Pediatric Classifications

Question 1

SCHF Gartland

Answer 1

Type I Nondisplaced, beware of subtle medial comminution leading to cubitus varus
Type II Displaced, posterior cortex intact
Type III Completely displaced
Type IV*
Complete periosteal disruption with instability in flexion and extension

Question 2

CRITOE

Answer 2

Ossification center/Years at ossification/Years at fusion 
Capitellum	1 / 12
Radius	4 / 15
Medial epicondyle	  6 / 17
Trochlea	 8  / 12
Olecranon	10 / 15
Lateral epicondyle	12 /  12

Question 3

SCFE Loder

Answer 3

Stable
Able to bear weight with or without crutches
Minimal risk of osteonecrosis (<10%)
Unstable
Unable to ambulate (not even with crutches)
Associated with high risk of osteonecrosis (~47%)

Question 4

SCFE ? From frog

Answer 4

Southwick Angle Classification

Mild 50°

Question 5

SCFE %

Answer 5

Grading System for SCFE
Grade I 0-33% of slippage
Grade II 34-50% of slippage
Grade III >50% of slippage

Question 6

Hip Septic

Answer 6

Kocher's
90% chance of septic arthritis if 3 out of 4 of the following are present q
1. WBC > 12,000 cells/µl
2. inability to bear weight
3. fever > 101.3° F (38.5° C)
4. ESR > 40 mm/h
5. CRP > 2.0 (mg/dl)
* temperature > 101.3° (38.5° C) is the best predictor of septic arthritis followed by CRP of >2.0 (mg/dl)

Question 7

OI

Answer 7

Type I Autosomal dominant blue Mildest form. Presents at preschool age (tarda). Hearing deficit in 50%. Divided into type A and B based on tooth involvement
Type II Autosomal recessive blue Lethal in perinatal period
Type III Autosomal recessive normal Fractures at birth. Progressively short stature. Most severe survivable form
Type IV Autosomal dominant normal Moderate severity. Bowing bones and vertebral fractures are common. Hearing normal. Divided into type A and B based on tooth involvement

Question 8

Lateral Condyle Fracture

Answer 8

Milch or Lateral Displacement
1. Lateral to trochlear groove
2. Into trochlear groove
Lateral
1. 4mm - displaced and rotated

Question 9

Neurofibromatosis

Answer 9

NF1 (von Recklinghaussen disease)
most common
NF2
associated with bilateral vestibular schwannomas
Segmental NF
features of NF1 but involving a single body segment

Question 10

Brachial Plexus

Answer 10

Narakas Classification
Group Roots Characteristics
Group I (Duchenne-Erb’s Palsy) C5-C6 Paralysis of deltoid and biceps. Intact wrist and digital flexion/extension.
Group II (Intermediate Paralysis) C5-C7
Paralysis of deltoid, biceps, and wrist and digital extension. Intact wrist and digital flexion.
Group III (Total Brachial Plexus Palsy) C5-T1 Flail extremity without Horner’s syndrome
Group IV (Total Brachial Plexus Palsy with Horner’s syndrome) C5-T1 Flail extremity with Horner’s syndrome

Question 11

Radial head fractures

Answer 11

Chambers Classification
Group 1: Primary displacement of radial head (most common)	Valgus Injury
A: Salter-Harris I or II
B: Salter-Harris IV
C: metaphyseal

Elbow Dislocation
D: reduction injury
E: dislocation injury
Group 2: Primary displacement of radial neck Monteggia variant

Group 3: Stress injury Osteochondritis dissecans

Question 12

Langenskiold Classification

Answer 12

type I thru IV consist of increasing medial metaphyseal beaking and sloping
type V and VI have an epiphyseal-metaphyseal bony bridge (congenital bar across physis)
provides prognostic guidelines

Question 13

CP (Function)

Answer 13

Gross Motor Function Classification Scale (GMFCS)
Level I Near normal gross motor function, independent ambulator
Level II Walks independently, but with limitations
Level III Dependent ambulator
Level IV Minimal walking ability, uses adult assisted or powered devices for community ambulation
Level V Nonambulator with global involvment, dependent in all aspects of care

Question 14

CP (Anatomic)

Answer 14

Anatomic Classification
Quadriplegic Total body involvement and nonambulatory with a low IQ and a high mortality
Diplegic Legs more than arms but usually still ambulatory. IQ may be normal (injury in brain is midline)
Hemiplegic
Arms and legs on one side of the body, usually with spasticity; all will eventually be able to walk, regardless of treatment

Question 15

CP (Physiologic)

Answer 15

Physiologic Classification
Spastic (most common) Velocity-dependent increased muscle tone and hyperreflexia with slow restricted movement due to simultaneous contraction of agonist and antagonist muscles. Most amenable to operative treatments.
Athetoid Characterized by constant succession of slow, writhing, involuntary movements
Ataxic Characterized by inability to coordinate muscle movements. Results in unbalanced wide based gait.
Mixed
Usually mixed spastic and athetoid features and involves the entire body

