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RC: Specialties Woo Hoo > Orthopaedic > Flashcards

Orthopaedic Flashcards

1
Q

What does SCFE stand for?

A

SCFE= Slipped Capital Femoral Epiphysis

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2
Q

What is true about SCFE:

  • sports related
  • F > M
  • associated w/ steroids
  • subsequent bone necrosis
A

Complication: subsequent bone necrosis (avascular necrosis)

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3
Q

What is a SCFE?

A

Failure of physis + displacement of femoral head relative to neck.

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4
Q

Classic pop’n for SCFE?

A 
Obese
Black 
Boy
11-16 y.o.
Left > Right
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5
Q

Classic SCFE ppt?

A

Black obese teen

Limp + EXTERNALLY rotated lower limb.

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6
Q

What do you see on XR for SCFE?

A

AP + Frog

  • Blanch sign
  • Klein’s Line (femoral neck does not intersect epiphysis)
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7
Q

How do you tx SCFE?

A

Admit to Hospital
Bed Rest
Ortho Consult
Immediate OR

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8
Q

What are two serious complications of SCFE?

A
  1. Osteonecrosis (avascular necrosis)

2. Chondrolysis (cartilage dissolution)

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9
Q

Picture of club foot. What do you do?

A

Ortho Ref within 1st month= Ponseti casting

Weekly casting
+/- tenotomy for hind foot equinus

Then bracing (boot + braces) x 3 mo. and then nightly

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10
Q

What is the mnemonic to describe Club Foot?

A

Congenital Talipes Equinovarus

= CAVE

  • Cavus= arch
  • Adductus= mid foot
  • Varus = heel supinated
  • Equinus= heel moved up back of leg
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11
Q

T or F: casting for club foot results in delayed motor milestones.

A

False

casting DOES NOT delay motor milestones

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12
Q

Child with achondroplasia. Which is true:

  • decreased life expectancy
  • despite small foramen magnum rarely get SC compression
  • mental retardation
  • spinal stenosis in childhood
A

Small foramen magnum, but few have cord compression

Other complications:

  • OSA
  • restrictive lung dx
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13
Q

How is achondroplasia inherited?

A

AD but most new mutation.

Normal torso but limbs short

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14
Q

List 5 features of achondroplasia:

A
  1. shortened long bones
  2. large head w/ frontal bossing
  3. short metacarpal
  4. Trident hand (tips of fingers can’t touch)
  5. spinal lordosis
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15
Q

T or F: achondroplasia typically have normal IQ.

A

True.

+/- delayed motor milestones but normal IQ.

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16
Q

T or F: achondroplasia have normal life span.

A

yes

  • unless hydrocephalus or spine compression
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17
Q

Which feature is typical for achondroplasia:

  • proximal limb shortening
  • distal limb shortening
  • short mid-portion of bone
  • non-specific shortening
A

Proximal limb shortening (shortening of arms + leg)

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18
Q

Short limb with normal torso. Not walking till 18-24 due to large head. Normal IQ. Dx?

A

Achondroplasia

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19
Q

12 y.o. with L knee pain + swelling. Pain over R heel. FHX (+) for:

  • psoriasis
  • ankylosing spondylitis
  • rheum arthritis
A

Ankylosing Spondylitis

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20
Q

Spondylosis Def’n

A

degeneration of spinal disc
= pain w/ extension

versus vertebral # or disc herniation is pain w/ flexion

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21
Q

Spondylolisthesis Def’n

A

forward slippage

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22
Q

What is legs-calve perthes dx?

A
  • young kids (4-8)
  • male
  • idiopathic AVN of femoral epiphysis
  • less ABduct + INTERNALLY rotate
  • Tx: ROM w/ exercise
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23
Q

What is osgood-schlatter dx?

A

Tendonitis of tibial tubercle
(irritation of patellar tendon at point of insertion on tubercle)

  • teen active boy
  • anterior knee pain
  • Clinical dx
  • quad + hamstring stretch
  • gradual activity
  • knee mobilizer or crutches until pain resolve if severe
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24
Q

What are XR findings of osgood-schlater’s dx?

A

XR to R/O other dx

If finding= fragmentation of tibial tubercle and soft tissue swelling

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25
Q

All are done for Osgood-Schlater except:

  • protective gear
  • ice to reduce swelling
  • stop activities that cause pain
  • quadriceps strengthening once pain resolve
  • cast x 3-4 week
A

NO casting needed

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26
Q

What findings on XR do you see in legg-calve-perthes dx?

