Pediatric Ortho Flashcards

Question

Colle's Fracture

Answer 1

Colle's Fracture - FOOSH injury: distal radius fractures with the displaced protion (closer to the hand) displaced upwards (dorally toward back of hand) treatment - sugar tong cast/splint

Answer 2

Etiology - displaced of the femoral head through the physis (growth plate): sudden or gradual (head through the palte) - considered a Salter-Harris 1: through the physis - happens during teenage years: growth spurts Risk Factors - male - obese - AA - atheltics involvment - endocrine disorders Symptoms - pain worsened with activity - pain: located in the anterior proximal thigh/hip - rarely, to knee and ankle PE - **lost internal rotation** is the most sensitive and specific - reduced abduction and extension - gait : abnormal ex. rot. of the hip and limb length issue

Answer 3

Diagnosis - **Frog-Legged View XRAY** - mild : < 30degree angle - moderate 30-50 degree - severe 50+ degree Findings on XRAY - doube density at metaphasis (slips off the top and malaligned in back) - widened physis - decreased epiphsyeal height **Klines Lines** - when drawing a line from femoral neck to the hip, should have some overlap over the epiphysis - if the line does not cross over the epiphysis,slipped cap Treatment - **NON WEIGHT BEARING** untile surgery - risks if not: ostenoencrosis, chdrolysis premature growth plate closure - treatment: surgical stabilization and reduction with screws

Answer 4

Etiology - **idopathic osteonecrosis** (avscualr necrosis) of the femoral head - males, white Symptoms - painful limp, **worse in the evening and after activity** - pain can be anywhere in the thigh, groin or knee PE - **restricted hip motion**: cannot ABDUCT or INTERNAL ROTATE Diagnosis - **XRAY**: AP and frog leg - increased density of femoral head - femoral head flattened Treatment - refer to ortho: bedrest and traction - observe if low risk - older kids = increased risk of dislocation, may need stabilization

Answer 5

What - a pigeon toeing: foot turns inward more thant expected during walking - by age2: kids usually have some outtoesing Causes - femoral antiversion: femur internally rotating - tibial torsion: inward twisintg - foot deformitiy - neuromsuc. dz. PE - ortho exam & eval for neuromsucle. issues - assess tone, giat, clonus and motor milestones

Answer 6

PE - excessive internal rotation of the hip with limitied ability to externally rotate kids - will sit in a W position instead of criss-cross applesauce - "kissing knees" management - most cases you can observe: will resolve - discourage the W position - refer to orther if its still there at age 7, or have difficulting waling/running

Answer 7

results in intoeing - inward turning of the tibia can be normal in infancy - but commonyl as child grows, teh tiba will externally rotate Measure thigh foot angle - a neutral or internal angle signifies tibial torsion managment - corrects self at age 6 - surgeury delayed until 8-10

Answer 8

examine the same as the intoeing hip rotation: excessive external rotation can create this ; with limitied ability to internally rotate - **risk for SCFE** the thigh foot anlge will be more than 30 degrees

Answer 9

as a baby - genu varum (knees bowed out) then by the age 3-4 =straightened up Genu Varum - bow legged: the tibia is adducted in comaprison to the femur Causes - rickettes - dwarfism - ostegen. imperfecta - osteochrondritis - neuromusc - blount disease - trauma Workup - measure height (if under 25th% = xray) - measure ankle to knee distance - **measure degree of angulation with goniometer** Treatment - refer to ortho - < 36 months = brace - older - ostotomy

Answer 10

Valgum: "knock knee" - tibia is laterally displaced from femur - assocaited with over pronation of the ankle - overweight kids causes - ricketts - renal osetodystrophy - skeletak dysplasia - unilateral: trauma, infection, tumor Work up - measure height - measure tibiofemoral angle - measure intermalleolar distance treatment - refer to orther if short or older thatn 3-4 - observe, often they resolve

