Ped Ortho - Exam 3 Flashcards

1
Q

A true groin pull is actually an _____. Always rule out a ____

A

adductor strain

slipped capital femoral epiphysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

____ is the test of choice for an osteochondral fx. What should you do next?

A

MRI

refer to pediatric ortho

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are 2 common “groin pain” injuries in young adults?

A

Avulsion fractures of the pelvis are common in young adults

Stress fractures of the femoral neck is a common injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 3 “groin pain” red flags?

A

Refusal to bear weight at all

Refusal to move hip

Pain more than 24-48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 7 red flag symptoms for knee pain?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

_____ is the MC fx of the knee. _____ is another one that presents as knee pain

A

Tibial spine or osteochondral Fx

Patellar sleeve fx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does the Ballotment test test for? How do you perform it?

A

effusion in the knee

Knee straight - pressure applied at top of patella toward femur. Spongy feeling suggests effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

_____ is an important bony prominence that anchors the attachment of the ____

A

Tibial spine

ACL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Mechanically speaking, an avulsion fracture of the ____ is the equivalent of an _____ in adults

A

tibial spine

ACL rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the MOI for a tibial spine fx?

A

Hyperextension of knee with concurrent rotation of femur on tibia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hemarthrosis
joint pain
markedly decreased ROM in the knee
sudden pain

What am I?
What is the tx based on?

A

tibial spine fx

nondisplaced vs displaced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the tx for a nondisplaced tibial spine fx?

A

Nondisplaced fractures may be managed conservatively with immobilization in extension and ortho f/u

Diagnosis by radiographs, repeat in 2 weeks to check healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the tx for a displaced tibial spine fx?

A

Displaced fractures need reduction and immediate ortho consult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What am I?

A

tibial spine fx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Osteochondral fractures to the intra-articular portions of the femoral condyles or tibial plateau frequently accompany _____, ____, or _____

A

patellar dislocation

ligament tears

meniscal injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

osteochondral _____ may arise from osteochondral fracture. What age range? What is a common presenting symptom?

A

fragments

think 12-18 years old

“locking knee”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What am I?

A

osteochondral knee fx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

_______ 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?

A

Patellar Sleeve Avulsion Fracture

Occurs when someone lands on feet after jumping from moderate height

Or comes to sudden stop from full sprint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

______ happens if the force generated by the quadriceps exceed the strength of the patella. What is a common PE finding? What imaging is needed?

A

Patellar Sleeve Avulsion Fracture

May not be able to extend knee against gravity

MRI may be needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the tx for a Patellar Sleeve Avulsion Fracture?

A

immobilize knee and refer to ortho

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

for a patellar sleeve fx, _______ and _____ are more predictive than xray evidence. What do you need to have in this specific injury?

A

hemarthrosis

physical exam

there is a high morbidity with this injury so a LOW index of suspicion should be held

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What am I? ____ is a super common exam finding

A

patellar sleeve fracture

hemarthrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is Osteochondritis dissecans? What is it due to?

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What happens in osteochondritis dissecans as the lesion progresses?
What is the tx?

A

focal areas of demineralization and repeated shear forces cause detachment of bone and overlying cartilage

