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OITE Review Book > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Age at elbow ossification

A

CRITOE

Capitellum (1)
Radial head (3)
Internal (medial) epicondyle (5)
Trochlea (7)
Olecranon (9)
External (lateral) epicondyle (11)
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2
Q

What direction does a transphyseal distal humerus fracture typically displace?

A

posteromedial

radiocapitellar line is preserved

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3
Q

Tx of transphyseal separation of distal humerus

A

CRPP

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4
Q

How to differentiate between transphyseal separation distal humerus and elbow dislocation

A

Arthrogram

In elbow dislocation, the radiocapitellar line is disrupted

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5
Q

Most common femur fracture associated with abuse

A

transverse

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6
Q

Most common and second most common cause of death in children

A

1st - accident

2nd - abuse

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7
Q

The greatest skeletal linear growth occurs during…

A

the first year of life.

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8
Q

Best measurement of LLD if there is joint contracture

A

CT scanography

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9
Q

Meleneus method

A

girl reaches skeletal maturity at 14 years, boys at 16 years

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10
Q

Treatment of LLD for projected length

A

< 2 cm: non-op
2-5 cm: epiphysiodesis
> 5 cm: limb lengthening

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11
Q

Advantage of dome osteotomy

A

provides most bone contact with the least amount of translation and shortening

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12
Q

Partial physeal arrest results in…

A

angular deformity while complete results in LLD.

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13
Q

When to treat physeal arrest with bar resection and interposition

A

physeal bar < 50% and > 2 yrs or > 2 cm growth remaining

otherwise, complete epiphysiodesis and address LLD PRN

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14
Q

Cerebral palsy leads to…

A

static encephalopathy before 2 years old.

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15
Q

How to treat CP medically

A

baclofen activates GABA receptors –> inhibited action potentials

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16
Q

Best predictor for ability to ambulate in CP

A

sitting by age 2

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17
Q

Best predictor for functional improvement after surgery for UE deformity in CP

A

voluntary control of motion

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18
Q

In CP, NM hip dysplasia is…

A

with acetabular deficiency located posterosuperior.

***The migration index correlates with GMFCS level.

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19
Q

Treatment of CP pt w/ NM hip dysplasia (generally)

A

< 4 yrs: adductor and psoas release
> 4 yrs:
- functioning child: dega and proximfal femoral osteotomy
- non-functioning (GMFCS V): femoral head resection (+/- PFO)

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20
Q

Lyme caused by…

A

borrelia burgdorferi via deer tick (ixodes).

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21
Q

Lyme symptoms

A

erythema migrans
CN7 palsy
carditis
encephalopathy

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22
Q

Tx of lyme if no neuro or cardiac sx

A

doxycycline (not in kids < 8 yrs) or amoxicillin for 28 days

***if neuro or cardiac sx, then needs IV ceftriaxone, cefotaxime or PCN G

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23
Q

Timing of prosthesis fitting for congenital UE amp

A

6 months (sitting)

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24
Q

Timing of prosthesis fitting for congenital LE amp

A

12 months (walking)

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25
Q

Rett syndrome

A
  • ataxia, hypotonia, chorea, NM scoliosis

- X-linked dominant (male fetuses die in utero)

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26
Q

Treatment of radial neck fx

A

< 30 degrees angulation: cast w/o reduction

> 30 degrees: closed reduction and cast (if CR fails –> perc vs open reduction and pinning)

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27
Q

Nursemaid’s elbow

A

radial head subluxation with interposition of annular ligament in the radiocapitellar joint

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28
Q

Treatment of nursemaid’s elbow

A

reduce by supinating and flexing, no immobilization

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29
Q

To assess rotation of BBFF, check….

A

AP xray. Radial styloid and biceps tuberosity should be 180 degrees.

Lateral xray. ulnar styloid and coronoid should be 180 degrees.

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30
Q

Distal 1/3 BBFF or DRF in kids can be treated with…

A

SAC.

