Pediatric Orthopaedics

Question 1

Scoliosis:

Answer 1

Lateral curvature greater than 10 degrees, often associated with rotational deformity

Question 2

Scoliosis exam:

Answer 2

Forward bend test

Question 3

Scoliosis treatment (2):

Answer 3

• > 30 degrees = brace

- > 40-50 degrees = surgery

Question 4

Club foot:

Answer 4

Idiopathic congenital food deformity, characterized by plantar flexion of ankle, adduction of heel, high arch, adduction of the forefoot

Question 5

Club foot treatment:

Answer 5

Manipulation and casting immediately, surgery if still rigid at 3 years

Question 6

Osgood schlatter:

Answer 6

Overuse injury causing apophyseal injury at tibial tubercle

Question 7

Osgood Schlatter, xrays show:

Answer 7

Fragmentation of tubercle

Question 8

Hip displasia:

Answer 8

Malformed hip socket and femoral head

Question 9

Hip dysplasia exams (2):

Answer 9

• Barlow exam

- Ortolani exam

Question 10

Hip dysplasia treatment (2):

Answer 10

• Pavlik harness to force relocation of hip

- Casting and surgery in older kids

Question 11

Perthes disease:

Answer 11

Idiopathic osteonecrosis of femoral head, between 4 - 8 years old

Question 12

Perthes disease exam findings:

Answer 12

Decreased internal rotation and abduction

Question 13

Slipped capital femoral epiphysis:

Answer 13

Displacement of the femoral head through the physis usually during growth spurt

Question 14

Slipped capital femoral epiphysis exam finding:

Answer 14

Loss of internal rotation with hip flexed

Question 15

If slipped capital femoral epiphysis is bilateral:

Answer 15

Workup for endocrine abnormality

Question 16

Tarsal coalition:

Answer 16

Abnormal connection between tarsal bones

Question 17

Tarsal coalition on exam:

Answer 17

Restricted hindfoot movement

Question 18

Tarsal coalition on x-ray:

Answer 18

Calcaneal navicular coalition

Question 19

Transient synovitis of the hip:

Answer 19

Sterile effusion of the hip causing pain

Question 20

Transient synovitis of the hip test results (4):

Answer 20

• X-rays show effusion
• CBC, ESR, CRP not elevated
• Joint aspirate < 50,000 WBCs
• Gets better with NSAIDS

Question 21

Most common elbow fx:

Answer 21

Supracondylar humerus fracture

Question 22

Rickets:

Answer 22

Error in Vit D metabolism causes failure of mineraliztion

Question 23

Rickets on X-ray (2):

Answer 23

• Looser lines (osteoid seam)

- Widened growth plates

Question 24

Majority of upper limb growth from:

Answer 24

Ends of humerus and radius

Question 25

Majority of lower limb growth from:

Answer 25

Knee

Question 26

Common patterns of fx in non-accidental trauma (3):

Answer 26

• Posterior rib fx
• Spiral fx
• Metaphyseal corner fx

Question 27

Cerebral palsy:

Answer 27

Permanent, non-progressive brain injury in the peripartum period

Question 28

Achondroplasia (4):

Answer 28

• Disproportionate short stature
• FGFR3 mutation
• Autosomal dominant
• Hypertrophic zone in growth plate in narrow

Question 29

Marfan syndrome:

Answer 29

Fibrillin mutation

Question 30

Osteogenesis inperfecta:

Answer 30

Defect in collagen I from osteoblasts