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Pediatrics- Noelle > orthopedics > Flashcards

orthopedics Flashcards

1
Q

what causes buckle fracture, treatment

A

FOOSH

cast if symptomatic

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2
Q

what are greenstick fractures

A

incomplete fractures of long bones

typically children <10 yo

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3
Q

what is the salter Harris clasification

A

SALTR
type I
slipped
5-7%
fracture plane passes all the way through the growth plate, not involving bone
cannot occur if the growth plate is fused
good prognosis

type II
above
~75% (by far the most common)
fracture passes across most of the growth plate and up through the metaphysis
good prognosis

type III
lower
7-10%
fracture plane passes some distance along with the growth plate and down through the epiphysis
poorer prognosis as the proliferative and reserve zones are interrupted

type IV
through or transverse or together
intra-articular
10%
fracture plane passes directly through the metaphysis, growth plate and down through the epiphysis
poor prognosis as the proliferative and reserve zones are interrupted

type V
ruined or rammed
uncommon <1%
crushing type injury does not displace the growth plate but damages it by direct compression
worst prognosis
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4
Q

Ossification centres about the elbow

A 
ossification centers always appear in a specific sequence
Capetellum- 1
Radius- 3
Internal (medial) epicondyle- 5
Trochlea- 7
Olecranon- 9
External (latreral) Epicondyle- 11
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5
Q

what is monteggia fracture

A

fracture of proximal 1/3 of ulna and radial head dislocation

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6
Q

A corner fracture is pathognomonic of what?

A

child abuse

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7
Q

what is the treatment for sever’s disease?

A

achilles stretching activity modifications and symptomatic treatment
nelsons: relative rest, ice, massage, stretching and strengthening the achilles tendon
symptoms frequently improve in 4- 8 weeks

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8
Q

name 3 overuse syndromes

A

osgood schlauer disease
sinding-larsen Johansson
sever’s disease
tx: symptomatic with NSAIDs, rest and and activity modification, physiotherapy

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9
Q

what is considered to be the threshold for scoliosis

A

10 degree curve is considered to be the threshold for scoliosis

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10
Q

congenital scoliosis is associated with what?

A

VACTERL

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11
Q

what are some red flags for scoliosis

A 
history:
pain
gait changes
weakness
rapid progression
bowel/bladder
physical:
foot deformity
hypnotic thoracic spine
abnormal reflexes
abnormal pattern
signs of dysraphism (Myelomeningocele: Can cause incontinence, hydrocephalus, tethered cord, sensory loss, orthopedics deformities, leg weakness and/or or paralysis.)
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12
Q

what are some risk factors for progression for adolescent idiopathic scoliosis? (4)

A 
larger curve (>30)
thoracic curve (> lumbar)
double primary curve
physiologic age (based on menarche Risser grade)
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13
Q

curve <20
>20
risk of progressing?

A

<20- low risk of progressing

>20- higher risk of progressing therefore should refer to ortho

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14
Q

what degree for surgery for scoliosis? bracing?

A

surgery >40

bracing >25

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15
Q

who should you refer with scoliosis? (5)

A 
atypical curve (left sided)
skeletally immature, curve >/= 20 at presentation
skeletally immature, progressive curve
rapid progression/pain
skeletally mature, curve >45
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16
Q

Clubfeet- CAVE

A

C- cavus
A- adductus
V- varus
E- equinus

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17
Q

what is the treatment for club feet

A

ponseti method

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18
Q

what type of intoning do we see for
infants
toddlers
child/adolescent

A

infants- metatarsus adductus
toddlers- internal tibial torsion
child/adolescent- increased femoral anteversion (internal hip rotation)

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19
Q

what is the treatment for intoeing

A

typically improves with growth and development
no evidence of significant long term effects
no imaging required
takes years to improve
would not operate until done growing (>12 anyways)

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20
Q

what are some warning signs of genu valgum

A 
progressive deformity
asymmetry
persistence beyond expected age
short stature
beyond 2 standard deviations
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21
Q

what are some urgent causes of limp? (6)

A 
septic arthritis hip
SCFE
osteomyelitis
discitis
fracture
neoplasia
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22
Q

DDx limping child >10

A

Non-painful:
LLD

Painful:
SCFE
Juvenile arthritis
overuse syndromes
osteo/septic arthritis
tumors
discoid meniscus
osteochondritis dissecans
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23
Q

osteochondritis dissecans

A

small segment of bone begins to separate from its surrounding region due to a lack of blood supply.

