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X Pediatrics 2 > Orthopedics > Flashcards

Orthopedics Flashcards

1
Q

Characteristics of the periosteum

A

Metabolically more active (promotes callus formation, remodeling ability)
Thicker and more durable (less likelihood of displacement and gives unique fracture presentations)

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2
Q

What are some apophyseal injuries?

A

Fibrocartilage
Fusion over time
Site of tendon or ligament attachment
Prone to overuse with inflammation or avulsion injuries
(bony prominences arising from separate ossification centers)
-growth plates that don’t add to length of bone

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3
Q

What are occult fractures?

A

Fractures not initially evident on plain radiographs

Toddlers, Salter Harris 1, non-displaced elbow fractures or stress fractures

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4
Q

What is the epiphysis vs metaphysis?

A

Epiphysis is at the end of the bone past the growth plate and metaphysis is between growth plate and shaft

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5
Q

Salter Harris Classification

A 
1- Separate/straight across
2- Above into metaphysis
3- Lower/beLow into epiphysis
4- Two/Through both
5- Reduced/ERasure of growth place/cRush
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6
Q

What the the type 1/ slipped fracture?

A

“Epiphyseal slip”
Separation through the physis
Excellent prognosis- non operative management

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7
Q

What is the type 2 fracture?

A

Above physis
Fracture through part of physis that extends through metaphysis
Excellent prognosis- likely non-operative management

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8
Q

What is the type 3 fracture?

A

Lower to physis
Fracture through part of physis that extends through epiphysis and often involves joint space
Unstable prognosis
+/- operative management

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9
Q

What is the type 4 fracture?

A

Fracture through metaphysis, physis and epiphysis
Unstable prognosis and can lead to limb length discrepancies
+/- operative management

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10
Q

What is the type 5 fracture?

A

ERasure of the physis
Crush injury to the physis
Unstable prognosis can lead to limb length discrepancies
+/- operative management

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11
Q

Types of fractures unique to kids

A

Bowing
Torus/buckle
Greenstick

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12
Q

What are the elbow ossification centers?

A

CRITOE (in order of ossification)

1: Capitellum
3: Radial head
5: Internal (medial) epicondyle
7: Trochlea
9: Olecranon
11: External (lateral) epicondyle

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13
Q

What is the most common pediatric elbow fracture?

A

Supracondylar humeral fracture (most <10 YO)

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14
Q

MOI for supracondylar humeral fracture

A

Fall from moderate height (FOOSH typically with hyperextension)

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15
Q

Presentation of supracondylar humeral fracture

A

Swelling, pain, maybe deformity

Must do NV exam (median nerve at anterior interosseus nerve-pt not making an OK sign)

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16
Q

What diagnostics are used for a supracondylar fracture?

A

Xray: AP, lateral and oblique

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17
Q

What wouldn’t be seen on the x-ray for a supracondylar fracture?

A

Anterior humeral line will not intersect the capitellum

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18
Q

Management for type I/II supracondylar fracture

A

Splint with light overwrap (avoid elastic bandages)
Sling, NSAIDs
Ortho refer and maybe reduction for type II
Then immobilize for 3 wks

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19
Q

Management for type III supra condylar fracture or ones with neurovascular concerns

A

Emergent ortho consult

Closed reduction percutaneous pin fixation or open reduction

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20
Q

Most common Salter Harris fracture

A

II- above

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21
Q

Presentation of lateral humeral condyle fracture

A

Soft tissue swelling concentrated to lateral elbow

TTP over lateral condyle

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22
Q

How might a lateral humeral condyle fracture look on xray?

A

Like small sliver on the imaging due to large cartilaginous portion

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23
Q

Diagnostic views for lateral humeral condyle fracture

A

AP, lateral and internal oblique focused on lat. condyle

maybe MRI

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24
Q

When do you need an emergent referral and surgery for lateral humeral condyle fracture?

A

Displacement > 2 mm on internal oblique view

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25
Q

Management for lateral humeral condyle fracture

A 
Splint, sling, NSAIDs
Casting vs surgery
Immobilize for 6 wks
Open reduction with screw fixation
High risk for complications!
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26
Q

MOI for medial humeral epicondyle fracture

A 
(think baseball player)
Muscle attachment avulsion- throwing or gymnast
FOOSH with arm fully extended
Secondary to posterior elbow dislocation
Hear a "pop"
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27
Q

Presentation of medial humeral epicondyle fracture

A

Localized pain
Pain with resisted flexion
Ulnar nerve dysfunction

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28
Q

Imaging views for medial humeral epicondyle fracture

A

AP, lateral and external oblique

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29
Q

What do you need to r/o in medial epicondyle fracture?

A

Incarceration of fragment in joint (use advanced imaging if needed)

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30
Q

Management for medial epicondyle fracture

A

Emergent if trapped fragment
Splint with wrist also or sling
NSAIDs
Short term immobilization vs open fixation

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31
Q

Complications for medial epicondyle fracture

A

Ulnar nerve palsy
Nonunion
Angular deformity
Decreased ROM

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32
Q

Presentation of radial neck fracture

A

TTP over radial head/neck
Pain with supination and pronation is worse than with flexion and extension
Young kids may have wrist pain!