immobilization for 3-6 mos vs surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
_____ is used first in Osteochondritis Dissecans but _____ is diagnostic of choice
xray is used first MRI is diagnostic of choice
25
What does knee popping usually indicate? What is the tx?
meniscal tear meniscal tear = refer to ortho
26
What is the MC ankle sprain? What is the tx?
Calcaneofibular ligament and anterior talofibular ligament most common sprain Brace, support, NSAIDS Still need controlled ROM
27
What are the different grades of an ankle sprain?
28
What is the MC reason a child may limp?
injury/inflammation or infection
29
_____ is the most common reason for inflammatory childhood limp. What is the underlying cause? What does it usually occur after?
Toxic synovitis is actually an inflammation of the joint- hips and knee affected the most It occurs after a recent URI usually!!! think recent cold
30
What are the different Kosher criteria for septic arthritis? Give level 1-4
31
**What are the Kosher criteria for septic arthritis?
Fever over 101.3 ESR > 40 WBC >12 K NO weight bearing
32
What should be included in your work up of a pt when trying to determine if it is transient synovitis or a septic hip?
consider the hx xrays: AP pelvis with frog leg views labs: CBC, ESR, CRP, BMP
33
What is the tx for a septic hip?
I&D of hip if warranted - aspiration of joint fluid Antibiotics- cover staph aureus
34
**____ is the MC cause of Intoeing in infants birth to 12 months old. Describe the presentation. Will it involve the ankle? How would a non-medical person describe it?
**Metatarsus Adductus Inward deviation of the forefoot in relation to the hind foot does NOT involve the ankle “C”-shaped foot or “kidney bean” shape
35
If you draw a line from the middle of the heel to the toes, where will the line intersect in a normal foot?
intersect between toes 2 and 3
36
What is metatarsus adductus linked to? What sex?
Linked to intrauterine molding and position in the womb equal boys and girls
37
_____ is the MC congenital foot deformity in children < 1 year old
Metatarsus Adductus
38
What are the risk factors for Metatarsus Adductus?
Risk factors: breech presentation family history of MA hip dysplasia decreased amniotic fluid first born twins
39
In metatarsus adductus, ____ resolve by 1st birthday and the rest by ____ old without intervention
90% 5-6 years
40
What dx testing should you order in metatarsus adductus?
NONE!! no testing or xrays needed
41
_____ MA examiner can passively over-correct the deformity into abduction with little effort. What is the tx?
Mild Treatment - stretching, observation
42
____ MA examiner can passively correct the deformity only into middle position. What is the tx?
moderate stretching observation
43
____ MA examiner is unable to correct the deformity to midline. What is the tx?
severe corrective casting before 8 months of age or surgery in severe cases
44
_____ is when the foot points downward and inward and soles of feet face each other - foot appears internally rotated at ankle. What sex? How common is it?
Clubfoot (Talipes Equinovarus) males > females 1 in every 1,000 babies born
45
What is the underlying cause of clubfoot?
Shortening of Achilles tendon, tendons of medial lower leg, as well as unusual shape to talus bone calf muscles are also underdeveloped
46
What are the 3 features of clubfoot?
Plantar flexion of the foot and ankle Inversion of the heel Medial deviation of the forefoot
47
What are the risk factors for clubfoot?
decreased amniotic fluid genetic factors familial history twins spina bifida SMOKING during preg infection during preg illicit drug use while preg
48
What is the chance that if one child born with a clubfoot, the next will be also?
1/30 chance
49
What are the 3 different types of clubfoot? Which one is MC?
congenital - MC type syndromic positional
50
What is syndromic clubfoot associated with?
spina bifida
51
What is positional clubfoot associated with?
Intrauterine crowding – example: twins Breech Low amniotic fluid
52
What are the 3 different tx options for clubfoot?
ponseti method surgery french functional method
53
What is the ponseti method for tx of clubfoot? What is the associated timing?
Specialist manipulates foot with hands to correct bend in foot Plaster cast applied from toes to thigh to hold in position Process occurs weekly and may last 4-10 applications
54
What is the sx tx for club foot? For how long?
Achilles tendon release Boots and braces after surgery to hold feet in position for 2-3 months worn 23 hours per day Braces continued during night and naps until 2-4 years of age
55
What is the french functional method for clubfoot? For how long?
