Orthopedics

Question 1

If a child slowly develops limping of the left side over several years and has decreased motion of the hip on exam, what might be going on?

Answer 1

Legg-Perthes Disease – avascular necrosis of of the capital femoral epiphysis

Question 2

If a chubby boy around the age of 13-14 develop groin pain and when they site the affected painful side sole of foot points towards other side. Exam indicates limited hip flexion and thigh goes into external rotation, no internal rotation.

Answer 2

Slipped Capital Femoral Epiphysis

Question 3

A young toddler had otitis media, which the toddler then develops hip pain and refuses to move it or allow others to passively move it. Elevated sed rate.

Answer 3

Septic Hip, aspirate under anesthesia

Question 4

What is the most common cause of severe localized bone pain in the femur without any known trauma in children?

Answer 4

Acute hematogenous osteomyelitis, need abx

Question 5

Who most commonly get scoliosis?

Answer 5

adolescent girls, spine bends to the right

Question 6

What are the most common symptoms of primary bone tumor in children?

Answer 6

• persistant low-grade pain for months
• sunburst appearance on x-ray
• periosteal onion skinning

Question 7

What are the differences in Osteogenic Sarcoma vs Ewing Sarcoma?

Answer 7

Osteogenic Sarcoma – usually around the knee lower femur or upper tibia, 10-25 year olds
Ewing Sarcoma – usually affects diaphysis of bones, younger population 5-15

Question 8

What are the two most common causes of metastatic bone lesions in men and women?

Answer 8

Men – Prostate

Women – Breast

Question 9

If a patient has a clavicular fracture in the proximal 1/3rd, what should be suspected?

Answer 9

pathologic fracture

– middle 3rd and distal 3rd are most common from trauma

Question 10

If there is a broken bone confirmed by x-ray, what should be done additionally?

Answer 10

X-ray the joints above and below the fracture since they can be involved to due to being in the line of force

Question 11

If a patient has a herniated disc, what things should make it worse, if not, then not a herniated disc?

Answer 11

coughing, sneezing, and/or defecating

Question 12

If a patient has hip pain and on exam you notice the leg is shortened, internally rotated, and adducted, what should you be suspicious of?

Answer 12

Posterior Hip Dislocation

Question 13

What is the most common type of hip dislocation and what is it associated with?

Answer 13

Posterior Hip Dislocation, ~90%

– Acetabular Fracture

Question 14

How might an anterior superior and inferior dislocation present as?

Answer 14

anterior superior – extended and externally rotated

anterior inferior – flexed and externally rotated

Question 15

What is the best way to diagnose a dislocated hip?

Answer 15

Plain Film X-ray - Pelvis

Question 16

After a dislocated hip is reduced, what is recommended in follow up?

Answer 16

3-4 weeks post-reduction, MRI should be performed to look at the ligament damage and rule out avascular necrosis of the femoral head.

Question 17

Why is it important to reduce a dislocated hip in a timely fashion if there is no other fracture or injury?

Answer 17

The longer the hip is dislocated the higher risk for avascular necrosis and sciatic nerve damage

Question 18

What are the long term complications from hip dislocation?

Answer 18

• • traumatic arthritis
• • avascular necrosis
• • sciatic nerve damage
• • recurrent dislocations