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24
Q

DDx limp 4-10

A 
Non-painful
DDH
congenital limb deficiencies
neuromuscular conditions
LLD
discoid meniscus
Painful
septic arthritis
Perthes
transient synovitis
osteomyelitis
disci tis
trauma
tumors
overuse apophysitis
osteochondritis dissecans
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25
Q

Ddx limp <4

A

Non-painful
DDH
congenital limb deficiencies
neuromuscular conditions

Painful:
toddlers fracture
osteomyelitis
septic arthritis
transient synovitis
reactive arthritis
juvenile arthritis
tumors
trauma
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26
Q

what is the most common bug to cause pediatric septic arthritis?

A

staph aureus

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27
Q

what is the treatment for septic arthritis?

A

aspiration of the joint

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28
Q

what imaging should you do for SCFE

A

xray AP and frog leg pelvis

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29
Q

Ottawa ankle rules

A

An ankle X-Ray series is only required if there is any pain in the malleolar zone and…
Bone tenderness at the posterior edge or tip of the lateral malleolus (A)
OR
Bone tenderness at the posterior edge or tip of the medial malleolus (B)
OR
An inability to bear weight both immediately and in the emergency department for four steps

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30
Q

foot x ray rules

A

A foot X-Ray series is only required if there is any pain the midfoot zone and…
Bone tenderness at the base of the fifth metatarsal (C)
OR
Bone tenderness at the navicular (D)
OR
And inability to bear weight both immediately and in the emergency department for four steps

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31
Q

Risk factors for DDH (4)

A 
Risk Factors:
• First Born
• Female
• Family history
• Frank breech
32
Q

where does sever’s disease occur

A

at the insertion of the Achilles tendon into the calcaneus

- present with pain with squeezing the heel (positive squeeze test)

33
Q

where do we see osteosarcoma

A

metaphysis of long bones

34
Q

what 2 conditions predispose you to osteosarcoma

A

hereditary retinoblastoma

Li-Fraumeni syndrome

35
Q

what is the classic X-ray finding for osteosarcoma? tx?

A

sunburst appearance

chemo, surgery

36
Q

where do we see Ewings sarcoma? what is the classic xray finding

A

diaphysis of long bones, axial skeleton
onion skinning appearance
tx: chemo, surgery +/- radiation

37
Q

what is spondylolysis

A

common cause of back pain in athletes
stress fracture of the pars interarticularis
most likely at L4/L5
acute hyperextension causes an acute fracture

38
Q

what is spondylolethesis

A

with spondylolysis you get displacement of one vertebrae over another

39
Q

what is the treatment for SCFE

A

admit to hospital
bed rest
percutaneous pinning
partial weight bearing with crutches for 4-6 weeks after surgery

40
Q

2 complications of SCFE

A

avascular necrosis

chondrolysis (destruction of articular cartilage)

41
Q

what are some risk factors for SCFE (5)

A 
obese
male
African American
history of radiation therapy
endocrinopathies (GH and hypothyroid)
42
Q

what is the natural history of untreated DDH

A

• Dysplasia: Inadequate development of femoral
head and/or acetabulum or both
– Maybe associated with degenerative arthritis

• Subluxation
– Associated with degenerative arthritis

• Dislocation
– Early degenerative arthritis
– Limb length inequality
– Scoliosis
– Ipsilateral knee pain
– Gait abnormality
– Low back pain
43
Q

What are some complications of missed DDH (5)

A 
Clinically disabling degenerative arthritis
Limb length inequality (if unilateral)
Scoliosis
Ipsilateral knee deformity and pain
gait abnormality
44
Q

what are two treatment options for DDH

A

Pavlik (for 6 weeks)

closed reduction and spica cast(if older than 6 months of failed pavlik)

45
Q
  1. A 14-year-old girl with spina bifida at the T12 level presents with a one-day history of a swollen leg and foot with erythema over the anterior tibia. Temp 37.8. WBC 16. ESR 22. Most likely:
    a) fracture
    b) cellulitis
    c) osteomyelitis
    d) deep venous thrombosis
    e) erythema nodosum?
A

Fractures in children with myelomeningocele can present with marked swelling and redness, and may be mistaken for osteomyelitis. Physeal fractures in children with myelomeningocele can compromise bone growth.

46
Q

A patient has a scoliosis Cobb angle of 50 degrees. What is the treatment ?
Spinal fusion
Repeat x-ray
Orthotic brace

A

spinal fushion

47
Q

what is the kocher criteria? (4)

A
  1. fever >38.5
  2. wbc >12 000
  3. ESR >40, CRP >20
  4. unable to weight bear
48
Q

In children suspected of having an anterior shoulder dislocation, which nerves should you check are intact?

A

Axillary nerve: deltoid contraction and sensory patch over deltoid
Musculocutaneous nerve: biceps contraction and sensory patch on lateral forearm

49
Q

What are the indications for open reduction?

