Orthopaedics Flashcards
You are working in the fast-track area of a paediatric emergency department, and you see a 13-year-old female who has rolled her ankle. She has rolled both of her ankles on multiple occasions and feels it takes a long time to recover from these injuries. She is otherwise well.
O/E:
- pes planus bilaterally without correction on heel raise
- swelling and tenderness to the lateral aspect of her right ankle
You make a provisional diagnosis of right anterior talofibular ligament sprain.
You decide to do an ankle x-ray because you are concerned about:
Tarsal Coalition: important diagnosis to consider and is a fibrous bony connection between two or more of the tarsal bones. It can be diagnosed on x-ray. It is often bilateral, is congenital but not usually symptomatic until the second decade of life when the coalition ossifies. It often presents with recurrent ankle sprains and slow recovery.
A three and a half-year-old boy presents after falling off a coffee table at home. He has sustained an injury to his right elbow and is complaining of a ‘funny feeling’ in his right thumb and forefinger. On examination he has obvious deformity of his right elbow with a strong radial pulse and normal capillary refill of his nail beds. An X-ray of his elbow is shown below. Which of the following movements is most likely to be affected on clinical examination?
Abduction of the fingers - ulnar nerve
Adduction of the fingers - ulnar nerve
Thumb abduction - median nerve
Thumb adduction - ulnar nerve
Wrist extension - radial nerve
Supracondylar fractures are the most common elbow fracture
Incidence of nerve injury is 15% - often a neuropraxia that resolves within 4 months
Median nerve injuries, including injury to anterior interosseous nerve - occurs with posterolateral displacement of the distal fragment
Radial nerve injuries are seen more often with posteromedial displacement
Vascular injury - brachial artery
A 14-year-old girl presents with intermittent knee pain following a netball injury. An X-ray of her knee is shown (show’s sunbursting). The most likely diagnosis is:
The tumour is solid, hard, irregular (“fir-tree,” “moth-eaten” or “sun-burst” appearance on X-ray examination) due to the tumour spicules of calcified bone radiating in right angles. These right angles form what is known as Codman’s triangle. Surrounding tissues are infiltrated.
Aneursymal bone cyst
Radiographic findings usually consist of an eccentric or, less commonly, a central or subperiosteal lesion that appears cystic or lytic. Images may show expansion of the surrounding bone with a blown-out, ballooned, or soap-bubble appearance.
Ewing sarcoma
Most common osseous presentation is a permeative lytic lesion with periosteal reaction. The classic description of lamellated or “onion skin” type periosteal reaction/elevation is often associated with this lesion.
Blount’s disease
can be infantile or adolescent. The infantile form presents before the age of four years and is more common in children of African descent. Obesity is also a risk factor. Children often walk earlier and the bowing becomes more pronounced once walking.
condition found in children that affects the growth plates around the knee. The disease causes the growth plate near the inside of the knee to either slow down or stop making new bone.
“tibia vara”
In long QT (LQT) syndrome, subtypes LQT1 and LQT2 account for the majority of cases. Both are caused by genetic mutations that alter ion movement during the cardiac action potential.
Which of the following ion movement abnormalities occurs in the cardiac action potential of patients with LQT1 and LQT2 mutations?
Prolonged potassium efflux is seen in LQT1 and LQT2 resulting in prolonged QT interval.
Prolonged sodium influx is seen in LQT3 due to SCN5A mutation.
Prolonged calcium influx would shorten QT interval. Prolonged calcium efflux is not known to be associated with LQT syndrome.
