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Alexey Ortho Flashcards > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Rhizomelic
Mesomelic
Acromelic

A 
Rhizo = "root", so more proximal than distal shortening
Meso = "middle", so middle segment shortening
Acro = "tip", so distal segment shortening
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2
Q

Achondroplasia features

A 
Rhizomelic shortening
Frontal bossing
Button nose
Cervical stenosis
Radial head dislocation
Trident hands
Lumbar lordosis
Short pedicles
Champagne glass pelvis
Genu varum
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3
Q

Diastrophic dysplasia features

A 
Short-limbed dwarfism
Cleft palate
Clubfoot
Hip dysplasia
Cauliflower ears
Hitchhiker thumb
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4
Q

Multiple Epiphyseal dysplasia

A

Proportionate dwarfism (no spinal involvement)
Shortened metacarpals
Double-layer patella

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5
Q

Spondyloepyphyseal dysplasia

A

Proportionate dwarfism
Spinal involvement
Barrel chest
Cervical instability (common)

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6
Q

McCune-Albright syndrome triad

A

Polyostotic Fibrous dyslplasia
Cafe-au-lait spots
Endocrine dysfunction

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7
Q

What investigations to order in Non-accidental Injury with:

  1. Children less than 2 years old
  2. Children less than 1 year old
  3. Neurological findings
  4. Shaking is suspected
A
  1. Skeletal survey (Skull, CXR, extremities)
  2. Lateral thoracolumbar x-ray
  3. Head CT
  4. Ophthalmologic exam
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8
Q

Age at Appearance (ossification) of ossification centers of the elbow

A

CRITOE

Capitellum = 1
Radial head = 4
Inner epicondyle = 6
Trochlea = 8
Olecranon = 10
External epicondyle = 12
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9
Q

Age at Fusion of ossification centers of the elbow

A

CET OR I

Capitellum, External epicondyle, Trochlea = 12
Olecranon, Radial head = 15
Inner epicondyle = 17

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10
Q

Indications for fixation in Supracondylar fractures

A 
Medial comminution
Type IIb
Type III
Type IV
Flexion type
Urgent:
Pulseless
Neuro deficit
Floating elbow
Brachialis sign "subcutaneous bone"
Swelling (if excessive)
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11
Q

Baumann’s angle

A

Humeral shaft
Lateral condylar physis on AP

Normal = 70-75 degrees
Deviation of 5-10 degrees should not be accepted

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12
Q

Indications for ORIF in medial epicondyle fractures in Paeds

A 
Fracture entrapped in the joint
Extension of the fracture to the articular surface
Displaced >5 mm
Elbow dislocation
Open fracture
> 2 mm displacement in athletes

Note: 9x higher rate of radiographic union with surgery

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13
Q

Indications for ORIF of radial head fractures in Paeds

A

> 30 degrees residual angulation (after reduction)
3 mm residual translation
< 45 degrees pronation / supination ROM

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14
Q

Patterson maneuver for closed reduction of Paediatric radial head fracture

A 
Extension
Traction
Supination
Varus
Direct pressure
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15
Q

Israeli technique for closed reduction of Paediatric radial head fracture

A

Supination
Flex to 90
Direct pressure
Pronate while maintaining pressure

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16
Q

Metaizeau technique for reduction of Paediatric radial head fracture

A 
Sharpen end of TENs nail a bit
Insert TENs nail
Guide it into radial head
Rotate TENs nail
Check on II
Rotate the other way if no improvement
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17
Q

Indications for reduction of both bone forearm fracture in Paeds

A

If less then 9 yo then:
> 15 degrees angulation

If more than 9 yo then:
> 10 degrees angulation

Bayonetting > 1cm
Don’t accept malrotation (doesn’t remodel)

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18
Q

What is a Morscher osteotomy

A

Femoral neck lengthening osteotomy for residual Perthes. Take GT off, osteotomy in line with inferior neck, reattach GT more lateral and distal.

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19
Q

Cast Index in Distal radius fractures

A

Lateral x-ray inner cast diameter (excluding padding)
Divided by
AP x-ray inner cast diameter (excluding padding)
(measured at the fracture site)

Ideal is 0.8 or less. This is associated with a lower chance of fracture redisplacement (5.6% vs 26%).