Daily stretching and exercise Massage Immobilization and taping foot in position PT until child is 2 years old
56
What is the difference between in-toeing and out-toeing?
57
What are the 2 different version of tibial torsion? What is the slang terms?
internal vs external “Knock-knees” or “Pigeon-toes”
58
What is the MC cause of intoeing and outtoeing in older kiddos?
tibial torsion
59
____ is the MC cause of intoeing in kiddos 1-3 years old. When is it noticed? Is it normally uni or bilateral?
internal tibial torsion Usually noticed when toddlers start to walk Bilateral in 2/3 of cases
60
Describe internal tibial torsion in medical words
Medially deviated foot with patella facing forward
61
What type of bone deformity do the fastest runners usually have?
Fastest runners are typically in-toed (sprinters and athletes)
62
How should you evaluate a pt's normal leg anatomy?
kneecaps needs to be symmetric and straight up
63
When does tibial torsion tend to resolve? What is the tx?
Typically resolves by age 5 when tibia rotates laterally Observation only at yearly WCC
64
When would you need to tx tibial torsion? What should you do next? What is an INEFFECTIVE method of tx?
treat if feet still turn inward by > 15 degrees at age 5 because spontaneous correction unlikely at that point Refer to orthopedics if > 8 years old and activity is limited due to in-toeing or cosmetic reasons Treatment with orthotics is ineffective
65
____ is the MC cause of out-toeing in toddlers and young children. Describe it in medical terms. When is it usually discovered?
External Tibial Torsion Medial malleolus is anterior to the lateral malleolus Can be discovered later at 4-7 years old or even early adolescence
66
_____ is the increased angle of rotation of femoral neck in relation to transcondylar axis of femur
Femoral Anteversion
67
____ is the MC cause of intoeing AFTER 3 years old. Describe it in medical terms
femoral anteversion Inward facing feet and patella
68
What am I? What does it cause? What is the pattern of walking?
Prefer sitting in “W” position Femoral Anteversion Egg-beater” or “Windmill” pattern of walking and swimming
69
When should you refer for femoral anteversion?
Refer if persists past 11 years of age
70
What is the MC cause of intoeing if the kiddo is less than 12 months old?
Metatarsus Adductus
71
What is the MC cause of intoeing if the kiddo is between 12 months and 3 years old?
Tibial Torsion most common cause
72
What is the MC cause of intoeing if the kiddo is older than 3 years old?
Femoral Anteversion
73
What are the different terminology for hip dysplasia?
unstable subluxation dislocation dysplasia
74
_____ hip loose in socket with abnormal movement
unstable
75
_____ partial dislocation (hip partly out of socket)
subluxation
76
____ hip completely out of socket
dislocation
77
_____ wide spectrum term ranging from unstable to dysplastic to malformed
dysplasia
78
What is the preferred term if the hip is noted to enter and exit the socket? What is it?
Newborn hip instability Normally formed hip that becomes displaced in utero or at ≤ 1 yr of age in otherwise healthy child
79
Developmental Dysplasia of Hip (DDH) is bilateral in __% of cases. What sex?
20% of cases and has a genetic component Girls > Boys (75%)
80
What are the risk factors for DDH? Left or right hip?
Breech Twins First born may have swaddling link left > right
81
Asymmetrical buttock or thigh hip creases / skin folds may have hip clicks Painless, but exaggerated waddling limp after learning to walk Swayback Limited abduction of the hip What am I? What PE finding?
DDH Trendelenburg sign
82
What is Trendelenburg sign?
painless limp and lurch to one side with a dip in pelvis on opposite side when child stands on affected leg (secondary to weakness of gluteal muscle)
83
_____ Thigh grasped loosely with examiner’s index and middle finger along the greater trochanter and thumb along inner thigh. Hip adducted and posteriorly directed pressure applied
Barlow maneuver
84
______ Thigh grasped loosely. From an adducted position – the hip is abducted while lifting the trochanter anteriorly
ortolani maneuver
85
Is Barlow or ortolani the more important test? Why?
Ortolani relocates dislocated hip - more important test
86
What are the different types of DDH? What is the most severe form?
subluxated dislocatable dislocated- most severe form
87
______ DDH types: Head of femur loose in socket. Bone moved during physical exam but won’t dislocate
Subluxated
88
____ DDH types: Head of femur is in acetabulum but easily pushed out during physical examination
Dislocatable
89
_____ DDH types: Head of femur completely out of socket
dislocated
90
