Ped Ortho - Exam 3 Flashcards
A true groin pull is actually an _____. Always rule out a ____
adductor strain
slipped capital femoral epiphysis
____ is the test of choice for an osteochondral fx. What should you do next?
MRI
refer to pediatric ortho
What are 2 common “groin pain” injuries in young adults?
Avulsion fractures of the pelvis are common in young adults
Stress fractures of the femoral neck is a common injury
What are the 3 “groin pain” red flags?
Refusal to bear weight at all
Refusal to move hip
Pain more than 24-48 hours
What are the 7 red flag symptoms for knee pain?
Deformity
“Kneecap Slipped out of place”
Large lacerations
Unable to flex knee , walk
Immediate edema (not gradual)
Intolerable pain
May be a disguiser of HIP PAIN
_____ is the MC fx of the knee. _____ is another one that presents as knee pain
Tibial spine or osteochondral Fx
Patellar sleeve fx
What does the Ballotment test test for? How do you perform it?
effusion in the knee
Knee straight - pressure applied at top of patella toward femur. Spongy feeling suggests effusion
_____ is an important bony prominence that anchors the attachment of the ____
Tibial spine
ACL
Mechanically speaking, an avulsion fracture of the ____ is the equivalent of an _____ in adults
tibial spine
ACL rupture
What is the MOI for a tibial spine fx?
Hyperextension of knee with concurrent rotation of femur on tibia
Hemarthrosis
joint pain
markedly decreased ROM in the knee
sudden pain
What am I?
What is the tx based on?
tibial spine fx
nondisplaced vs displaced
What is the tx for a nondisplaced tibial spine fx?
Nondisplaced fractures may be managed conservatively with immobilization in extension and ortho f/u
Diagnosis by radiographs, repeat in 2 weeks to check healing
What is the tx for a displaced tibial spine fx?
Displaced fractures need reduction and immediate ortho consult
What am I?
tibial spine fx
Osteochondral fractures to the intra-articular portions of the femoral condyles or tibial plateau frequently accompany _____, ____, or _____
patellar dislocation
ligament tears
meniscal injuries
osteochondral _____ may arise from osteochondral fracture. What age range? What is a common presenting symptom?
fragments
think 12-18 years old
“locking knee”
What am I?
osteochondral knee fx
_______ is caused by an indirect force applied to the patella through sudden, forceful contraction of quadriceps to a flexed knee. What are 2 common MOIs?
Patellar Sleeve Avulsion Fracture
Occurs when someone lands on feet after jumping from moderate height
Or comes to sudden stop from full sprint
______ happens if the force generated by the quadriceps exceed the strength of the patella. What is a common PE finding? What imaging is needed?
Patellar Sleeve Avulsion Fracture
May not be able to extend knee against gravity
MRI may be needed
What is the tx for a Patellar Sleeve Avulsion Fracture?
immobilize knee and refer to ortho
for a patellar sleeve fx, _______ and _____ are more predictive than xray evidence. What do you need to have in this specific injury?
hemarthrosis
physical exam
there is a high morbidity with this injury so a LOW index of suspicion should be held
What am I? ____ is a super common exam finding
patellar sleeve fracture
hemarthrosis
What is Osteochondritis dissecans? What is it due to?
Bone beneath the cartilage of the knee joint dies due to lack of blood flow an the necrotic bone is replaced by subchondral trabeculae or cartilage
aka a piece of bone in the middle of the joint
Osteonecrosis of subchondral bone due to overuse (think avascular necrosis)
What happens in osteochondritis dissecans as the lesion progresses?
What is the tx?
focal areas of demineralization and repeated shear forces cause detachment of bone and overlying cartilage
immobilization for 3-6 mos vs surgery