Hypotonic Usually precedes spastic or ataxic for 2-3 years

Question 16

Myelodysplasia

Answer 16

Forms of myelodysplasia
spinal bifida oculta 
defect in vertebral arch with confined cord and meninges
meningocele 
protruding sac without neural elements
myelomeningocele 
protruding sac with neural elements
rachischisis 
neural elements exposed with no covering

Question 17

Bado Classification

Answer 17

Type I Apex anterior proximal ulna fracture with anterior dislocation of the radial head
Type II Apex posterior proximal ulna fracture with posterior dislocation of the radial head
Type III Apex lateral proximal ulna fracture with lateral dislocation of the radial head
Type IV Fractures of both the radius and ulna at the same level with an anterior dislocation of the radial head (1-11% of cases)

Question 18

Proximal Femoral fractures (Delbet)

Answer 18

Type Description Incidence AVN Nonunion Images
Type I Transphyseal (IA, without dislocation of epiphysis from acetabulum; IB, with dislocation of epiphysis) <10%, 90-100%
Type II Transcervical 40-50%, 50%, 15%
Type III Cervicotrochanteric (or basicervical) 30-35%, 25% , 15-20%
Type IV Intertrochanteric 10-20, 10%, 5%

Question 19

Tibial Eminence Fracture

Answer 19

Meyers and McKeever Classification
Type I Nondisplaced

Type II Minimally displaced with intact posterior hinge

Type III Completely displaced

Question 20

Tibial Tubercle fracture

Answer 20

Ogden Classification (modification of Watson-Jones)
Type I fracture of the secondary ossification center near the insertion of the patellar tendon
Type II
fracture propagates to proximal to the junction with the primary ossification center
Type III
fracture extend posteriorly to cross the primary ossification center
Modifier: A (nondisplaced), B (displaced)

Newer descriptions have been added to the original system
Type 4 is a fracture through the entire proximal tibial physis
Type 5 is a periosteal avulsion of the extensor mechanism from the secondary ossification center

Question 21

Proximal humerus fracture

Answer 21

Neer-Horowitz Classification
Type I • Minimally displaced (< 1/3 of shaft width

Type III • Displaced greater than 1/3 and less than 2/3 of shaft width
Type IV • Displaced greater than 2/3 of shaft width

Question 22

Stages of LCP

Answer 22

Stages of Legg-Calves-Perthes (Waldenström)
Initial • Infarction produces a smaller, sclerotic epiphysis with medial joint space widening • Radiographs may remain occult for 3 to 6 mos
Fragmentation •Femoral head appears to fragment or dissolve
• Result of a revascularization process and bone resorption producing collapse and subsequent increased density • Hip related symptoms are most prevalent
•Lateral pillar classification based on this stage
Reossification •Ossific nucleus undergoes reossification as new bone appears as necrotic bone is resorbed • May last up to 18m
Healing or remodeling •Femoral head remodels until skeletal maturity • Begins once ossific nucleus is completely reossified trabecular patterns returns

Question 23

Lateral Pillar

Answer 23

Lateral Pillar (Herring) Classification
Group A 	• lateral pillar maintains full height with no density changes identified	• uniformly good outcome	 
Group B 	• maintains >50% height	• poor outcome in patients with bone age > 6 years	 
B/C Border	• lateral pillar is narrowed (2-3mm) or poorly ossified with approximately 50% height	• recently added to increase consistency & prognosis of classification	 
Group C 	• less than 50% of lateral pillar height is maintained	• poor outcomes in all patient

Question 24

Stages of Hip Deformity

Answer 24

Stages of Hip Deformity in Cerebral Palsy
Hip at risk
Hip abduction of 33%
Disrupted Shenton’s line
Treat with adductor tenotomy if abduction is restricted.
Consider proximal femur and pelvic osteotomies if significant dysplasia is present

Spastic dislocation
Frankly dislocated hip
Reimers index >100%
Open reduction with varus derotational osteotomy, + femoral shortening, and pelvic osteotomies

Windswept hips
Abduction of one hip with adduction of the contralateral hip
Brace adducted hip with or without tenotomy and release abduction contracture of abducted hip

Question 25

PFFD

Answer 25

Aitken classification
Femoral Head/Acetabulum
A
present/normal
B
present/mildly dysplastic
C
absent/severely dysplastic
D
absent

Question 26

Classification of Juvenile Rheumatoid Arthritis

Answer 26

Polyarticular (30%), Pauciarticular (50%) (oligoarticular), Systemic

Question 27

Pelvic Fracture

Answer 27

Torode/Zieg Classification
Type 1 • Avulsion injuries

Type II • Fractures of the iliac wing

Type III • Fractures of the ring with no segmental instability (check for acetabular step >2mm)
Type IV • Fracture of the ring with segmental instability