Pediatrics

Question 1

Indications for prophylactic pinning of the femoral epiphysis

Answer 1

1) inability to obtain regular follow up
2) metabolic/endocrine disorders
3) open triradiate cartilage
4) girls younger than 10
5) and boys younger than 12.5 years

Question 2

Positioning of the Pavlik harness

Answer 2

The correct hip position should be 90-100 degrees of flexion and 20-40 degrees of abduction. Excessive flexion should be avoided to reduce the incidence of femoral nerve palsy.

Excessive abduction should be avoided as this can increase the incidence of hip avascular necrosis.

Indications to discontinue a Pavlik harness early include hips that do no reduce within 3 to 4 weeks (as this can cause erosion of the posterosuperior acetabulum known as “Pavlik harness disease”), femoral nerve palsy, and systemic comorbidity (e.g. early spinal/thoracic/cardiac surgery, etc.).

Question 3

most common factors shown to increase the risk of bilateral SCFE include

Answer 3

• hypothyroidism
• renal osteodystrophy
• male
• younger age (<10 years old).

Question 4

Indication spica cast for trauma

Answer 4

Immediate spica casting is indicated in children 6 months to 6 years with diaphyseal fractures with less than 2 cm of shortening.

Question 5

mutation in the fibroblast growth factor receptor 3 (FGFR3)

and inheritance

Answer 5

Achondroplasia

autosomal dominant

Question 6

mutation in the fibroblast growth factor receptor 3 (FGFR3)

Answer 6

Achondroplasia

Question 7

mutation in the fibroblast growth factor receptor 3 (FGFR3)

Answer 7

Achondroplasia

Question 8

Imaging findings achondroplasia

Answer 8

• “champagne glass” pelvis
• squared iliac wings
• flat acetabular roof

Question 9

Characteristic clinical features of achondroplasia

Answer 9

• rhizomelic dwarfism
• frontal bossing- trident hands
• and excessive lordosis secondary to congenitally short pedicles