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20
Q

Indications and treatment of Femoral Shaft fractures in Paeds

A

< 6 months old = Pavlik harness
0-5 years old + no shortening = Spica casting
0-5 years old + shortening = Traction, then delayed Spica
5-11 years old + <49kg + Length stable = TENS nails
>5 years old + >49kg = Submuscular plate
>11 years old or >49kg = Antegrade nail (trochanteric)

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21
Q

Cozen’s Phenomenon

A

Late valgus deformity after proximal tibial metaphyseal fracture in Paeds (3 to 6 year old)

Occurs in 50-90% of cases
Develops 5-15 months post injury
Maximal deformity at 12-18 months
Prevent by casting in extension and Varus mold. However, deformity occurs regardless of treatment.
Valgus deformity usually resolves spontaneously.

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22
Q

Blocks to open reduction of hip DDH

A 
Capsule (lax, can be constricted by psoas)
Psoas (tight)
Labrum (inverted)
Ligamentum teres (thickened)
Transverse ligament (hipertrophied)
Pulvinar (thickened)

Extrinsic: adductor tightness

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23
Q

Packaging conditions / disorders

A

Neck (Torticollis)
Hip (DDH)
Knee (Dislocation)
Foot (Metatarsus adductus)

24
Q

Acetabular index in DDH

A

Line between:
Hilgenreiner’s line
A line formed by: point on the lateral margin of triradiate cartilage and point on the lateral margin of the acetabulum

Should be less than 25 degrees after 6 months of age.

25
Q

Center-edge angle of Wiberg in DDH

A

Line between:
Perkin’s line
A line formed by: Center of femoral head to a poin on the lateral margin of the acetabulum

Should be more than 20 degrees after 5 years old (can’t seen bone very well until then)

26
Q

Basic DDH treatment by age

A

< 6 weeks - Observe or Pavlik
< 6 months - Pavlik
< 18 months - Closed reduction and Spica
> 2 years - Open reduction + Femoral osteotomy
> 4 years - Open reduction + Acetabular osteotomy
> 14 years - Periacetabular ostotomy or Shelf

27
Q

What is Pavlik Harness disease

A

Erosion of the Posterior Superior Acetabulum due to persistent dislocated position
Discontinue Pavlik if fails after 3-4 weeks

If hip is reducible (ortalani positive), go into a semi-rigid brace

28
Q

Conditions affecting the Hypertrophic Zone of the Physis

A 
SCFE
Rickets
Multiple Epiphyseal Dyslplasia
Spondyloepiphyseal dysplasia
Fractures (Zone of provisional calcification)
29
Q

Conditions affecting the Proliferative Zone of the Physis

A

Achondroplasia

Multiple Hereditary Exostoses

30
Q

Conditions affecting the Reserve Zone of the physis

A

Gaucher’s
Diastrophic dysplasia
Pseudoachondroplasia

31
Q

Indication for physeal bar resection

A

< 50% of physis involved

2+ years of growth remaining

32
Q

Indication for physeal bar resection

A

< 50% of physis involved

2+ yearsof growth remaining

33
Q

What is the angle of Drennan and what is its significance

A

Metaphyseal - Diaphyseal angle of the proximal tibia in Infantile Blount’s disease
< 10 = 95% chance of spontaneous recovery without bracing
> 16 = 95% chance of progression

34
Q

What conditions are associated with congenital vertical talus

A 
Spinal muscular atrophy
Cerebral palsy
Arthrogryposis
Myelomeningocele
Diastematomyelia
Congenital hip dislocation
35
Q

At what age does the navicular bone ossify

A

Age 3
This is relevant in Congenital vertical talus, where the 1st metatarsal is used as a surrogate for the navicular on x-rays.

36
Q

What is the physiological varus / valgus ages and alignment in Paeds

A

1 year = Varus 15 deg
2 yo = Neutral
3 yo = Valgus 10 deg
6 yo = 6 degrees valgus

Saleneus chart / curve
15 degree variation each way at each age

37
Q

Pathologic causes of Varus legs in paeds

A 
Fibrous dysplasia
Infection
Rickets
Skeletal dysplasias (OI, FGFR3)
Trauma
JRA
AnteroLateral bowing
Blount's

FIRST JAB
from bone school

38
Q

Important steps / points in Blounts correction osteotomy

A

Osteotomy distal to TT
Must correct Internal rotation as well as Varus
If doing acute correction, must do an ANTERIOR COMPARTMENT FASCIOTOMY!
“Rab” oblique osteotomy (banana osteotomy) vs corticotomy and frame vs closing wedge (shortening)
Fibula osteotomy required in most cases