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31
Q

BBFF displaced should be treated with…

A

reduction and immobilization with thumb pointing away from apex of fx.

Apex volar fx (supination injury): pronate forearm
Apex dorsal fx (pronation injury): supinate forearm

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32
Q

Usual reason for pink, pulseless hand after SCH CRPP

A

brachial artery spasm

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33
Q

Crossed pins for SCH are…

A

biomechanically more stable***.

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34
Q

What structures prevent reduction in SCH fx?

A

extension type: brachialis, median nerve, brachial artery

flexion type: ulnar nerve

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35
Q

Best view to evaluate lateral condyle fracture

A

internal oblique

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36
Q

Treatment of lateral condyle fx

A

CRPP if > 2 cm of displacement

**Vascular supply comes posteriorly so avoid posterior dissection to prevent lateral condyle AVN

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37
Q

Cubitus valgus can present with…

A

tardy ulnar nerve palsy.

Supracondylar osteotomy if needed.

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38
Q

How to prevent lateral spurring with lateral condyle fractures

A

anatomic reduction

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39
Q

Status of LCL in lateral condyle fractures

A

intact, attached to lateral condyle fragment proximally and radial neck distally

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40
Q

Best view to determine displacement of a medial humeral epicondyle fracture

A

distal humeral axial view

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41
Q

Pediatric trigger thumb

A

Notta’s node (thickened flexor tendon nodule)
Fixed deformity > 1 yr of age: release A1 pulley
**be careful of radial digital nerve

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42
Q

Pediatric trigger finger

A

in addition to A1 pulley release, may need to release one or more FDS slips

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43
Q

Most common osbstetric brachial plexus birth palsy

A

upper trunk (Erb’s) palsy C5-C6

**Has a better prognosis because of preserved hand function

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44
Q

In Erb’s palsy, treatment should include…

A

parents performing passive stretching with emphasis on shoulder elevation, abduction and ER.

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45
Q

Treatment of brachial plexus palsy with elbow flexion contracture

A

serial casting

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46
Q

Late presentation of a brachial plexus palsy will show…

A

IR contracture, posterior glenohumeral dysplasia and dislocation

If > 5 yrs old, perform proximal humerus derotation osteotomy to improve ER.

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47
Q

Sprengel deformity is thought to be due to…

A

an embryonic vascular interruption (like poland syndrome).

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48
Q

Sprengel deformity is associated with…

A

omovertebral body, klippel-feil syndrome and congential scoliosis.

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49
Q

What motion is most limited in a sprengel deformity?

A

shoulder abduction

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50
Q

The psoas is intervated by…

A

the lumbar plexus.

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51
Q

The iliacus is innervated by…

A

the femoral nerve.

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52
Q

Injury to the greater trochanter apophysis leads to…

A

coxa valga ( > 135 degrees).

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53
Q

Overgrowth of the greater troch apophysis leads to…

A

coxa vara (< 120 degrees).

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54
Q

Most common complication after injury to the pediatric proximal femur is….

A

AVN (injury to MFCA).

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55
Q

What vessels are injured with piriformis entry IMN in a kid?

A

lateral epiphyseal vessels (deep branches of MFCA).

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56
Q

In a pediatric distal femur fracture, if pins need to cross the physis, use….

A

smooth k-wires.

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57
Q

Treatment of tibial eminence fracture

A 
Type I (nondisplaced) --> immobilize with knee in extension
Type II (intact posterior hinge) --> closed reduction
Type III (displaced) --> open vs scope reduction and fixation
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58
Q

Premature closure of the tibial tubercle apophysis can lead to…

A

recurvatum deformity.

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59
Q

In a cozen phenomenon, the valgus deformity will…

A

generally resolve but the affected limb will be longer.

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60
Q

Tillaux fracture

A

SH III ankle fracture with avulsion of AITFL.

*ER injury

**obtain CT to evaluate step off

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61
Q

Triplane fracture

A

SH IV –> SH II in lateral view and SH III in AP view

*obtain CT scan

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62
Q

Closure of the distal tibial physis

A

Central physis is first to close while anterolateral is last (which is why tillaux and triplanes affect the anterolateral region).

