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Pediatrics 1 > Ped orthopedics > Flashcards

Ped orthopedics Flashcards

1
Q

intoeing

A

metatarsus adductus

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2
Q

what is genu valgus

A

vaLgus- “knock knees”

L is out

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3
Q

what is gen varus

A

vaRus- “bow legs”

Return back in

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4
Q

two examples of genu varum

A

blount’s disease

rickets (vitamin D deficiency)

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5
Q

Salter-harris type 1

A

S-slipped “ephiphyseal slip”
separation through the physis (growth plate)

excellent

non-operative management

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6
Q

Salter-harris type 2

A

A-above physis
fracture through a part of the PHYSIS that extends through the METAPHYSIS

excellent

likely non-operative

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7
Q

Salter-harris type 3

A

L-lower to physis
fracture through part of the PHYSIS that extend through the EPHIPHYSIS often involving the joint space

often unstable
+/- operative management

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8
Q

Salter-harris type 4

A

T-through the physis
fracture through the METAPHYSIS, PHYSIS, and EPHIPHYSIS

unstable can lead to limb length discrepancies

+/- operative managment

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9
Q

Salter-harris type 5

A

ER- ERasure of physis (reduced)
crush injury to PHYSIS (growth plate)

unstable, can lead to limb length discrepancies

+/- operative management

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10
Q

what is C.R.I.T.O.E and what does each letter stand for

A 
CRITOE is the order of ossification of bone
(# means years old)
1: capitellum
3: radial head
5: internal (medial) epicondyle
7: trochlea
9: olecranon
11: external (lateral) epicondyle
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11
Q

what is the fat pad sign

A

dark area around elbow on x-ray that can represent a break in the area. darkness may be from blood

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12
Q

Supracondylar humeral fractures MOI

A

fall from moderate height

fall out with outstretched hand FOOSH

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13
Q

supracondylar humeral fractures clinical presentation

A

swelling, pain, +/- deformity
Neurovascular exam is critical
Medial nerve Anterior interosseous nerve

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14
Q

supracondylar fracture diagnosis

A

xray: AP, lateral, and oblique radiographs
anterior humeral line should intersect the capitellum
type 1: intersects
type 2: is in line
type 3: completely out of line

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15
Q

supracondylar fracture management

A 
type`1/2 splint with light overwrap
sling, NSAIDs, elevation
refer to ortho +/- reduction for type 2
immobilization x3 weeks
type 3 or neurovascular concerns
CRPPF closed reduction percutaneous pin fixation
open reduction

to check neurovascular have the pt do the OK sign

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16
Q

lateral humeral condyle fx clinical presentation

A

soft tissue swelling concentrated to lateral aspect of elbow

tender palpation over lateral condyle ONLY

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17
Q

lateral humeral condyle fx diagnosis

A

x-ray: AP, lateral, and INTERNAL oblique view focused on lateral condyle
MRI if needed

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18
Q

lateral humeral condyle fx management

A 
emergent referral if displacement > 2 mm on internal oblique view
splint, sling, NSAIDs
Ortho:
immobilization 6 w
open reduction with screw fixation
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19
Q

Medial humeral epicondyle fx MOI

A

muscle attachment avulsion (throwing, gymnasts)
FOOSH with arm fully extended
secondary to posterior elbow dislocation

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20
Q

Medial humeral epicondyle fx clinical presentation

A

localized pain
pain with resisted wrist flexion
ulnar nerve dysfunction (try not to do surgery)

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21
Q

Medial humeral epicondyle fx diagnosis

A

xray
ap, lateral, and external oblique
rule out incarceration of fragment in joint
advance imaging may be needed

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22
Q

Medial humeral epicondyle fx management

A

emergent if entrapped fragment
splint including wrist sling
NSAIDs
Ortho: Short term immobilization vs open fixation

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23
Q

Medial humeral epicondyle fx complications

A

ulnar nerve injury/palsy
nonunion
angular deformity
decreased ROM

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24
Q

Radial neck fracture MOI

A

FOOSH with valgus stress

posterior elbow dislocations

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25
Q

Radial neck fracture clinical presentation

A

tenderness to palpation over radial head/neck
pain with supination/pronation» flexion/extension
young children may complain of wrist pain