_____ is used for the standard dx of DDH. When should a newborn be screened?
US Any male or female born breech > 34 weeks gestation should be screened and/or Family history of DDH
91
if a kiddo is 4 - 6 months of age and older with instability or any child with a limp or unstable gait when able to walk, what should you order next?
X-ray evaluation :A-P pelvis, bilateral hips and frog leg views
92
Under what circumstances may DDH resolve spontaneously? **When should you refer to a specialist?
Most resolve spontaneously by 2 – 6 weeks of age **Positive Ortolani at any age - refer to specialis
93
What should you do if the Barlow test is positive? Give tx options for the following age ranges 0-6 months 6-18 months 18 months- 6 years older than 6 years
observe and follow 0 – 6 months – Pavlik Harness 6 – 18 months – closed reduction and Spica casting for 2-3 months 18 months – 6 years – closed reduction vs. open reduction > 6 years – no treatment
94
_____ is inflammation of the patellar tendon. What is it associated with? What sex? What age range is MC?
Osgood Schlatter Disease Growth spurts during puberty boys> girls Affects 1 in 5 adolescent athletes
95
Pain and tenderness to tibial tubercle with or without edema Worsens with activity / Improves with rest Tightness in surrounding muscles usually unilateral but can be bilateral What am I? What is the MOI?
Osgood Schlatter Disease Overuse injury caused by repetitive strain and chronic avulsion of ossification center of tibial tubercle
96
______ Anterior knee pain increasing over time with activity and may limp but improves with rest. What dx test? Where is TTP?
Osgood Schlatter Disease no xrays are needed!! Tenderness to palpation over tibial tubercle
97
What is the tx for Osgood Schlatter Disease? Can they still play sports?
Treatment – Ice (20-30 min. twice daily), NSAIDS, Stretching (quadriceps), PT if needed usually waxes and wanes over 16-18 months YES!!! Complete avoidance of PE not recommended – playing IS permitted. No crutches or knee immobilizers
98
_____ is the MC chronic anterior knee pain in athletes? What is it due to? Why does it happen?
Patellofemoral Syndrome Degeneration of cartilage due to poor alignment of kneecap Abnormal tracking allows patella to grate over the femur causing chronic inflammation
99
What pt population is at the highest risk of patellofemoral syndrome? name 2 additional populations
teenage females highest risk Knock-knee and flat footed pts
100
What makes patellofemoral syndrome worse? What is the sign called?
Aggravated by activity or prolonged sitting with bent knee “theatre sign”
101
How do you dx patellofemoral syndrome? What is the tx?
Clinical, although may see on x-ray or MRI Ice NSAIDS Discontinue activity causing the pain Strengthening quadriceps and hamstrings
102
_____ happens when the ball of upper end of femur slips off in a backward direction secondary to weakness in the growth plate
Slipped Capital Femoral Epiphysis
103
_____ is one of the MC hip disorders in adolescents
Slipped Capital Femoral Epiphysis
104
What are the risk factors for Slipped Capital Femoral Epiphysis? What sex? When does it tend to occur? What hip?
OBESITY!! Males > Females aka chubby teanage boys Occurs during periods of accelerated growth during puberty Left hip > Right hip
105
Several weeks or months of hip or knee pain, intermittent limp. Pain during exam with limited internal hip rotation What am I? What are the 2 different options?
Slipped Capital Femoral Epiphysis acute vs chronic
106
Define acute vs chronic and stable vs unstable Slipped Capital Femoral Epiphysis?
Acute – symptoms less than 3 weeks Chronic – symptoms more than 3 weeks Stable – can ambulate with assistance such as crutches; foot is gradually externally rotating Unstable – cannot ambulate even with crutches. Non-weight bearing aka stable can walk and unstable CANNOT walk
107
What dx should you order for SCFE?
X-ray, U/S, MRI
108
What is the tx for SCFE?
internal fixation with single cannulated screw placed in center of epiphysis
109
How is SCFE categorized?
Type 1 (mild) - <33% displaced (epiphysis <1/3 diameter of femoral head) Type 2 (moderate) – 33 – 50% displaced Type 3 (severe) - >50% displaced
110
What are the compications of SCFE? What is the major one? What are the post-op instructions?
Avascular necrosis of femoral head** major one Chondrolysis at hip joint (loss of cartilage); osteoarthritis Limited weight bearing and crutches
111
_____ happens when the blood supply temporarily interrupted to femoral head and the bone dies and easily breaks. What is another name for it?
Legg-Calve Perthes Disease Idiopathic avascular necrosis of the hip aka the femoral head flattens
