Peadiatrics Flashcards
What factors are associated with outcomes of a distal femoral fracture
SH classification
presence of displacement
open fracture
presence of hardware across the physis
direction of displacement is not associated with outcome
Findings of osteopetrosis
Inability to acidify the howship lacunae
AR not compatible with life
AD compatible with life
Rugger jersey spine multiple fractures coxa vera (stress fractures) deafness blindness anemia frequent infections
Radiographic indicators of both bone forearm fractures following reduction
On AP biceps and radial styloid are 180 degrees apart
On Lateral ulnar styloid and coronoid are 180 degrees apart
Complications and concerns following transphyseal distal humerus injury
posteromedial displacement
child abuse
closed reduction and splinting
pin if very displaced
Varus
medial condyle AVN
(no risk of tardy ulnar nerve palsy)
Phenotype of diastropic dysplasia
defect in sulphate transporter affecting cartilage
cauliflower ear
hitchikers thumb
symphangalisism
kyphosis c-spine
Fracture associated with highest morbidity and mortality
spine
Acceptable angulation of a radial neck fracture
30 degrees
begin ROM early to prevent stiffness
Percutaneous pinning
Open reduction - associated with stiffness and increased risk of AVN
Reduction technique for radial neck fracture
Patterson - extension and supnation
Isralei - flexion and pronation
Compression bandage
K-wire joystick
Metaizeau - retrograde nail across fracture
complications of radial neck fracture
stiffness (loss of pronation)
radial head ON
synostosis (open, delayed)
radial head overgrowth (40%)
Multifocal mycobacterial infection
Polyarthrosis swelling
elevated ESR
from foreign place
spine (50%), large joints, long bones
subchondral erosions with diffuse osetopenia
treatement with Abx
Surgery for residual constitutional sx
Best predictors of septic hip
Fever CRP ESR Refusal to bear weight WBC
In that order
Bones with intra-articular metaphyses
shoulder
elbow
hip
ankle
Indications for surgical treatment of proximal humerus fracture
usually can be treated nonoperativley because of ability to heal and remodel
open
NV
> 45 degrees
Drop in BP intraop myelomeningocele
latex allergy
IGE mediated
Risk factors for spina bifida
DM2
maternal hyperthermia
valproic acid
folate deficiency
10% have chromosomal abnormality
Level of myelomeningocele at risk for hip dislocation
L3-4
(level is the lowest functioning level)
usually confined to wheelchair
L5 is more normal functioning
Procedure to correct calcaneus heel in L5 level
posterior transfer of tib ant
Larsen syndrome
hyperlaxity, presents with multiple dislocations
at risk for cervical kyphosis
Scoliosis with no curve and assymetric abdominal reflex
syrinx
most common cause of malignant back pain
leukemia
lower extremity growth
Proximal femur - 3mm
Distal Femur - 9mm
Proximal tibia - 6mm
what is the teardrop comprised of
quadrilateral surface
cotyloid fossa
normal hip at 18 months
usually not there in untreated DDH
Side of congential pseudoarthrosis
Right middle
Cosmesis or function at 3-6 years old
Iliac crest graft with ORIF
Factor most associated with loss of reduction of forearm fractures
Cast index > 0.85
Acceptable reduction forearm fracture
9yo - 10 deg, 30 deg rotation, 1 cm bayonette
What is the most common cause of physical disability in child abuse
head injury
most common age of child abuse
acceptable alignment of distal radius fracture
> 10 yo - 20 deg ang, 30 deg rotation
closed reduction initially
if inadequate or reduction lost then do closed reduction with pinning
Disease associated with olecranon fracture
OI
What is the most common complication requiring intervention following hip spica treatment for femoral shaft fractures
loss of reduction
Treatment of anterolateral bowing associated with neurofibromatosis
bracing
If fracture then IM device (growing rod)
Gauchers mutations
glucocerbridase
fibrous dysplasia mutation
cAMP
SLC6A2A sulphate transporter
diatrophic dysplasia
Morqoio
keratin sulphate
proportionate dwarfism
normal intellegence
odontoid hypoplasia
Hurlers
C1-2 instability
Hunters
X-linked recessive
metal retardation
clear corneas
diatrophic dysplasia
cervical kyphosis
cauliflower ears
hitchhikers thumb
indications for physeal bar resection
20% will require osteotomy as they are unlikley to correct
superior lens dislocation
marfans
inferior lens dislocation
homocystinuria
dolichostenomelia
long limbs associated with marfans
SCFE associations
left hip
males
hip pain (not knee pain)
best radiograph for lateral epicondyle
internal oblique
long term consequences of brachial plexus palsy
glenohumeral dysplasia - due to internal rotation contracture (70%)
elbow contracture - due to overdrive of the biceps
prognosis of brachial plexus palsy
90% recover with early PT
Good - erbs, biceps activity
Poor: lack of biceps by 3 months preganglionic injuries (elevated hemi, rhomboid dys) horners C5-7 klupkes
Erbs
C5-6 - most common
waiter’s tip
Axillary/SS - absent deltoid, teres minor, SS, IS
MC - biceps, BR
intact wrist and hand
Klumpke
C8-T1 - poor prognosis
Median and ulnar nerve - claw hand
often associated with horners
Early brachial plexus treatment
Nerve graft
- flail arm at 1 month
- horners at 1 month
- no biceps by 3 months
Nerve transfer
- root avulsion at 3 months
Late surgery for brachial plexus
Glenohumeral dislocation
- ORIF with capsuloraphy
- proximal humerus osteotomy (no glenoid)
Glenohumeral dysplasia
- lat dorsi transfer - persistant ER with mild dyplasia
- pec major - 5yo
SMN-1
spinal motor dystrophy
PMP 22
CMT
myelomeningocele hip dislocation
observe
highest risk in L3
most common foot deformity with spina bifida
clubfoot
