pediatric orthopedics

Question 1

physis

Answer 1

longitudinal growth of long bones occurs here

Question 2

gowers sign

Answer 2

weakness of proximal hip muscles. limit child’s ability to rise from sitting position

Question 3

circumduction gait

Answer 3

patient will hold his or her arm to one side and drags his or her affected leg in a semicircle

Question 4

antalgic gait

Answer 4

pattern of walking that ultimately causes a limp
the stance phase is shortened relative to the swing phase

Question 5

trendelenburg gait

Answer 5

abnormal gait resulting from a defective hip abductor mechanism (jutting hip out to side when walking?)

Question 6

acute limp can be due to

Answer 6

fracture/contusion, transient synovitis, osteomyelitis, arthritis

Question 7

chronic limp

Answer 7

apophysitis, SCFE, rheumatic disease, legg-calve-perthes disease

Question 8

what should you do if you can’t find the reason for a limp in a child?

Answer 8

evaluate weekly until problem resolves or diagnoses reached
do not take lightly

Question 9

salter harris classification system

Answer 9

type 1 - fracture through growth plate
type 2 - fracture through metaphysis and growth plate
type 3 - fracture through epiphysis and growth plate
type 4 - fracture through metaphysis, epiphysis, and growth plate
type 5 - crushed through growth plate

Question 10

most common salter harris fracture?

Answer 10

type 2

Question 11

greenstick fracture

Answer 11

results from bending force applied perpendicular to shaft
usually occurs in forearm of young child

Question 12

toddlers fracture presentation

Answer 12

limping and pain but minimal swelling

Question 13

toddlers fracture imaging

Answer 13

xrays does not always show fracture
treat like fracture anyways and split

Question 14

buckle fracture (torus fracture) etiology

Answer 14

FOOSH, axial load causes compression of bone

Question 15

buckle fracture treatment

Answer 15

immobilization 4 weeks

Question 16

supracondylar elbow fracture treatment

Answer 16

long arm cast, analgesics, serial radiographs
ORIF

Question 17

nursemaid’s elbow (radial head subluxation) etiology

Answer 17

caused by being pulled/lifted by the hand
radial head subluxes under annular ligament

Question 18

nursemaid’s elbow presentation

Answer 18

child not using arm, pronated wrist, tender elbow

Question 19

nursemaid’s elbow treatemnt

Answer 19

pressure with thumb on radial head and gentle supination of forearm while flexing elbow

Question 20

slipped capital femoral epiphysis pathophysiology

Answer 20

displacement of epiphysis relative to femoral neck/shaft
head slips posteriorly through growth plate

Question 21

slipped capital femoral epiphysis presentation

Answer 21

groin/thigh pain, knee pain
external rotation or trendelenburg, decreased hip motion

Question 22

slipped capital femoral epiphysis imaging

Answer 22

ap hip and frog leg lateral

Question 23

slipped capital femoral epiphysis treatment

Answer 23

immediate referral to pedi ortho
non-weight bearing

Question 24

slipped capital femoral epiphysis prognosis

Answer 24

abnormal gait and rotated leg position are permanent

Question 25

developmental dysplasia of the hip etiology

Answer 25

aberrant development of hip joint

Question 26

developmental dysplasia of the hip risk factors

Answer 26

female firstborn baby family hx spina bifida

Question 27

developmental dysplasia of the hip presentation

Answer 27

toe walking, waddling gait, limb length inequality, hyperlordosis

Question 28

developmental dysplasia of the hip PE

Answer 28

delicately examine hips barlow, galeazzi, and ortolani test

Question 29

developmental dysplasia of the hip imaging

Answer 29

ultrasound single AP xray

Question 30

developmental dysplasia of the hip treatment

Answer 30

conservative - pavlik harness, abduction orthosis surgery - if conservative fails. closed reduction first, open reduction, spica cast.

Question 31

transient synovitis of hip etiology

Answer 31

self-limiting inflammatory condition of hip. occasionally follows URI

Question 32

transient synovitis of hip presentation

Answer 32

rapid onset of limping and subsequent refusal to walk/bear weight

Question 33

transient synovitis of hip diagnostics

Answer 33

labs: +/- mild elevation of WBC, ESR, CRP xray: ap pelvis/ frog leg lateral US: evaluate effusion must exclude septic arthritis

Question 34

transient synovitis of hip treatment

Answer 34

treat symptoms, rest, NSAIDs

Question 35

legg-calve-perthes etiology

Answer 35

idiopathic avascular necrosis of femoral head osteonecrosis generally occurs secondary

Question 36

what arteries supply blood to femoral head

Answer 36

medial femoral circumflex, lateral femoral circumflex, artery of ligamentum teres

Question 37

legg-calve-perthes presentation

Answer 37

atraumatic hip pain or lip, coincidental trauma hx, persistent hip pain more common in boys 5x

Question 38

legg-calve-perthes imaging

Answer 38

AP hip, frog leg lateral

Question 39

stages of legg-calve-perthes

Answer 39

initial, fragmentation, reossificiation, final

Question 40

legg-calve-perthes treatment

Answer 40

goal is maintaining ROM and containment of femoral head through petrie cast or abduction brace non-weight bearing if in fragmentation phase surgical

Question 41

osgood schlatters etiology

Answer 41

traction at insertion of patella tendon into tibial tuberosity

Question 42

osgood schlatters presentation

Answer 42

chronic focal pain at tibial tubercle, pain relieved with rest, +/- swelling, redness

Question 43

osgood schlatters treatment

Answer 43

RICE, NSAIDs, activity modification, cho-pat straps

Question 44

sever's syndrome (calcaneal apophysitis) etiology

Answer 44

inflammatory condition of growth plate in heel repetitive stress on growth plate as foot strikes ground

Question 45

stages of sever's syndrome

Answer 45

hurts after activity, hurts during and after activity, hurts before during and after activity

Question 46

sever's syndrome presentation

Answer 46

heel pain +/- limp

Question 47

sever's syndrome treatment

Answer 47

RICE, activity modification, gel heel pads, NSAIDs, stretching of achilles

Question 48

toe walking etiology

Answer 48

tends to be habitual achilles tendon contracture

Question 49

toe walking PE

Answer 49

+/- reduction of ankle dorsiflexion

Question 50

toe walking treatment

Answer 50

PT - heel cord stretching serial casting surgical - heel cord lengthening

Question 51

what should you rule out before diagnosing toe walking

Answer 51

neuromuscular disorder, cerebral palsy, autism

Question 52

Osgood-schlatters PE

Answer 52

pain with straight leg raise