball

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28
Q

Presentation of panner disease?

A

rapid onset of pain

deep, lateral pain

ROM: limited extension

no locking sensation

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29
Q

panner disease PE findings?

A

+/- swelling, TTP

pain/guarding w/ passive extension

lateral pain w/ valgus stress

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30
Q

Management of panner disease?

A

sxs care: ice, NSAIDs, rest

+/- immobilization, PT

avoidance of elbow stress for wks-mos

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31
Q

What is a monteggia fx?

A

ulnar (or radial and ulnar) shaft fracture w/ dislocation of radial head

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32
Q

When might you see a “dinner fork deformity”?

A

wrist fxs

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33
Q

common causes of wrist fractures?

A

direct fall: FOOSH

direct trauma

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34
Q

MC type of wrist fx?

A

distal radius typically involved at metaphysis

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35
Q

Presentation of wrist fx?

A

point TTP, swelling, ecchymosis

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36
Q

Management of wrist fx?

A

emergent w/ sig. clinical deformity or NV compromise

splint, NSAIDs

ortho: cast +/- reduction v. surg

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37
Q

Presentation of femur fx?

A

hx of trauma, pain in groin/buttock, unable to bear weight/walk

prox femur fx: pt will hold leg in slight adduction and external rotation-may see limb shorting

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38
Q

What must you r/o in child presenting with a femur fx?

A

child abuse

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39
Q

management of femur fx?

A

ortho: hip spica cast v. surg

40
Q

comps of femur fx?

A

shortening, lengthening, angulation

41
Q

What is the MC patellar fx seen in kids <13?

A

patellar sleeve fx

42
Q

What causes a patellar sleeve fx?

A

forced extension w/ knee in flexion -jumping, kicking

43
Q

Management of patellar sleeve fx?

A

knee immobilizer, NWB, elevate

NSAIDs

cast v. surg

44
Q

MCC of toddler’s fracture?

A

young child falling while running, twisting mechanism

often clinical dx

45
Q

Management of toddler fx?

A

immobilize

NWB, NSAIDs, elevate

ortho: wee walker v. cast

46
Q

Presentation of fx and sprains of the ankle?

A

TTP, swelling, ecchymosis, WB status varies

47
Q

Management of fx v. sprains of the ankle?

A

posterior v. stirrup splint

elevation, NWB, NSAIDs

ortho consult PRN

48
Q

MOI for triplane fx

A

external rotation

49
Q

What do you need to order to assess displacement of triplane fx (ankle)? other management?

A

CT

ortho: surg fixation v. closed reduction

50
Q

What is a jones, Psuedo-jones/avulsion fx?

A

fx of the base of the 5th MT

51
Q

common MOI for jones fx?

A

traction injury

52
Q

etiology of torticollis?

A

compartment syndrome SCM secondary to venous outflow obstruction

53
Q

presentation of torticollis?

A

head tilt to shortened muscle and chin rotation to contralateral side

eval for assoc. plagiocephaly

54
Q

Tx of torticollis?

A

stretching/PT

positioning education

55
Q

What is considered scoliosis?

A

lateral curve of the spine >10deg

W >M

56
Q

Presentation of adolescent idiopathic scoliosis?

A

typically asxs
+/- pain

obstructive lung sxs if severe

57
Q

PE seen in AIS?

A

shoulder or pelvic obliquity
asymmetry of scapulae
adam’s forward flexion exam

abd reflexes

58
Q

What are you evaluating on imaging in pt w/ scoliosis?

A

cobb angle

59
Q

tx for AIS?

A

TLSO brace: 25 deg

surg; 45 deg

60
Q

What is osteochondritis dissecans (OCD)?

A

idiopathic osteonecrosis of subchondral bone

61
Q

Presentation of OCD?

A

gradual onset of poorly localized deep pain

decreased ROM in elbow but not typically knee

+/- limited WB in LE lesions

+/- int swelling

+ popping, locking or catching in more advanced

62
Q

x-ray findings seen in OCD?

A

flatting of articular surface (crater)

63
Q

Tx of stage I-III OCD? stage IV?

A

conservative, avoid running/jumping
immobilization
+/- PT

surg

64
Q

Presentation of septic hip? What has a similar presentation?

A

leg in flexion, abduction and slight external rotation

refusal to bear weight, walk w/ limp

Transient synovitis can look similar

septic arthritis: febrile, ill appearing

transient synovitis: can follow URI

65
Q

What is used to dif. septic hip from transient synovitis?