A

Small capital femoral epiphysis
Sclerosis of head
Fragmented and collapsed head

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27
Q

Complex Regional Pain Syndrome Signs

A
  • Teen
  • F
  • disproportionate pain
    > allodynia= ht response to pain
    > hyperalgesia= pain to normal stimuli
    > swelling of limb, autonomic indicator like cyanosis, mottling
  • PT + CBT
28
Q

6 wk ankle pain. Can’t wt bear. Foot swollen, red, warm. Likely cause:

  • complex regional pain sun
  • osteo
  • manchaussen
A

Osteomyelitis

29
Q

List two RF for SCFE (slipped capital femoral epiphysis)

A
  • Male
  • Puberty
  • Hypothyroid, Hypo-Pit, Renal osteodystophy
  • Obesity
30
Q

List two steps for managing a SCFE?

A
  1. Admit + Bed rest
  2. BW if < 10 y.o. (to R/O endo like hypothyroid)
  3. OR for pinning
  4. Crutches x 4-6 wk
  5. Prophylactic pin fixation of contralateral side (high risk b/l 60%)
31
Q

How do you tx Legg-Calves-Perthes?

A

ROM with exercise

+/- Casting x 6 week then orthosis

32
Q

What determine poor prognosis for legg-calves-perthes?

A

> 9 y.o. (older you are the less you remodel)

33
Q

1 y.o. with metaphyseal femur #. What is next:

  • Ca2+ Phos and Alk-Phos level
  • full skeletal survey
  • Bone scan
A

Full skeletal survey

Reminder: skeletal survey if < 2 with suspicion of abuse or < 5 with suspicious fracture.

34
Q

T or F: 1/2 of neonate with osteo do not show fever.

A

True

35
Q

How is osteomyelitis primarily spread?

A

Hematogenous

36
Q

Most common pathogen for osteomyelitis:

A
  • Staph aureus, Strep pneumoniae, Strep pyogenes
  • Common neo= GBS, E coli.
  • Penetrating foot= Pseudomonas aeurginosa
  • Sickle Cell= Salmonella
  • Immunocompromised= Fungal, Bacteria
37
Q

How early can you’d detect osteo changes on Bone scan versus XR?

A

Bone Scan: 2-3d

XR: 1-2 wk

38
Q

Mom pulled arm during horseplay. 2 y.o. child now holding pronated. Next:

  • XR
  • Sling then ortho
  • ortho
  • skeletal survey
  • manipulate until arm f’n resotred
A

Manipulate at elbow until arm function restored.

39
Q

What is the most common childhood wrist fracture?

A

Colles Fracture

= # of distal radius
= wrist #

40
Q

Flat feet w/ standing. Arch normal when sitting with feet in air. Dx? Intervention?

A
  1. Hypermobile Pes Planus
  2. No long term problems. Treat if pain, abN shoe wear or fatigue after long walk. Orthosis (support) help symp. Stretch if tight Achilles.
41
Q

Child presents with ER with fever, sore hip, pain. Next?

  • aspirate joint
  • XR
  • CBC
A

Aspirate joint

R/O septic hip

42
Q

3 y.o. hip pain after URTI. Best way to R/O osteo:

  • lack of fever
  • normal WBC
  • (-) BCX
  • bone scan
A

Bone Scan

43
Q

What is the position of septic hip in septic arthritis?

  • ABduct + internal
  • ABduct + external
  • ADDuct + internal
  • ADDuct + external
A

AB duct

EXTERNALLY rotated

44
Q

Most common pathogen for Septic arthritis?

A
  1. Staph Aureus

Other:

  • GAS
  • Streptococcus pneumoniae
  • N. gonorrhoea
  • MRSA

Neo: GBS, Ecoli
Sickle cell: Salmonella

Tx: cefazolin x min. 2 wk

45
Q

Hip pain. Fever. Leg flexed and externally rotated. Two most important condition. 3 test to differentiate

A

Septic arthritis versus Osteo

Joint aspirate
MRI
Bone scan

46
Q

3 y.o. intoeing gait. Tibial torsion and flexible metatarsus adducts. FHX (+). Neuro exam normal. You advice:

  • stop W sit
  • ortho referral
  • no tx as invariably resolve
  • dennis split
  • Xray limbs
A

No tx necessary as invariably resolves

47
Q

2 y.o. flat feet. FHX (+). You suggest:

  • no intervention
  • shoes at all times
  • orthotics
  • foot exercise
  • ortho referral
A

No intervention necessary

Flexible feet until 6 y.o. normal variant. Small will last till 10 y.o. If persistent to adulthood rarely cause issue.