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63
Q

Can treat pediatric distal tibial fractures with closed reduction if…

A

there is < 2 mm of articular stepoff. Need to internally rotate foot to reduce typically.

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64
Q

In a SHII distal tibia fracture, what may prevent successful closed reduction?

A

entrapment of torn anterior periosteum

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65
Q

Cast ankle in…

A

neutral to resting plantarflexion (37 degrees) to prevent compartment syndrome.

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66
Q

Risk factors for development of DDH (4)

A

firstborn, female, breech, family history

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67
Q

Barlow and Ortolani

A

Barlow dislocations, Ortolani reduces

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68
Q

In DDH, the acetabular deficiency is…

A

anterolateral.

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69
Q

The alpha angle determines…

A

the degree of horizontalization of acetabular sourcil.

Normal is > 60 degrees.

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70
Q

The beta angle measures…

A

displacement of the hip abductor muscles.

Normal is < 55 degrees.

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71
Q

If a hip is still dislocated after 3 weeks of Pavlik harness, then…

A

switch to semirigid abduction orthosis.

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72
Q

Treatment of femoral nerve palsy in harness

A

discontinue harness and observe

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73
Q

Hyperabduction in pavlik harness leads to…

A

impingement of posterosuperior retinacular branch fo the MFCA leading to AVN.

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74
Q

Treatment of DDH at 6-18 months if non-op fails

A

closed reduction and spica casting

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75
Q

Blocks to closed reduction in DDH

A

inverted labrum, inverted limbus, transverse acetabular ligament, capsule, pulvinar, ligamentum teres

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76
Q

Treatment of DDH > 18 months old

A

open reduction +/- osteotomy and spica casting

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77
Q

DDH is associated with…

A

femoral antersion and coxa valga (needs VDRO)

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78
Q

Open approach to DDH is typically…

A

anterior (Smith-Pete) to minimize risk to MFCA.

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79
Q

Treatment of residual acetabular dysplasia with open triradiate

A

Pemberton osteotomy or Salter

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80
Q

Angles indicating adult hip dysplasia

A

LCEA < 20 or Tonnis angle > 10

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81
Q

Treatment of Legg-Calve-Perthes in a young child

A

activity modification and symptomatic treatment

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82
Q

Best prognostic factor for Legg-Calve-Perthes

A

age less than 6

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83
Q

Treatment of Legg-Calve-Perthes in 8-11 year old

A

containment surgery (femoral or pelvic osteotomy) for AVN

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84
Q

If there appears to be bilateral legg-calve-perthes, think…

A

multiple eiphyseal dysplasia (MED)

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85
Q

Tx of congenital knee dislocation

A

if knee can be passively flexed to neutral, treat with serial casting followed by bracing at bedside

if not, open reduction (quad lengthening, soft tissue release).

86
Q

Congenital knee dislocation is associated with…

A

myelomeningecele, arthrogryposis, DDH, clubfoot

87
Q

If have congenital hip and knee dislcations, which to treat first

A

knee

88
Q

Congenital longitudinal deficiency includes…

A

proximal femoral focal deficiency, fibular hemimelia, ACL deficiency, and tarsal coalition

89
Q

Which gene regulates limb bud formation

A

sonic hedge hog

90
Q

Fibular hemimelia is associated with…

A

absent lateral rays and equinovalugs foot

91
Q

Treatment of fibular hemimelia

A

w/ functional, plantigrade foot –> sx to address LLD

w/ non-functional foot –> syme amp

92
Q

In SCFE, what is the direction of displacement?

A

metaphysis slips anterior and superior relative to epiphysis

93
Q

What will MRI of SCFE show?

A

metaphyseal edema

94
Q

What zone of the growth plate does a SCFE involve?

A

hypertrophic zone

95
Q

What does SCFE have referred knee pain?