39
Q

What are the predictors of Walking in Cerebral Palsy

A 
Hemiplegic - 100% walk
Diplegic - 75% walk
Quadriplegic - 25% walk
Sit by 2
Stand by 4
40
Q

Coxa Vara in Paeds indications for surgery

A

Epiphyseal angle (vs Hilgenreiner’s line)
< 45 - no operation
45-60 and stable - observe
45-60 and progressing - Valgising osteotomy
> 60 - Valgising osteotomy

Aim is to get angle to < 40
Use 150 degree plate
Add 20 degrees anteversion (usually retroverted)

41
Q

What are the three types of Tibial Bowing

A

Antero - Lateral = Neurofibromatosis
Antero - Medial = Fibular hemimelia
Postero - Medial = Physiologic

42
Q

Fibular Hemimelia associated conditions

A 
Ankle instability
DDH
Absent lateral rays
PFFD
Tibial Bowing (anteromedial)
Talipes equinoVALGUS
Tarsal coalition
Cruciate ligament deficiency
Genu VALGUM
LLD
43
Q

Differentials for hemihypertrophy

A

Beckwith-Weidermann syndrome
Neurofibromatosis
Klippel-Trenaunay-Weber syndrome
Proteus syndrome

Malignant tumors
Ollier's
Fibrous dysplasia
Poliomyelitis
Spastic hemiplegia
Russell-Silver syndrome (hemiartrophy, short, cafe-au-lait, clinidactyly)
Haemophilia
Xray therapy
Condrodysplasia punctata
44
Q

Perthes disease good prognostic factors

A 
Male gender (longer remodeling time)
Involvement of head low (Caterall or Herring)
Containment of head good
Range of Movement
Age < 6 at onset

Herring low
Stuhlberg low

45
Q

What are the three types of osteochondroses (and give an example of each)

A

Crushing
Pulling
Splitting

Crushing = Kohler's, Friedberg's, Panner's, Kienbock's
Pulling = Osgood-Schlatter, Sever's, Sinding-Larsen-Johansson, Menelaus-Batten
Splitting = OCD (knee, ankle, hip)
46
Q

What is Kohler’s Disease

A

AVN of the navicular

4-6 yo boys
Resolves in 18+ months

47
Q

What is Panner’s Disease

A

AVN of the capitellum

4-10 yo boys
Non-op mgmt if no OCD
If OCD, then treat as required

48
Q

Indications for amputation in Fibular Hemimelia

A

Less than 2 rays of the foot
> 16cm LLD at maturity (some texts say 20)
Unstable ankle (relative)
Associated severe PFFD (relative)

49
Q

4 things to examine for in a Juvenile Hallux Valgus case

A

Ligamentous laxity
Achilles tightness
TMTJ hypermobility
Neurological exam

50
Q

Infications for contralateral SUFE pinning

A

PRE SLYPT

Portly
Remote
Endocrine

Severe slip
Late presentation
Young age (<10 yo)
Posterior sloping angle (>14 degrees)
Triradiates open
51
Q

Physeal / Metaphyseal dysplasias

A 
Multiple hereditary exostoses
Achondroplasia
Hypochondroplasia
Metaphyseal chondrodysplasia
Dyschomdrodysplasia (Olliers and Maffuci)
52
Q

Epiphyseal dysplasias

A

Multiple epiphyseal dysplasia
Spondyloepiphyseal dysplasia
Dysplasia epiphysealis hemimelica
Chondrodysplasia punctata

53
Q

Diaphyseal (/metaphyseal) dysplasias

A 
Metaphyseal dysplasia
Craniodiaphyseal dysplasia
Diaphyseal dysplasia
Craniometaphyseal dysplasia
Osteopetrosis
Pyknodysostosis
54
Q

Autosomal Recessive Conditions

A

FrOGS SHODM

Friedrich’s ataxia
Osteogenesis imperfecta 2/3
Gauchers
Sickle cell
Spinal Muscular atrophy
Hypophosphatasia
Osteopetrosis
Diastrophic dysplasia
Mucopolysacharidpses (except Hunter, which is X)
55
Q

What is the safe zone for the hip in closed reduction for DDH

A

Less than 60 abduction
Less than 90 flexion

“Ramsay” safe zone
Maximum abduction - Position of re-dislocation
If this zone is less than 20 degrees, then not safe.

Alexey Ortho Flashcards (21 decks)

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