112
What sex for Legg-Calve Perthes Disease? Ethnicity? Age range? How common is it to be in bilateral hips?
Boys > Girls WHITE!! 3 – 12 years old, peak 5 – 7 Bilateral hips in 10 – 20%
113
How long will it take to see someone on xray for Legg-Calve Perthes Disease? What will it show? What should you order next?
May take 1-2 months to show on x-ray Joint effusion with widening of joint space and periarticular swelling MRI and bone scan
114
What is the tx for Legg-Calve Perthes Disease?
aka it will get better on its own no WEIGHT BEARING is important
115
_____ is any degree of curvature of the spine as described by the _____
scoliosis Cobb's angle
116
When should you screen for scoliosis? What test? What is the mean age of dx?
Screened age 8 – 9 and older by Adam’s forward bend test (AFB) 14 years of age – mean
117
What is the MC section of the spine for scoliosis to occur in? What sex?
Right thoracic – most common Girls > Boys aka right as girls are going through puberty
118
How do you dx scoliosis? What is the tx?
scoliosis films and measurement of Cobb’s angle **<20 degrees – follow for progression **>20 degrees or progression of ≥5 degrees – refer for bracing or surgery
119
How is the Cobb's angle measurement taken?
120
What is a Toddler's fx? What is the MC age?
Distal ½ of tibia that happens as a result of a Trivial injury common: Fall from low height Tripping Twisting ankle 9 – 36 months most common age
121
What is a CAST fx? How will it present? What should you do next?
“CAST” – Childhood Accidental Spiral Tibial fracture child will refuse to bear weight screen for child abuse
122
_____ is a genetic CT disease that results in multiple and recurrent fx. **What are the 2 super highlighted points? What will they more than likely develop?
Osteogenesis Imperfecta **BLUE sclera and hearing loss may also have deformed teeth and super prone to develop osteoporosis
123
______ is the result of a genetic mutation causing short-limbed dwarfism. How is it inherited?
Achondroplasia autosomal dominant w/ 80% cases from random mutation
124
How tall will a pt with achondroplasia usually get? What are some additional PE features?
Short stature – usually around 4 feet tall max Average-sized trunk Short arms and legs w/ bowing Waddling gait Macrocephaly with prominent forehead Normal Intelligence and sexual function
125
What is the tx for achondroplasia?
Endocrine - growth hormone in some cases Genetics
126
______ is a birth defect causing the early growing together of two or more bones of the skull. What does it result in?
craniosynostosis Asymmetrical head shape or appearance, hydrocephalus from the sutures closing too early
127
What is plagiocephaly?
Craniosynostosis from how the baby is laid resulting in an aysmmetrical head shape
128
What is another name for Familial Hypophosphatemic Rickets? It encompasses ___% of all hypophosphatemia. Why does it occur?
Specifically referred to as X-linked hypophosphatemia (XLH) 80% of all hypophosphatemia Mutation of the phosphate-regulating gene
129
Impaired growth and bowing of the femur/tibia which results in the short stature of the lower limbs dental abnormalities deafness Chiari malformation of the brain Calcification of tendons, ligaments and joints Craniosynostosis What am I? How do you dx?
Familial Hypophosphatemic Rickets xrays, severe hypophosphatemia (<2.5 mg/dL), elevated serum alk phos
130
What is the tx for Familial Hypophosphatemic Rickets?
Calcitriol with Amiloride and HCTZ Growth Hormone is a possible option
131
What is nursemaid's elbow? What age range? What is the MOI?
Subluxation of the radial head 1-4 years of age most common Tug or pull injury
132
What is the tx for nursemaid's elbow? What will the xrays reveal? How will the kiddo be holding their arm?
closed reduction – supinate hand and flex elbow – “pop” over radial head xray will be normal Holds arm by side - fully pronated, refuses to use
133
A 2 year old boy new to your office comes in with his parents who complain that their child is “pigeon toed”. You watch the child walk and notice that his toes are pointed inward and his knees are facing forward. The most common cause would be A. Metatarsus Adductus B. Internal Tibial Torsion C. External Tibial Torsion D. Femoral Anteversion
B Internal tibial torsion
134
A 2 month old infant presents to your office for a WCC. On examination of the hips, you can palpate a “clunk” on his left hip while performing the Barlow maneuver. The next most appropriate step would be: A. Order hip films, including A-P pelvis and frog leg views B. Order an Ultrasound of the hips C. Observation only and recheck at next WCC in 2 months D. All of the above
B US
135