A

medial obturator nerve

96
Q

Acute vs chronic SCFE

A

less or more than 3 weeks

97
Q

In situ fusion of a SCFE should be…

A

proximal and anterior (compared to CRPP for adults).

98
Q

Contralateral fixation of contralateral hip in SCFE if…

A

< 10 years old or has endocrine disorder.

99
Q

Placement of screw to prevent impingement in SCFE

A

should be lateral to the intertrochanteric line to prevent screw impingement w/ acetabulum/labrum during hip flexion

100
Q

Maximum physiologic genu valgum occurs between…

A

ages 2-4.

101
Q

When to consider distal femoral medial plate hemiepiphysiodesis for genu valgum

A

> 7 years old w/ valgus > 12 degrees

102
Q

Hueter-Volkmann principle

A

compression across growth plate slows growth

103
Q

If a patient with genu valgum has a large deformity with inadequate growth remaining for hemiepiphysiodesis, treat with…

A

distal femoral varus osteotomy.

104
Q

Posteromedial tibial bowing is…

A

physiologic. Treat with observation.
* May have LLD.

**associated with calcaneovalgus.

105
Q

Anterolateral tibial bowing is associated with…

A

NF1.

106
Q

Tx of anterolateral tibial bowing

A

no fx or pseudarthrosis: total contact orthosis
bowing w/ acute fx: LLC
pseudarthrosis: surgical fixation w/ bone graft

107
Q

anteromedial tibial bowing is associated with…

A

fibular hemimelia

108
Q

Normal progression of knee alignment

A

physiologic genu varum until <2 years old –> maximum genu valgum at 3 years old –> physiologic genu valgum at 7 years old

109
Q

Infantile Blounts is seen in…

A

kids 2-5 years old.

110
Q

Mild infantile blount’s treatment (stage I&II) for kids less than 3 years old

A

valgus-inducing KAFO brace (unload medial compartment)

111
Q

Treatment of moderate to severe infantile blounts or in kids > 3 years old

A

proximal tibia/fibula valgus osteotomy.

**Overcorrect 10-15 degrees of valgus

112
Q

Adolescent blounts is seen in…

A

kids over 10 years old and is usually unilateral.

113
Q

Treatment of adolescent blounts

A

small deformity w/ adequate remaining growth: lateral tibia/fibula hemiepiphysiodesis.

large deformity, skeletally mature: proximal tibia/fibula osteotomy

114
Q

Congenital vertical talus

A

rigid rocker bottom/flatfoot deformity due to dorsal dislocation of the navicular on the talus

115
Q

Plantarflexion lateral xray will reveal…

A

oblique talus: talonavicular joint is reduced

CVT: persistent dorsal dislocation of the navicular

116
Q

CVT will have a meary angle….

A

> 20.

117
Q

Treatment of CVT

A

reverse ponseti casting followed by surgery at 6-12 months (soft tissue releases, reduction of TN joint, pinning)

*refractory cases –> talectomy, triple arthrodesis

118
Q

Foot progression angle determines…

A

in-toeing (negative value) or out-toeing (positive value)

119
Q

3 common causes of in-toeing

A
  1. metatarsus adductus (infant)
  2. internal tibial torsion (toddler)
  3. femoral anteversion (childhood)
120
Q

Dx of internal tibial torsion

A

internal thigh foot progression angle (negative value)

121
Q

Dx of external tibial torsion

A

external thigh foot progression angle (positive value)

122
Q

Femoral anteversion is associated with…

A

packaging disorders (DDH, metatarsus adductus, congenital muscular torticollis).

**Increased hip IR

123
Q

2 common causes of out-toeing

A
  1. external rotation contracture of hips

2. external tibial torsion

124
Q

Treatment for recurrent clubfoot after casting is…

A

recasting.

125
Q

Extensive soft tissue release for clubfoot is associated with…

A

poor long term foot function.

