Orthopedics

Question 1

By what point should infants triple their birth weight?

Answer 1

1 year

Question 2

Treatment of developmental dysplasia of the hip

Answer 2

<6 months Pavlik harness (holds hips flexed)

Question 3

Legg-Calve-Perthes disease

Answer 3

Noted ages 4-8yo; limited internal rotation, avascular necrosis of femoral head.

Question 4

SCFE

Answer 4

Dehiscence of capital femoral growth plate, proximal femoral neck migrates anteriorly and laterally. Internal rotation limited and child limps. Management is surgical!

Question 5

Treatment of clubfoot

Answer 5

ponseti casting

Question 6

What are the Ottawa ankle rules?

Answer 6

An Ankle x ray is required only if: Any pain in the malleolar zone AND 1.) bony tenderness along distal 6cm of posterior edge of tibia or tip of medial malleolus OR 2.) Bony tenderness along the distal 6cm of posterioir edge of fibula or top of lateral malleolus OR 3.) Inability to bear weight in the ED for 4 steps.

Question 7

What is the most likely cause of death for patient with achondroplasia?

Answer 7

Cervicomedullary junction compression.

Question 8

Congenital torticollis

Answer 8

An infant with head tilited to one side, a mass in the sternocleidomastoid muscle and or facial asymmetry. Treated with daily stretching and physical therapy - if no improvement in one year - needs surgery

Question 9

Paroxysmal torticollis

Answer 9

Migrain variant seen in infants - repeated attacks of head tilting, last for only a few minutes at a time. No intervention necessary

Question 10

Which side is developmental dysplasia of the hip more common?

Answer 10

left

Question 11

How do you diagnose DDH?

Answer 11

ultrasound - after 4 months can see on x ray

Question 12

What is the Barlow exam?

Answer 12

Adduction with downward pressure

Question 13

What is the Ortolani exam?

Answer 13

attempt to relocated a dislocated femoral head

Question 14

Other physical findings of DDH

Answer 14

May have asymm gluteal folds, later on waddling gait or leg length deformity

Question 15

Risk factors for DDH?

Answer 15

first born, female, breech delivery, family history

Question 16

What degree of scoliosis needs treatment?

Answer 16

> 25 degrees and still more growth to be had - should brace. If > 40 should have surgery

Question 17

What is the normal degree of kyphosis in the spine?

Answer 17

20-40 degrees

Question 18

Caffey Disease

Answer 18

Infantile cortical hyperostosis. Occurs during first 6 months of life, swelling of bone shafts, only involves cortical bone, not periosteum.

Question 19

The patient falls back on a posteriorly rotated abducted arm

Answer 19

Anterior humeral dislocation

Question 20

Pain over distal clavicle with a prominence over area of point tenderness

Answer 20

Acromioclavicular injury

Question 21

Bowlegged fancy name

Answer 21

Genu Varus

Question 22

Knock-kneed fancy name

Answer 22

Genu valgus

Question 23

When does genu varus need intervention

Answer 23

When persists past 2, or unilateral

Question 24

Salter harris type 1

Answer 24

Separation of epiphysis and metaphysis. Fracture right through physis. X rays may be negative - diagnose clinically. needs casting for 2-3 weeks

Question 25

Salter Harris type 2

Answer 25

physis and metaphysis, closed reduction 3-6 weeks

Question 26

Salter Harris type 3

Answer 26

through growth plate and epiphysis (worse than type 2 bc goes through growth plate.

Question 27

Salter Harris type 4

Answer 27

crack through metaphysis, physis, growth plate, epiphysis - needs OR reduction

Question 28

Salter Harris type 5

Answer 28

compression fracture causing microvascular compromise - may have poor growth later

Question 29

Scaphoid fracture

Answer 29

pain in snuffbox - often x ray is normal

Question 30

position of leg with SCFE

Answer 30

extended and externally rotated