Orthopaedics Flashcards
What are the components of of the Kocher Criteria?
○ Refusal to weight bear
○ ESR > 40
○ WBC > 12
○ Fever >38.5 C
What are the most common organisms in osteomyelitis?
○ Staphylococcus aureus (most common) ○ Group A streptococcus ○ Kingella kingae (higher in infants) ○ Streptococcus pneumoniae ○ Streptococcus pyogenes
In those with Sickle Cell - atypical Gram negatives and salmonella
What antibiotics should be considered if osteomyelitis is suspected?
○ cefazolin IV q 8 hrs +/- vancomycin for MRSA coverage
○ cefuroxime IV q 8 hrs if <4 yoa or unimmunized
may transition to cloxacillin (MSSA) or cephalexin oral when appropriate
consult ID regarding transition to clindamycin or septra for MRSA
What is the most common childhood fracture?
Fracture of distal radius (Torus being the most common pattern, buckle)
At what age should physiological “in-turning” resolve?
Metatarsus adductus - 1 year
Tibial torsion - 5 years
Femoral anteversion - 8-10 years
You are called to see a child with bowed legs. Weight is >97th %ile and height is at 50th %ile. They began walking at age 9 months of age. What is your main concern?
Blount disease (Idiopathic tibia vara)
may brace if <3 and less than stage 3. Otherwise will need to treat operatively
What are the risk factors for blount disease?
- African-Americans
- Toddlers who are overweight
- Those with an affected family member
- Children who started walking early in life
A child presents with unremitting and gradually increasing pain that is worst at night and relieved by aspirin. What is your suspicion?
Osteoid osteoma
- X-ray will show a round/oval metaphyseal or diaphyseal lucency
(any bone can be affected by proximal femur and tibia are most common)
Features of osteochondroma
- bony, nonpainful mass
- irritated by pressure during athletic activity
- distal femur, proximal humerus and proximal tibia are most common
What is the difference between unicameral bone cysts and aneurysmal bone cysts?
- ABC will have fluid levels
- ABCs will have more rapid growth; concern for malignancy as ddx
- UBCs are usually in the proximal humerus or femur, ABCs can be in any bone (usually the femur, tibia or spine)
What is the bone condition expected in McCune Albright Syndrome?
Fibrous dysplasia
What are the 4 components of a club foot?
CAVE
Cavus - plantarflexion
Adductus
Varus - of the hindfoot
Equinovarus - of the hindfoot
Treatment for clubfoot
Serial casting (Ponseti method) with percutaneous tenotomy of heel cord, followed by abduction brace full-time x 3 months and night time abduction brace x 3-5 years
What is Caffey’s Disease?
Cortical hyperostosis with inflammation of the fascia and muscle (mandible (75%), clavicle and ulna)
Think baby with swollen, puffy and painful cheeks with wood-like induration
Tx: indomethacin and prednisone
What is the cause of a nursemaid’s elbow?
Subluxation of the radial head caused by longitudinal traction applied to an extended arm
This causes pain and the child will hold their arm pronated and flexed into their chest