126
Q

Treatment of dynamic supination following ponseti casting

A

anterior tibialis transfer to lateral cuneiform

127
Q

Treatment of dorsal bunion following ponseti casting

A

(due to dorsiflexed first MT)

FHL lengthening and FHB flexor to extensor transfer

128
Q

Charcot marie tooth genetics

A

autosomal dominant usually

duplication of peripheral myelin protein 22 (PMP22) on chromosome 17

129
Q

Charcot Marie Tooth Characteristics

A

cavovarus foot, claw toes/hammertoes

**intrinsic foot muscles (longest axons) are first to be weakened

130
Q

OI genetics

A

AD and AR forms, COL1A1/COL1A2 –> glycine substitution in procollagen –> impaired cross-linking of colalgen

131
Q

OI traits

A
  • congenital anterolateral radial head dislocations
  • olecranon avulsion fx
  • blue sclera
  • basilar invagination –> myelopathy
  • dentinogenesis imperfecta
132
Q

Long term use of bisphosphonates in OI will show…

A

parallel metaphyseal bands on xrays

133
Q

Fix fractures in OI with…

A

intramedullary (load-sharing) constructs

134
Q

Achondroplasia genetics

A

AD
gain of function mutation in FGF3R –> inhibits chondrocytes in the zone of proliferation thus impairing endochondral bone formation

135
Q

Risk factor for achondroplasia

A

advanced parental age

136
Q

Thoracolumbar kyphosis in achondroplasia will…

A

likely resolve at walking age.

137
Q

Achondroplasia traits

A
  • lumbar spinal stenosis (2/2 short pedicles adn decreased interpedicular distance)
  • normal intelligence
  • trident hands
  • stenosis of foramen magnum –> central apnea
  • champagne glass pelvis
  • genu varum
138
Q

What type of dwarfism is achondroplasia?

A

rhizomelic dwarfism (disproportionate limbs, arms shorter than forearms, thighs shorter than legs)

139
Q

Osteopetrosis

A

marble bone disease due to osteoclast dysfunction

140
Q

Osteopetrosis is linked to…

A

a defect in TCIRG1 gene which encodes a subunit of the proton pump in osteoclasts.

Impaired osteoclast carbonic anhydrase activity –> cannot acidify Howship lacunae for bone resorption.

141
Q

Traits of osteopetrosis

A
  • cranial nerve palsies (esp. optic nerve)
  • pancytopenia 2/2 encroachment of bone marrow
  • erlenmeyer flask femur
  • rugger jersey spine
142
Q

Neurofibromatosis I genetics

A 
AD
NF1 gene (neurofibromin)
143
Q

Traits of NF1

A
  • smooth cafe au lait spots
  • optic glioma
  • axillary freckling
  • Lisch nodules (iris hamartomas)
  • dystrophic scoliosis
  • hemihypertrophy
  • anterolateral tibial bowing
  • pseudarthrosis of tibia/radius/ulna
144
Q

NF2 has…

A

vestibular schwannomas.

145
Q

Neurofibromas may transform into…

A

malignant peripheral nerve sheath tumors.

**malignant transformation is associated with increased uptake on PET-CT.

146
Q

Larsen syndrome is…

A

bilateral congenital hip, knee and elbow dislocations (specifically radial head); clubfoot, cervical kyphosis (*Need C-spine imaging).

147
Q

Larsen syndrome is due to…

A

a mutation in filamin B.

148
Q

Freidreich’s ataxia genetics

A

AR
GAA repeat mutation in frataxin gene –> absence of frataxin leads to spinocerebellar degeneration (primarily posterior columns of the spinal cord)

149
Q

Traits of Freidreich’s ataxia

A
  • cavovarus foot
  • ataxia
  • areflexia
  • scoliosis
150
Q

Marfan syndrome genetics

A

AD

fibrillin-1 gene (FBN-1)

151
Q

Traits of Marfan

A
  • dolichoostenomelia
  • arachnodactyly
  • scoliosis
  • protrusio acetabuli
  • dural ectasia
  • pectus excavatum
  • aortic root dilation
  • mitral valve prolapse
  • superior lens dislocation
152
Q

Muscular dystrophy genetics

A

X-linked recessive

Duchenne: absent dystrophin
Becker: decreased dystrophin

153
Q

Muscular dystrophy facts

A
  • Gower’s sign
  • elevated CPK
  • corticosteroid slows progression
154
Q

Treatment of scoliosis in muscular dystrophy

A

early posterior spinal fusion (20-30 degrees curve) to prevent restrictive lung disease.

