Pediatric Orthopedics

Question 1

Bone development and remodeling - ossification occurs in what ways

Answer 1

Intramembranous

Endochondral

Question 2

Bone development and remodeling - significance of growth plate

Answer 2

Physeal cartilage - helpful in remodeling for children so that we do not have to be as aggressive with surgery

Question 3

Bone development and remodeling - Zones of Growth Plate

Answer 3

Resting Zone
Proliferative Zone
Hypertrophic Zone
Metaphysis

Question 4

Bone development and remodeling - Growth Plate Zones - Significance of Hypertrophic Zone

Answer 4

Location of physeal fx

Fx in kids will usually go through hypertrophic zone (provisional)

Question 5

Bone development and remodeling - Growth Plate Zones - Parts of Hypertrophic Zone

Answer 5

Maturation zone
Degenerative zone
Provisional calcification zone

Question 6

Exam - Special Test - Hip *

Answer 6

Galeazzi Sign

Question 7

Exam - Special Test - Hip - Galeazzi Sign is looking for

Answer 7

Limb length discrepancy

If there is a hip dislocation, that femur will appear shorter

Question 8

Exam - Special Test - Hip - Galeazzi Sign - how to perform

Answer 8

Bend knees up while child is laying down so that feet are on the surface and the ankles touch the buttock

Question 9

In toeing - possible causes

Answer 9

Metatarsus adductus (birth to 1)
Internal tibial torsion (infant)
Inc. femoral anteversion (3+)

Question 10

In toeing - Medatarsus adductus - what is it

Answer 10

Foot appears C shaped with a concave medial border and a convex lateral border

Question 11

In toeing - Can be associated with

Answer 11

DDH!!!

So if you get a child referred to you with metatarsus adductus, you need to consider DDH!

Question 12

Tibiofemoral angle with changing age

Answer 12

Genu varum - corrects by 18 to 24 months
Genu valgum - peaks 3 or 4 yrs
Genu valgum - reaches norm of 7 degrees valgus by 7 or 8 yrs of age

Question 13

Clubfoot AKA

Answer 13

Talipes equinovarus

Question 14

Clubfoot - how to diagnosis

Answer 14

CAVE! Need all 4!
Cavus (high arch)
Forefoot adductus
Hindfoot varus
Equinus

Question 15

Clubfoot - used to be thought of as a

Answer 15

“packing” problem

Question 16

Clubfoot - what else do you need to think about when you have a pt with clubfoot

Answer 16

DDH
Torticollis
Metatarsus adductus

Question 17

Clubfoot - treatment

Answer 17

Ponseti method is the standard of care

Question 18

Clubfoot - treatment - Ponseti - what is it

Answer 18

Specific method of serial manipulation, casting, and achilles tenotomy

Question 19

Clubfoot - treatment - Ponseti - what is the last step to prevent relapse

Answer 19

Use of a foot abduction brace after the casting to prevent relapse

Question 20

Clubfoot - treatment - Ponseti - when developed

Answer 20

Developed at Univ of Iowa in 1940s

Question 21

Adolescent Idiopathic Scoliosis - most curves are

Answer 21

Centered at T7 or T8 and are apex RIGHT!!!

Question 22

Adolescent idiopathic scoliosis - RED FLAG

Answer 22

Apex LEFT curve - needs to be further evaluated with an MRI of the ENTIRE spine to look for intraspinal pathology

Question 23

Evaluation of limb length discrepancy - starred method

Answer 23

Arithmetic method

Question 24

Evaluation of limb length discrepancy - arithmetic method

Answer 24

Distal femoral - 9 mm/yr

Proximal tibial - 6 mm/yr

Question 25

Evaluation of limb length discrepancy - arithmetic method - boys grow until ____ girls grow until ___

Answer 25

Boys = until age 16
Girls = until age 14