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33
Q

Diagnostic view for radial neck fracture

A

AP, lateral and external oblique (to flatten head of the radius)

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34
Q

How to diagnose a radial neck fracture in a kid younger than 3-5?

A

Clinical b/c radial head not ossified yet

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35
Q

Management of radial neck fracture

A

Immobilize with wrist (sling)
NSAIDs
Cast vs surgery

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36
Q

Complications for radial neck fractures

A

Premature physeal closure
Loss of ROM
Nonunion

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37
Q

What is nursemaid’s elbow?

A

Subluxation of the radial head (commonly 1-3 YO) due to sudden pull of pronated arm

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38
Q

Presentation of nursemaid’s elbow

A

Arm fully extended or slightly flexed and pronated
Refuse to use arm but maybe use fingers!
Mild pain over radial head
Pain increased with supination

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39
Q

Imaging for nursemaid’s elbow

A

Not usually required

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40
Q

Management of nursemaid’s elbow

A

Reduce by either hyperpronation with pressure over radial head OR supination/flexion with pressure over radial head
Lollipop/popsicle test (grab with injured arm)

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41
Q

Common causes of wrist fracture

A

Direct fall (FOOSH) or direct trauma

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42
Q

Most common wrist fracture

A

Distal radius at metaphysis (maybe ulnar involvement)

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43
Q

Presentation of wrist fracture

A

Point tenderness, swelling, ecchymosis

Dinner fork deformity

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44
Q

Imaging for wrist fracture

A

AP/lat and maybe oblique

SH I is clinical without any xray findings

45
Q

When is a wrist fracture emergent?

A

Significant clinical deformity or NV compromise

46
Q

Management for wrist fracture

A

Splint and NSAIDs

Ortho: cast, reduction vs surgery

47
Q

Presentation of femur fracture

A

History of trauma
Pain in groin or butt
Unable bear weight/walk
If proximal femur then hold leg in slight adduction and external rotation (Shorten limb)

48
Q

What is a femur fracture due to when less than 1?

A

Child abuse

49
Q

Diagnostics for femur fracture

A

Must xray entire length of femur for proper eval

50
Q

Management for femur fracture

A

Ortho: hip spica cast or surgery

complication: shorten or lengthening, angulation

51
Q

What is a patellar sleeve fracture?

A

Unique to kids (most common patellar fx <13)
Caused by forced extension with knee in flexion
Either at superior or inferior pole of patella
*jumping/kicking etc

52
Q

Management for patellar sleeve fracture

A

Knee immobilizer (in full extension), NWB, elevate
NSAIDs
Cast vs surgery

53
Q

MOI for toddler fracture

A

Falling while running/twisting (slides!!)-spiral fx

54
Q

Presentation of toddler fracture

A

Limp or NWB (might mistake for foot)

TTP along tibia typically mid to distal diaphysis

55
Q

Problem with diagnostics in toddler fracture

A

May be occult on initial films

56
Q

Management for toddler fracture

A

Immobilize (splint/wee walker)

NWB, NSAIDs, elevate

57
Q

What is a triplane fracture of the ankle?

A

MOI external rotation
SH III on AP and SH II on lateral (SH IV- b/c growth plate had started to fuse)
CT to assess displacement*
Surgical fixation vs closed reduction

58
Q

Management for fracture or ankle sprain

A

Initial the same
Posterior vs stirrup splint
Elevate, NWB, NSAIDs
Refer most pediatric ankle injuries

59
Q

How do you prevent recurrence or ankle sprain or fracture?

A

Reconditioning (PT and home exercise programs)

60
Q

What is a torticollis?

A

Unilateral contraction of SCM muscle with visible shortening

61
Q

Cause of torticollis

A

Compartment syndrome of SCM secondary to venous outflow obstruction

62
Q

Presentation of torticollis

A

Head tilt to shortened muscle and chin rotation to contralateral side
(evaluate for plagiocephaly-flat head)

63
Q

Tx for torticollis

A

Stretching/PT and positioning education

64
Q

What is scoliosis?

A

Lateral curvature of spine >10 degrees

65
Q

Types of scoliosis

A

Congenital/infantile: 0-3
Juvenile: 4-9
Adolescent: over 10
(younger is more concerning)

66
Q

Presentation of adolescent idiopathic scoliosis

A 
Usually asymptomatic (maybe pain)
Obstructive lung sxs if severe
67
Q

Exam for adolescent scoliosis

A

Shoulder or pelvic obliquity
Asymmetry of scaps
Adams forward flexion exam (paraspinal prominences)
Abdominal reflexes

68
Q

Imaging for adolescent scoliosis

A

AP/PA standing regular xray on long cassette

Cobb angle

69
Q

Tx for scoliosis

A

TLSO:brace for 25 degrees (bending)
Surgery: 45 degrees and internal rod fixation

70
Q

What is a septic hip diagnosis?