155
Q

Multiple epiphyseal dysplasia (MED) genetics

A

usually AD

Cartilage oligometric matrix protein (COMP) mutation –> type II collagen dysfunction

156
Q

MED facts

A
  • impaired endochondral ossification of epiphyses

- disproportionate dwarfism

157
Q

Spondyloepiphyseal dysplasia (SED) genetics

A

COL2A1 mutation
AD (congenita)
X-linked recessive (tarda)

158
Q

SED is associated with…

A

atlantoaxial instability –> myelopathy

159
Q

Diastrophic dysplasia genetics

A 
AR
DTDST gene (sulfate transport protein)
160
Q

Diastrophic dysplasia traits

A
  • rhizomelic dwarfism
  • cauliflower ears
  • hitchhiker’s thumb
  • clubfeet
  • cervical kyphosis
  • cleft palate
161
Q

Metaphyseal chondrodysplasia

A

metaphysis is dysplastic while epiphysis is normal

162
Q

Jansen’s is…

A

a type of metaphyseal chondrodysplasia. AD. activating mutation of PTHrP leads to delayed maturation in the zone of hypertrophy

163
Q

Cleidocranial dysplasia genetics

A

AD

Runx2/Cbfa1 mutation –> impaired intramembranous ossification

164
Q

What structures are affected in cleidocranial dysplasia?

A

midline

clavicles, wide pubic symphysis, open fontanels

165
Q

Campomelic dysplasia

A

SOX9 mutation

-bowing of long bones with overlying cutaneous dimpling, hypoplastic scapulae

166
Q

In general, mucopolysaccharidosis (lysosomal storage disorders) show…

A

proportionate dwarfism and carpal tunnel syndrome.

167
Q

Morquio disease

A

AR

galactosamine-6-sulfate sulphatase, beta-galactosidase

keratan sulfate accumulation

odontoid hypoplasia –> atlantoaxial instability, normal intelligence

168
Q

Hurler disease

A

AR

alpha-L-iduronidase

dermatan sulfate accumulation

169
Q

San filippo disease

A

AR

heparan sulfate accumulation

170
Q

Hunter disease

A

X-linked recessive

sulpho-iduronate-suphatase

dermatan/heparan sulfate accumulation

clear corneas

171
Q

Down syndrome genetics

A

trisomy 21: type 6 collagen leads to ligamentous laxity y

172
Q

down syndrome traits

A
  • atlantoaxial and occipitocervical instability

- hip dysplasia due to hypotonia, patellofemoral instability

173
Q

Beckwith-Wiedemann syndrome

A
  • hemihypertrophy
  • macroglossia
  • Wilms tumor (requires frequent abdominal/pelvis US and AFP levels)
174
Q

Ehler-Danlos

A
  • COL5A1/COL5A2 mutation

- get echo to evaluate aortic root dilation

175
Q

Gaucher disease

A

sphingollipid lysosomal storage disorder

  • AR
  • beta-glucocerebrosidase
176
Q

Congenital muscular torticollis presents with…

A

palpable mass (SCM), usually painless. Head tilts toward while chin rotates away from affected side.

177
Q

US of congenital muscular torticollis shows…

A

fibrosis.

178
Q

Treatment of congenital muscular torticollis

A

stretching of SCM. stretch in the direction opposite of the contracture (tilt head away while rotate chin towards affected side).

**SCM lengthening/release if non op fails

179
Q

Benign paroxysmal torticollis

A

episodic torticollis associated with pallor, agitation adn ataxia.