A

NO CAST

N - non-union
O - open fracture
C - compromise of neurovasculature
A - intra-articular fracture
S - Salter Harris type 3, 4, 5
T - polytrauma
50
Q

In anterior shoulder dislocation, what tests can you perform to confirm the diagnosis?

A
  1. Apprehension test: abduct and externally rotate the arm and should see apprehension in the patient’s face since it re-creates a feeling of anterior dislocation
  2. Relocation test: posteriorly direct a force during the apprehension test to relieve apprehension
51
Q

What are two conditions to rule out in a child with fever and limb pain?

A
  1. osteomyelitis

2. septic arthritis

52
Q

Top common causes of septic arthritis? (3)
In neonates?
In sickle cell?
In teenagers?

A
  1. Staph aureus
  2. Strep pneumonia
  3. Non Group A strep
  4. Kingella Kingae

In neonates: GBS and gram negatives

Sickle cell: Salmonella

Teenagers: gonorrhea

53
Q

What is the prognosis of transient synovitis?

More common in boys or girls?

A

typically resolves in 7-10 days

more common in boys

54
Q

where is the most common site for metastasis for osteosarcoma?

A

the lungs

55
Q

What are clinical features of osteogenesis imperfecta? (5)

-what is the diagnostic test for OI?

A
  1. Blue sclera
  2. Wormian sutures: extra bones in between sutures
  3. Cortical bone thinning
  4. Dentinogenesis imperfecta
  5. Triangular facies
  6. Late onset hearing loss in 50% of children
    - diagnostic test: fibroblast testing or DNA testing
56
Q

A patient presents to you with leg pain that occurs solely at night. What is your differential diagnosis? (3)

A
  1. Malignancy: osteosarcoma, Ewing sarcoma
  2. Osteoid osteoma (benign)
  3. Growing pains
57
Q

McCune-Albright syndrome is associated with what skeletal abnormalities?

A

Polyostotic fibrous dysplasia

58
Q

A 15-year-old with tibial pain (worse at night and relieved by nonsteroidal anti-inflammatory drugs) has a small lytic area surrounded by reactive bone formation on x-ray. What is the likely diagnosis?

A

Osteoid osteoma, a benign bone-forming tumor

59
Q

How is metatarsus adductus treated?

A

passive stretching

60
Q

How are clubfeet treated?

A

Most clubfeet respond well to serial casting using the Ponseti method.

61
Q

What systemic conditions are associated with SCFE? (5)

A

hypothyroidism, panhypopituitarism, hypogonadism, rickets, and irradiation.

62
Q

what are the three screening tests for DDH

A

barlow- clunk for dislocation (posterior force)
ortolani- clunk of reduction (abduction)
galeazzi- inequality in the height of the knees

63
Q

what imaging do you do for DDH up to 6 months? after 6 months?

A

up to 6 months- ultrasound

after 6 months- x ray

64
Q

when should you do an ultrasound for DDH

A

at 3-4 weeks of age

65
Q

what are 4 consequences of inadequate treatment of septic hip?

A
  1. septic hip dislocation
  2. AVN
  3. arthritis
  4. growth arrest
66
Q

at what age do we see perthes disease

A

4-12 yo

67
Q

where do patients with SCFE feel their pain?

A

medial thigh or knee (referred pain from the hip)

68
Q

Differential for painful knee (4)

A 
Discoid Meniscus
Osteochondritis Dissecans (Lateral portion of medial
femoral condyle)
Patellofemoral (Anterior) knee pain
Osgood Schlatter’s Disease
69
Q

calcaneovalgus foot deformity is sometimes associated with what? does it need treatment?

A

Sometimes associated with posteromedial bowing of tibia

due to a packaging problem resolves spontaneously

70
Q

what is the cause of flexible flat feet? do they need orthotics?

A

due to ligamentous laxity
arch reconstitutes with standing on tiptoes
do not need orthotics or treatment

71
Q

what causes rigid flat feet

A

tarsal coalition

need casting x 6 weeks then surgery

72
Q

Valgum

A

gum makes your knees stick together

knock knees

73
Q

Varum

A

rum makes your knees spread apart

74
Q

Adolescent girl with scoliosis has undergone spinal surgery. She present with bilious vomiting for the last few days. What is the etiology?

a. bowel adhesions
b. superior mesenteric artery syndrome
c. malrotation with volvulus
d. Pancreatitis

A

superior mesenteric artery syndrome

In younger patients, superior mesenteric artery syndrome is most commonly described following corrective spinal surgery for scoliosis.

75
Q

what are 4 causes of toe walking

A
  1. CP
  2. muscular dystrophy
  3. short achilles tendon
  4. Autism

Pediatrics- Noelle (28 decks)

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