A

Kocher criteria:

WBC >12,000
ESR >40 
Fever >101.3 
NWB on affected side 
2/4 criteria warrants joint aspitation
66
Q

Tx of transient synovitis?

A

high dose NSAIDs: dx and theurapeutic

outpt with obs and activity restriction

67
Q

Tx of septic hip?

A

admit to hospital if concern for septic arthritis w/ emergent ortho referral
-joint aspiration or surg identification is diagnostic

drainage and IV abx

68
Q

What is legg-calve-perthes disease?

A

idiopathic AVN of the femoral head

MCly in boys 4-8

typically thin and extremely active

69
Q

Presentation of legg-calve-perthes disease?

A

limp at the end of the day

occasional pain (knee or hip region)

limited internal rotation and/or abduction of the hip

70
Q

dx of legg-calve-pethes?

A

initially dx clinical but confirm w/ x-rays

71
Q

Tx of legg-calve-perthes?

A

obs, PT to improve ROM

activity modification

surg for re-alignment if needed

72
Q

Course of perthes?

A

initial: necrosis of femoral head >
fragmentation: re-absorption of bone w/ femoral head collapse >

re-ossification: new bone formation

Healed (remodeling): femoral head reshapes itself into normal spherical shape

73
Q

What is slipped capital femoral epiphysis (SCFE)?

A

slippage of the femoral physis

74
Q

Epidemiology of SCFE?

A

M> F
peak: 10-16 y/o
OBESITY

75
Q

presentation of SCFE?

A

limp of NWB w/ c/o hip or knee pain (dull, achy)

restricted ROM: abduction and internal rotation

stable v unstable based on WB status

76
Q

dx of SCFE?

A

plain x-rays ( AP pelvis and frog later): ice cream slipping of the cone

MRI if high suspicion and negativex-rays

77
Q

Tx of SCFE?

A

urgent surg consultation for in situ single screw fixation

NWB = admit to hospital

78
Q

What is the MC ortho condition in newborns?

A

developmental dysplasia of the hip (DDH)

F > M

79
Q

screening for DDH?

A

in hospital and at well-child checks:
laxity, subluxation, dislocation

Barlow and Ortolani

80
Q

Greatest risk factors for DDH?

A

1st born

breech position

Fam hx

81
Q

Barlow test

A

provocation maneuver for DDH

flexion, adduction and provide posterior pressure to the joint

82
Q

ortolani test

A

reductive maneuver for DDH

flexion, abduction and posterior pressure to lift greater trochanter

83
Q

(+) Galeazzi sign?

A

apparent limp length discrepancy while supine and knees flexed at 90degs

may be consistent w/ unilateral hip dislocation

84
Q

Management of DDH?

A

ortho referral: palvik harness

avoid swaddling and tight fitting clothes

pt compliance is key

85
Q

What is osgood-schlatter’s disease?

A

inflammation and irritation of patellar tendon insertion on tibial tubercle (osteocondritis)

-traction at tibial tubercle apophysis

86
Q

Presentation of os-good schlatter’s disease?

A

focal TTP to tibial tubercle

enlargement or bony protrusion of tibial tubercle

87
Q

dx of os-good schlatter’s disease?

A

lateral x-ray to r/o avulsion

88
Q

Management of os-good schlatter?

A

rest, NSAIDs, ice

quad exercises and hamstrings stretches

chopat strap

pain flares around time of rapid growth

89
Q

What is calcaneal apophysitis, sever’s disease?

A

irritation, inflammation of calcaneal apophysis

  • overuse syndrome
  • pull of achilles’ tendon
90
Q

Epidemiology of sever’s disease?

A

children age 6-12 y/o

common in soccer players and gymnasts

91
Q

Presentation of sever’s disease?

A

pain at calcaneal apophysis

92
Q

Tx of sever’s disease?

A

stretches, Ice, NSAIDs

93
Q

What is club foot (congenital talipes equniovarus)?

A

fixed deformity

CAVE: 
midfoot Cavus 
forefoot Adductus 
hindfoot Varus 
hindfoot Equinus
94
Q

RF for club foot?

A

fam hx, maternal smoking

may be dx of fetal US

95
Q

Tx of club foot?

A

ponseti method: casting

PEDS 2- clinical disciplines (5 decks)

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