Pediatric Orthopedics

Question 0

Legg- Perthes disease – Definition and specific area affected? Age of onset? Signs? Diagnosed with? Treatment?

Answer 0

Avascular necrosis of the capital femoral epiphysis; around age 6

1. Insidious development of limping
2. Decreased passive hip motion
3. Hip/knee pain

AP/lateral hip x-rays

Controversial – contain femoral head within acetabulum by casting/crutches

Question 1

Developmental dysplasia of the hip – acquired how? Signs? Diagnosis? Test not appropriate for diagnosing condition? Treatment?

Answer 1

Genetically

Uneven gluteal folds, easily dislocated hip

Sonogram (x-rays not diagnostic – hip is not calcified a newborn)

Pavlik harness (adduction sprinting) for six months

Question 2

Two pediatric orthopedic emergencies?

Answer 2

Slipped capital femoral epiphysis and septic hip

Question 3

Slipped capital femoral epiphysis – typical child? Signs? Diagnosed with? Treatment?

Answer 3

Overweight or lanky male around age 13

1. Complain of growing/knee pain
2. When sitting with legs dangling, sole of the affected leg points towards other foot
3. Upon hip flexion, ?? cannot be internally rotated

X-rays

Pin femoral head into place

Question 4

Septic hip – typical patient? Signs? Diagnosed with? Treatment??

Answer 4

Toddlers post febrile illness

1. Patient refuses to move hip
2. Patient holds leg with hip flexed, abducted, and externally rotated
3. Elevated ESR

Aspiration under general anesthesia

Open drainage

Question 5

Orthopedic pathologies the present after febrile illness in children?

Answer 5

Septic hip; acute hematogenous osteomyelitis

Question 6

Patient presents with severe localized pain in a bone (with no prior history of trauma in that area) post febrile illness. Diagnosed with? Treat with?

Answer 6

Acute hematogenous osteomyelitis MRI; antibiotics

Question 7

Genu varum vs Blount disease? Management?

Answer 7

Normal under three versus persistent beyond the age of three

Normal (no treatment) vs surgery

Question 8

Genu valgus? Normal if?

Answer 8

Knock-knees; Between ages four and eight

Question 9

Osgood-Schlatter disease? Age? Symptoms? Symptoms exacerbated by? Management?

Answer 9

Osteochondrosis of the tibial tubercle; teenagers

pain over tibial tubercle, aggravated by contraction of the quadriceps

1. Conservative management (RICE)
2. If fails, Immobilization of the knee in an extension cast for four weeks

Question 10

Tapiles equinovarus aka? Symptoms? Management?

Answer 10

Clubfoot – At birth, both feet turned inward with plantar flexion of the ankle, inversion of the foot, abduction of the forefoot

1. Serial plaster cast started in neonatal period
2. If not corrected, surgery after eight months of age

Question 11

Scoliosis in children – age/sex? Most sensitive screening? Complication? Management?

Answer 11

Adolescent girls; observed from behind while she bends forward (hump over right thorax)

Decreased pulmonary function

1. Bracing
2. If fails, surgery

Question 12

Fractures in which children have special problems?

Answer 12

1. Supracondylar fractures of the humerus

2. Fracture of any bone that involves growth plate

Question 13

Pediatric patient presents after falling on extended arm – Likely fracture? Complications?

Answer 13

Supracondylar fracture of the humorous

Vascular/nerve injuries meeting to Volkmann contracture

Question 14

Management of a fracture that involves the growth plate in pediatric patient?

Answer 14

1. Closed reduction if growth plate displaced laterally but in one piece
2. Open reduction and internal fixation if in 1+ pieces

Question 15

Signs of primary malignant bone tumor?

Answer 15

Sunburst pattern and periosteal onion skinning on x-ray

Question 16

Most common primary malignant bone tumor? Age of onset? Typical location? Characteristic finding on imaging?

Answer 16

Osteogenic sarcoma; 10-25

Around knee (lower fever or upper tibia)

Sunburst pattern on x-rays

Question 17

Second most common malignant bone tumor? Age of onset? General location? Characteristic finding on imaging?

Answer 17

Ewing sarcoma; 5-15

Diaphysis long bones

Onion skinning on x-ray