pediatric ortho part II

Question 1

What is the H/P for physeal fractures?

Answer 1

pain, gross deformity, swelling, warmth, possible growth disturbance with limb inequality. xray will show premature closure of the pysis if there is a growth disturbance; otherwise, it is just a fracture

Question 2

What is the most severe type of physeal fracture?

Answer 2

crush injury of physis

Question 3

What is nursemaid’s elbow?

Answer 3

radial head subluxation that occurs via pulling and lifting on the hand. child presents with painful arm and won’t bend elbow

Question 4

What is the tx for nursemaid’s elbow?

Answer 4

manual reduction via supination of the arm with flexion of the elbow from 0 to 90 degrees

Question 5

What is the treatment for club foot?

Answer 5

serial casting of foot in correct position. may need surgery

Question 6

What is the EMG seen with duchenne muscular dystrophy?

Answer 6

polyphasic potentials and increased fiber recruitment

Question 7

What are the complications and tx for duchenne’s muscular dystrophy?

Answer 7

progressive cardiac issues, scoliosis, flexion contractures, respiratory compromise
give PT, steroids, pulm support, ACE-Is to decrease cardiac afterload

Question 8

What is the most common cause of a bone tumor in adults?

Answer 8

metastatic disease. may present as pathologic fracture

Question 9

What is the most common primary bone tumor?

Answer 9

osteosarcoma, common in male adolescents

Question 10

What are risk factors for osteosarcoma?

Answer 10

paget disease of bone, p53 mutation, familial p53 mutation (Li-Fraumeni), familial retinoblastoma, radiation exposure, bone infarction

Question 11

What are the radiographic findings of osteosarcoma?

Answer 11

x-ray shows bone lesion with a sunburst pattern and codman triangle (periosteal new bone formation at the diaphyseal end of the lesion)

Question 12

What is the “next step” after an x-ray suggests osteosarcoma?

Answer 12

chest CT to look for mets. may want PET or MRI

Question 13

What is Ewing sarcoma? what age is it most common in?

Answer 13

-highly malignant cartilage tumor in the diaphysis of long bones seen in kids 5-15

Question 14

What are the key radiographic findings of ewing sarcoma?

Answer 14

-“onion skinning” bone lesion; destructive lesion with periosteal reaction

Question 15

What is an osteochondroma? what age group? where does it occur

Answer 15

• common benign tumor in the metaphysis of long bones; more common in patients less than 25, male > female
• often in the low femur or upper tibia
• bone is continuous with lesion

Question 16

What is the treatment for an osteochondroma?

Answer 16

none unless it is causing soft tissue irritation, neurovascular compromise, or continuing growth, in which case you should recommend surgical excision
-rare (1%) transformation to chondrosarcoma