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26
Q

Radial neck fracture diagnostics

A

xrays
ap, lateral and external oblique
clinical if radial head not ossified ~3-5 y

27
Q

Radial neck fracture managment

A

immobilize including the wrist
sling
NSAIDs
ortho: vast vs surgery

28
Q

Radial neck fracture complications

A

premature physeal closure
loss of ROM
nonunion

29
Q

nursemaid’s elbow what is it and what causes it

A

subluxation of radial head

common cause is sudden pull of pronated arm`

30
Q

nursemaid’s elbow clinical presentation

A 
arm either fully extended or slightly flexed and protonated
overall refusal to use arm
mild pain over radial head
pain increases with attempts to supinate
evaluate entire extremity

imaging not required

31
Q

nursemaid’s elbow management

A

reduction by either

  1. hyperpronation with pressure over the radial head
  2. supination, flexion with pressure over radial head

“lollipop/popsicle test”

32
Q

wrist fractures common causes and clinical presentation

A

direct fall
FOOSH
direct trauma
distal radius typically involved at metaphysis

point tenderness, swelling, ecchymosis
“dinner fork deformity”

33
Q

diagnostic for wrist fracture

A

xray: ap/ lat +/- oblique

SH 1

34
Q

wrist fracture managment

A

emergent with significant clinical deformity or nerovascular compromise
splint and NSAIDs
ortho cast +/- reduction vs surgery

35
Q

femur fracture clinical presentation

A 
history of trauma
pain in groin and buttock
unable to bear weight/walk
proximal femur fx pt will hold leg in slight adduction and eternal rotation
may see limp shortening
  • must rule out child abuse especially less than 1 y
36
Q

femur fracture diagnostics management and complications

A

must xray entire length of femur for proper evaluation

ortho: hip spica cast vs surgery

shortening
lengthening
angulation

37
Q

what is a special fracture patellar sleeve fracture and managment

A

unique to children but common in kids <13 y
caused by forced extension with knee flexion
jumping kicking
can be seen either superior or inferior pole of the patella

knee immobilizer, NWB, elevate
NSAIDs
ortho: cast vs surgery

38
Q

toddler fracture MOI

A

falling while running/twisting mechanism

SLIDES!

39
Q

toddler fracture clinical presentation

A

limp or refusal to weight bear
often mistaken for foot injury
pain with palpation along tibia typically mid to distal diaphysis

40
Q

toddler fracture diagnosis and management

A

xray ap lateral and obliques

immobilize
NWB, NSAIDs, elevate
ortho: wee walker vs cast

41
Q

special fractures of the ankle

triplane fracture

A

“think high school athlete” 13-16
MOI is often external rotation
SH 3 on AP view and SH 2 on lateral view = SH 4
must get CT to assess displacement
ortho: surgical fixation vs closed reduction

42
Q

fracture or ankle sprain management

A

posterior vs stirrup splint
elevation, NWB, NSAIDs
ortho consult for NWB, bony pain, concerns on imaging

Reconditioning is key in preventing recurrence
pt and home exercise program

43
Q

torticollis etiology, clinical presentation, and treatment

A

compartment syndrome SCM secondary to venous outflow obstruction

clinical presentation
head tilt to shortened muscle and chin rotation to contralateral side
evaluate for associated plagiocephaly

stretching/PT
position education

44
Q

how is scoliosis defined and common ages

A

lateral curve of the spine > 10 degrees
has a rotational component
idiopathic
W>M

congenital/infantile 0-3y
juenile 4-9Y
adolescent >= 10 y
*neuromuscular

45
Q

adolescent idiopathic scoliosis AIS clinical presentation and physical exam

A

typically asymptomatic
+/- pain
obstructive lung sx if severe

physical exam
shoulder or pelvic obliquity
asymmetry of scapulae
adam's forward flexion exam 
abdominal refexes
46
Q

scoliosis diagnosis and treatment

A

cobb angle
ap/pa standing plain radiographs on long cassette

TLSO brace: boston, milwuakee, charleston bending
brace at 25 degrees
surgery at 45 degrees
internal rod fixation