48
Q

18 mo. African immigrant. Not walking. BF only. Now eat fruit. Distal radius, ulna, proximal tibia prominence. Which lab support dx:

  • low 25 OH vit D
  • low ALP
  • low PTH
  • high ionized Ca
A

Low Vitamin D

High PTH

High ALKP for compensation

Features of Rickets
- FTT, muscle wasting, craniotabes, frontal bossing, delayed fontanel closure, rachitic rosary, scoliosis, enlargement of ankle + wrist

49
Q

Name four causes of b/l toe walking

A
  1. Idiopathic (P/E normal and only seen with walking)
    * * 2. Cerebral Palsy
    * *3. Duchenne Muscular Dystrophy
    * *4. Tethered Spinal Cord
    * *5. Autism Spectrum Disorder
50
Q

Best determinant of scoliosis on P/E:

  • leg length
  • asymmetric shoulder ht
  • asymmetric rib cage on bending over
  • asymmetry on lateral flexion
A

Asymmetric Rib Cage on bending over.

51
Q

14 y.o. scoliosis. Cobb angle 50. Most appropriate management?

A

Posterior spinal surgery.

Recommended for skeletally immature pt w/ >45 OR skeletal mature > 50 degree.’

Remember Big Picture:
> 30= brace if skeletal immature (earlier if rapid progression)
> 40 think Sx; > 50 for sure.

52
Q

Teen post-op scoliosis. Bilious vomiting. Wt loss. Abdo pain. Likely Complication

A

Superior mesenteric artery syndrome.

53
Q

List aetiologies of scoliosis:

A
  • Idiopathic (teen)
  • Congenital
  • Neuromuscular
    > CP
    >Charie Marie Tooth
    > Spinal Tumour
    > Spinal Muscular Atrophy
    > Duchenne Muscular Dystrophy
  • Neurologic: tethered cord
    Syndromes
    > NF
    > Marfan
  • Compensation for leg length discrepancy
54
Q

How is scoliosis treated?

A

Big Picture:
30 degree = brace if will progress
>40-50 degree= Sx; 50 and mature= for sure!

Details: Brace

  • immature but > 30
  • progression beyond 25 degree

Details: Posterior Spinal Fusion

  • immature but > 45 degree
  • sekeltal mature with curve > 50 degree
55
Q

Gymnast with lower back pain w/ extension. Normal exam.

  • Spondyloarthropathy
  • Spondylosis
  • Posterior element overuse
  • Vertebral avulsion #
A

Spondylosis
** gymnast, extension with hamstring tight

Tx: avoid painful activity, stretch, PT, +/- brace

vs. posterior overuse= extension pain
vs. vertebral avulsion #= flexion related pain
vs. sponadyloarthropathy= inflamed joint, enthesitis, psoriatic

56
Q

What is most RELIABLE test of screen for DDH in 7 month old?

  • shortening of thigh on affected side
  • less hip aBduction of affected side
  • hip slide out of acetabulum
  • hip slip into socket
A

7 month old
= shortening of thigh on affected side

Barlow, Ortolani only helpful till 3 mo.

57
Q

List positive predictors of septic arthritis:

A
  • fever
  • refusal to wt bear
  • WBC > 12
  • ESR > 40

3 of those= >90% chance septic hip.

58
Q

Describe the classic population for legg calves perthes disease?

A

M
4-8 y.o.
Thin
Hyperactive

Why: physiologically younger than chronological age

59
Q

What are DDH risk factors

A 
First born
F
FHX
frank breech
left

Lecture: if (+) fhx screen with US at 6-8 wk.

other:

  • postnatal positioning
  • native Ca
  • syndromes
60
Q

What are the physical exam findings with DDH:

A

BB:

  • Galeazzi
  • Barlow (in popped out)
  • Ortolani (take the out in)
  • Leg Length Discrepancy

Late:

  • Galeazzi (shortening of dislocated hip when both knee flexed and feet on table)
  • Leg length discrepancy
  • Trendelenberg gait
  • Decreased ABduction
61
Q

At what age are Barlow and Ortolani not helpful anymore

A

After 3 mon. old

Hips are stuck in whatever position they are in then.

62
Q

Best screening tool for DDH in newborn period:

  • serial P/E
  • dynamic US
  • MRI
  • AP and frog XR
A

Serial P/E

Dynamic US have high false positive.

63
Q

When should you do a screening US?

A

6-8 week old

OR once tx started

64
Q

What is the use of AP and Frog leg pelvis in DDH?

A

Can use after 6 months as U/S less helpful.

65
Q

14 y.o. Scoliosis. 38 degree from T4-T12 and 30 degree from T12-L4. 2 year post menarche. No pain. What do you do?

A

Observation.

Pre-menarche highest risk of progression.
Post menarche usually won’t progress.

RC: Specialties Woo Hoo (31 decks)

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