Answer 11

Etiology - an overuse injury: in a growing child - pain at the tibial tuberosity: due to "pulling" of the apophysis - seen in : those at peak growth spirtis, sports related (run/jump) Clinical Manifestation - pain exacerbated by running, jumping or prolonged flexion of the knee - TTP and swelling over tibial tuberosity Xray - not necessary but if its unilateral pain: can help to r/o tumor Treatment - ice, NSAIDS & rest - taping/bracing

Answer 12

Sever Etiology - traction apophysitis at the calcaneous risks - athletes - adolecents symptoms - pain at the achilles tendon Xray - diagnosis to see widened physis Treatmnet - rest ice nsaids

Answer 13

Etiology - a lateral curvature of the spine over 10 degrees - thoracic, lumbar or both - rotation of the vertebrae elicts this - females > men - adolscent is most common - universial screening no longer recmmneded Causes - idopathic - congential - neuromusc. - vertebral disease - spinal cord tumor - connective tissue issue Symptoms - asymptomatic: in general is does not cause pain - pain = work up for tumor/infection - can create respiratory symtoms if sever enough thoracic Diagnosis - 10+ degree curve - ADAMS test : bend and look

Answer 14

Diagnosis - dx. of exclusion - abnormal cutaneous fnidings - asymmetry of illiac crest and scaular spine - waist line asymmetry - assess feet for asymmetry - neruo exam Xray: scoliosis survery: gets cervical, thoracic, lumbar spine and pelvis: **measures Cobb Angle** mri/ct if neuro issue Treatment - depedns on degrees of curve - mild/mod = observation - bracing for moderate or progression curves - curve beyon 50 in thoracic or 40-45 in thoracolumbar = posterior fusion

Answer 15

etiology - cramping pains of thighs, shins and cafts that feel muscalr in nature - assocaited with growth Presentation - pain **in evenin or nighttime** can awake them from sleep - disappears in the morning - no systemic sx. or limp disgnosis no tests needed treatment reassurace

Answer 16

Salter Harris: SALTR Type 1 = "slipped" - through the physis - xray: widened physis or displaced epiphysis type 2 = "above" - above the physis: distal to the physis, away from the joint - includes the metaphysis - **most common** Type 3 = "lower" - invovles the epiphyssi: closer to the joint - considered an intraarticualr fracutre - risk of growth issues and altereed joint here Type 4: "through" - includes the epiphysis, pysis and metaphysis - articualr cartilage impacted too - impacts joint mechanics Type 5 = "Rammed" - crush/compression of the growht plate - **electrical shock injuries** or frostbite/radiation - worst prognosis

Answer 17

a fracutre of the diaphysis : bone is bendy so it just like bends a little Torus Fx. - buckle fracture : incomplete: creating a "bludge" of the bone cortex - **due to axial loading** toddelrs fracture - **Spiral fracture** of the tibia

Answer 18

Etiology - uncommon group of syndromes: all are chronic artritis - under 16, 1+ join arthritis for 6+ weeks & all other diseases excluded

Answer 19

Oligo - less than 5 joints - persistant oligo = 1-4 joints befor dx. and no more during disease - extended olio = under 5 during first 6 months; added more than 4 during cannot be RF+, or have first degree relative with psoriasis or enthesis related arthritis

Answer 20

arthritis in 5+ joints either RF+ or RF-

Answer 21

**most severe** - arthritis in 1+ joints - fever 2+ weeks daily for at least 3 days at least 1+ of - erythematous rash - hepatomegaly - splenomegaly - lymph enlargement - serositis (pericarditis)

Answer 22

child with psoriasis and arthritis OR child with arthritis and - psoriasis in 1st degree relative - dactalysisi - fingernail ab. (pitting or oncy) cannot be RF+ or have enthestitis realted

Answer 23

Enthesistis related - those with enthesitis and arthritis, or just enthesitsi or enthesitis with - SI joint or lumbosacral pain - HLAb27 - first degree relative with uveitis - acute anterior uveitis - arthritis in males > 6 years old undiff. - doesnt fit in a categorty or has mixed features

Answer 24

JIA - needs to be treated: left untreated results in disability, growth issues, blindness treatment **MTX in all subtypes is first line** poor response = dmards biologics