47
Q

septic hip epidemiology and physiology

A

peak occurrence in first few months of life and again between ages 3-6 years old M>F

direct inoculation from trauma or surgery
hematogenus seeding
spreading of osteomyelitis from adjacent bone

48
Q

septic hip clinical presentation

A

FEBRILE and acutely toxic appearing
monoarticular pain: severly exacerbated with passive ROM
limited or refusal to weight bear

49
Q

transient synovitis of the hip and management

A

appears well, typically AFEBRILE
pain worse in am and improves during day
recent URI
etiology unclear, 3-8y M>F

NSAIDs
improves in 24-48 h with resolution within 1 week
must rule out septic arthritis, hospitalize if suspicious

50
Q

septic hip vs transient synovitis Kocher criteria

A
  1. WBC >12000
  2. ESR > 40
  3. Fever > 101.3
  4. Non-weight bearing on the affected side

2/4 warrants joint aspiration
CRP independent risk factor >2.0

51
Q

septic hip imaging

A

radiographs: AP and frog-leg lateral pelvic
potential joint space widening
ultrasound- effusion and aspiration
MRI

52
Q

septic hip management

A

management is emergent
operative management: surgical I and D
antibiotic: cephalosporin
S. aureus, S. pneumo, group A strep, H. influenza
non-operative: N. gonorrhoeae in adolescents: high doses penicillin

53
Q

Legg-calve-perthes

A

juvenile idiopathic osteonecrosis of the femoral head
peak incidence 4-8y M>F 5:1
risks: family history, Caucasian, maternal smoking
associated with ADHD

54
Q

perthes clinical presentation

A

painless limp or insidious onset of pain: hip, groin, thigh or knee
limp pain is often activity related and worse at end of day
pain relieved with rest
may have muscle spasticity
may have history of minor trauma

55
Q

perthes physical exam

A

antalgic limp/trendelenburg gait
limited internal rotation or abduction
limb length discrepancy
+ galeazzi

56
Q

Slipped capital femoral epiphysis SCFE etiology and presentation

A 
slippage of the femoral physis
"ice cream slipping off the cone"
M>F
peak incidence is 10-16 y
obesity is significant factor

limp or NWB with c/o hip or knee pain
restricted ROM abduction and internal rotation
stability: stable vs unstable is based on WB status

57
Q

SCFE diagnostics and treatment

A

plain radiographs (AP pelvis and frog lat), MRI if high suspicion and negative x-rays

requires urgent surgical consultation for in situ single screw fixation
NWB! admit to hospital

58
Q

Developmental dysplasia of the hip DDH

A

laxity, subluxation, dislocation

risk factors include
1st born, female gender, breech position birth, FHX

59
Q

tests for developmental dysplasia of the hip

A

positive Barlow B= push Back to dislocate
and/or
Ortolani O= creating an O
clunking sensation

galeazzi: affected hip shortened in comparison

60
Q

DDH treatment

A

pavlik harness
avoid swaddling and tight fitting clothes
radiographs used to monitor after 6-7 M of age

casting and surgical options rarely needed

61
Q

Osgood-schlatters’s disease

A

inflammation and irritation of patellar tendon insertion on tibial tubercle (osteochondritis)
traction at tibial tubercle apophysis

clinical presentation
focal tenderness to tibial tubercle
enlargement or bony protrusion of tibial tubercle

lateral xrays used rule out evulsion

occasional rest NSAIDs, ice
quad exercises and hamstring stretches
chopat strap

pain flares around time of rapid growth
girls 10-11
boys 13-14

62
Q

calcaneal apophysitis sever’s disease

A 
irritation, inflammation of calcaneal apophysis
overuse syndrome
pull of achilles tendon
children 6-12 most commonly affected
common in soccer players and gymnasts
clinical: pain  at calcaneal apophysis

treatment: stretches, ice, NSAIDs

63
Q

clubfoot

A 
fixed deformity
FHX, maternal smoking
may be diagnosed on fetal U/S
CAVE
bilateral vs unilateral
affected limb will have smaller foot and calf with shortened tibia

Pediatrics 1 (4 decks)

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