**typically resolves by 3 years

180
Q

Klippel-Feil syndrome

A

short webbed neck, low hairline, limited neck ROM

181
Q

Klippel-Feil syndrome is due to…

A

failure of segmentation or resegmentation of somites

182
Q

Klippel-Feil syndrome is associated with…

A

congenital scoliosis and Sprengel deformity.

183
Q

Atlantoaxial rotatory subluxation is usually associated with…

A

URI (Grisel’s disease), trauma or head/neck surgery.

184
Q

Gold standard for diagnosis of atlantoaxial rotatory subluxation is…

A

dynamic CT.

185
Q

Treatment of Atlantoaxial rotatory subluxation

A

< 1 week: soft collar, NSAIDs
> 1 week: head halter traction, muscle relaxant –> hard collar for 3 months
> 4 weeks: halo traction –> halo-vest immobilization for 3 months

**If all this fails –> posterior C1-2 fusion

186
Q

Pseudosubluxation of cervical spine is usually..

A

C2 on C3 and often reduces with extension radiograph.

187
Q

Treatment of acute, symptomatic pediatric spondylolysis/listhesis

A

TLSO

188
Q

Exam of pediatric spondylolysis

A

loss of normal lumbar lordosis, tight hamstrings, pain with single limb standing lumbar extension

189
Q

if xrays are normal and you suspect spondylolysis, obtain…

A

SPECT (most sensitive)

190
Q

Spondylolysis is most prevalent in…

A

native americans

191
Q

AIS is seen in…

A

10-18 year olds. Most commonly female with right thoracic curves.

192
Q

What risser stage has highest risk of curve progression?

A

stage 0 (peak growth velocity)

193
Q

Brace AIS for curves…

A

less than 25 degrees in skeletally immature.

Wear for > 12.9 hours per day.

194
Q

How to improve pedicle screw pullout strength

A
  1. tap 1 mm smaller than screw diameter

2. place screw via straightforward trajectory (vs anatomic)

195
Q

smallest pedicles in T spine

A

T4-T6

196
Q

smallest pedicle in L spine

A

L1

197
Q

Infantile idiopathic scoliosis

A

less than 3 years old
typically male and left thoracic curve
treat with serial casting

198
Q

What is a predictor of curve progression in infantile idiopathic scoliosis?

A

rib vertebral angle difference (RVAD) > 20 degrees

199
Q

Congenital scoliosis can be associated with…

A

VACTERL. Remember to obtain renal US and echo.

200
Q

Treatment of congenital scoliosis 2/2 hemivertebra

A

vertebral excision and short segment fusion

201
Q

What type of congenital scoliosis finding has the lowest risk for curve progression?

A

block vertebra

202
Q

Neuromuscular scoliosis is associated with…

A

cerebral palsy, SMA, muscular dystrophy, spina bifida

**Treat with early surgery (Posterior instrumented fusion). Extend fusion to include pelvis.

203
Q

Myelodysplasia

A

folate deficiency, AFP

204
Q

In patients with myelomeningecele, fracture presents like…

A

infxn w/ swelling, redness and elevated ESR/CRP.

205
Q

Latex hypersensitivity is…

A

a type I hypersensitivity (IgE mediated).

206
Q

The neurocentral synchondrosis (NCS) closes first in the….

A

cervical spine followed by lumbar followed by thoracic.

207
Q

Risk factor for caudal regression syndrome (sacral agenesis)

A

maternal diabetes

208
Q

Spinal muscular atrophy is also known as….

A

Werdnig-Hoffman disease.

209
Q

Etiology of SMA

A

death of alpha motor neurons in anterior horn –> progressive motor weakness (proximal to distal)

210
Q

Genetics of SMA

A

autosomal recessive

mutation of the survival motor neuron 1 (SMN1) gene

*Type I is more severe than Type II.

211
Q

Traits of SMA

A
  • NM scoliosis
  • NM hip dislocation
  • tongue fasciculations
  • absent DTR

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