A

Emergent!!!!

peak in first few mos and then b/w 3-6

71
Q

Reasons for a septic hip

A

Direct inoculation from trauma or surgery
Hematogenous seeding
Spreading of osteomyelitis from adjacent bone

72
Q

Presentation of septic hip

A

Febrile and toxic appearing
Monoarticular pain: severely exacerbated with passive ROM
NWB
(might think psoas abscess or transient synovitis)

73
Q

Most common cause of pediatric hip pain

A

Transient synovitis

74
Q

Presentation of transient synovitis

A

Appear well (afebrile)
Pain worse in AM and improves during day
Recent URI
(3-8 YO and male)

75
Q

Management for transient synovitis

A

NSAIDs (improves in first 2 days and resolve in 1 wk)

Must rule out septic arthritis

76
Q

How do you differentiate septic hip and transient synovitis?

A 
Kocher criteria:
WBC>12,000
ESR>40
Fever >101.3
NWB on affected side
2/4 warrants joint aspiration (if have 3 then 93% chance of septic hip)
Also CRP>2
77
Q

Imaging for septic hip

A

AP and frog leg lateral pelvic (normal early and might see potential joint space widening)
US for effusion and aspiration and maybe MRI

78
Q

Septic hip management

A

Operative: surgical I&D (joint aspiration or surgical ID is diagnostic)
Abx: cephalosporing IV (b/c s aureus mostly)
Older pt might be due to n gonorrhoeae so high dose penicillin

79
Q

What is legg-calve-perthes?

A

Juvenile idiopathic osteonecrosis of the femoral head

Necrosis–fragmentation–re-ossification–healed/remodel

80
Q

Who do you see legg-calve-perthes in more?

A

Whites (4-8) and male

maternal smoking or second hand smoke

81
Q

Association of legg-calve perthes

A

Hyperactivity (ADHD)

82
Q

Presentation of Perthes

A

Painless limp or insidious onset of pain (hip, groin, thigh or knee)-activity related so worse at end of day and relieve with rest
Muscle spasticity
History of minor trauma

83
Q

Most useful PE finding for Perthes

A

Limited internal rotation or abduction of hip

(may also see antalgic limp or trendelenburg limp_

84
Q

What is a later finding in Perthes?

A

Limp length discrepancy for positive Galeazzi

85
Q

Mainstay imaging for Perthes

A

AP and frog lateral radiograph (usually normal initially)

86
Q

What is seen on imaging with disease progression of Perthes?

A

Fragmentation and remodeling

87
Q

Best prognostic factor in Perthes

A

Age (younger onset is better outcome)

88
Q

Perthes tx

A

Symptomatic control and preserve hip function

89
Q

When do you see slipped capital femoral epiphysis most?

A

M, African Americans (10-16)

Obesity is a risk!!

90
Q

Presentation of SCFE

A

Limp or NWB c/o dull/achy hip or knee pain
Restricted ROM: abduction and internal rotation
Stable vs unstable based on WB status

91
Q

Highly suspicious of SCFE but negative x ray

A

MRI (after have done AP pelvis and frog lat)

92
Q

Tx for SCFE

A

In situ single screw fixation

NWB is admit to hospital!

93
Q

What do you evaluate for in developmental dysplasia of the hip (DDH)?

A

Laxity, subluxation or dislocation

94
Q

Risk factors for DDH

A

1st born, female, breech position, FHX

95
Q

Test for DDH

A

Positive Barlow or Ortolani (clunking sensation)

Galeazzi: affected hip is shortened in comparison

96
Q

Management DDH

A

Ortho (pavlik harness), not tight clothes

Monitor with U/s monthly and x-ray to monitor after 6 mos

97
Q

What is Osgood-schlatters?

A

Inflammation and irritation of patellar tendon insertion on tibial tubercle (osteochondritis)
Traction at tibial tubercle apophysis

98
Q

Presentation of Osgood-schlatters

A

Focal tenderness to tibial tubercle

Enlargment or bony protrusion of tibial tubercle

99
Q

Imaging for Osgood-schlatters

A

Lateral xray to r/o avulsion

100
Q

Management for Osgood-schlatters

A

Good days and bad
Rest, NSAIDs, ice, stretching, chopat strap
Pain flares at rapid growth times (10-11 in girls and 13-14 in boys)

101
Q

What is calcaneal apophysitis/Severs?

A

Irritation and inflammation of calcaneal apophysis due to overuse and pull of achilles
Pain at apophysis

102
Q

When see Severs more often

A

6-12 YO (soccer players and gymnasts)

103
Q

Tx for severs

A

Stretch, Ice, NSAIDs

104
Q

What is congenital talipes equinovarus?

A

Club foot- fixed deformity

Risks: FHX or mom smokes

105
Q

Types of clubfoot?

A 
CAVE
midfoot Cavus
forefoot Adductus
hindfoot Varus
hindfoot Equinus
Might not need to memorize
106
Q

How to tell which foot is affected with clubfoot

A

Affected limb has smaller foot and calf with shortened tibia

107
Q

Tx for clubfoot

A

Ponseti method for 4-6 wks

108
Q

Normal alignment by age

A

6 mos slight varus
18 mos straight
4 yrs slight valgus
Young adult straight

109
Q

Blount’s disease

A

Varus due to vit D deficiency

X Pediatrics 2 (10 decks)

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