Pediatrics Flashcards
What physeal zone does Gaucher’s disease affect?
Reserve zone
What physeal zone does achondroplasia affect?
Proliferative zone
What physeal zone does MHE affect?
Proliferative zone
What physeal zone is the location of chondrocyte maturation?
Hypertrophic zone
What are the physeal zones?
Reserve, proliferative, hypertrophic, primary spongiosa, secondary spongiosa
What physeal zone is responsible for chondrocyte hypertrophy?
hypertrophic zone
What zone is responsible for chondrocyte maturation?
Hypertrophic zone
Which physeal zone has the highest extracellular matrix production?
Proliferative zone
Which physeal zone has a large amount on chondrocyte growth?
Hypertrophic zone - specifically the degenerative zone; 5x the growth of chondrocytes
What physeal zone is affected by SCFE?
Hypertrophic zone
What physeal zone is affected by Rickets?
Hypertrophic zone (provisional calcification zone)
Which physeal zone does enchondromas affect?
Hypertrophic zone
What physeal zone is affected by mucopolysaccharide disease?
hypertrophic zone
Fractures most commonly occur through which physeal zone?
zone of provisional calcification (hypertrophic zone)
Which zone is affected in a metaphyseal corner fracture?
Primary spongiosa
Which zone is affected in renal SCFE?
Secondary spongiosa
What are the indications for bar resection?
<50% of physis affected; >2 cm or >2 years of growth remaining
Physeal fracture separations most commonly happen through which zone of the physis?
Hypertrophic zone; specifically zone of provisional calcification
What is the sequence of closure of the distal tibial physis?
central, posterior, medial then anterolateral
What is the weakest part of the growth plate?
Hypertrophic zone
In children, a diagnosis of osteomyelitis with concomitant deep venous thrombosis (DVT) has a high association with which causative organism?
MRSA; other risk factors children >8, CRP >6, need for surgical intervention
In Erb’s palsy, what changes at the shoulder can be expected?
internal rotation contracture, glenoid retroversion, posterior shoulder subluxation and humeral head flattening
What is the normal/average acetabular index?
27.5 deg
An acetabular index above what degrees is indicative of hip dysplasia?
> 35 deg
What levels are most commonly affected in a pediatric brachial plexus palsy?
C5-6 levels (Erb-Duchenne palsy)
What muscles are most commonly affected in an Erb-Duchenne palsy?
Deltoid and biceps (C5), wrist and finger extensors (C6)
What is a normal α angle on pediatric hip US?
> 60 deg
Absent clavicles is found in what genetic disorder?
Cleidocranial dysplasia
In DDH, what degree of abduction increases the risk for AVN?
> 60 deg of hip abduction increases the rate of AVN; if >60 deg is needed for hip reduction, open reduction should be performed
What is the innervation of the rhomboids?
dorsal scapular nerve
What is the second most common cause of death in pediatric patients?
NAT
[…] injury is the most frequent cause of long term physical morbidity in the child
head
What are corner fractures?
metaphyseal avulsion fracture
Fractures are the […] most common lesion in abused children
second
What is the most common physical exam finding on NAT?
skin lesion
If NAT is left unreported, there is a […] percent chance of repeat abuse and a […] percent chance of death.
30-50%; 5-10%
In pediatric trauma, […] injuries have highest overall morbidity and mortality
CNS
In pediatric trauma, […] fractures have highest morbidity/mortality among musculoskeletal injuries
spine
Cervical spine trauma injuries are more common in children less than […] years-old
8
Occipital cut-out needed in spine board when transporting children less than […] years old
8
A child’s blood volume is equal to […] mL/kg
75
Is systemic vascular resistance higher or lower in children compared to adults?
lower
Increased serum level of […] heralds onset of HO
alkaline phosphatase
Multiorgan failure occurs […] in hospitalization of pediatric patients
early
In clubfoot, the talar neck is […] and […] deviated
medially; plantarly
In clubfoot, the navicular and cuboid are displaced […]
medially
Clubfoot is linked to what gene?
PITX1
Hypoplasia or absence of what artery is common in clubfoot?
anterior tibial artery
Congenital club foot has a talocalcaneal angle less than […] degrees
25
What is the gold standard treatment for congenital clubfoot (talipes equinovarus)
Ponseti casting
In congenital clubfoot, the extent of medial soft-tissue release correlates […] with long-term function of the foot and patient
inversely
A talectomy is only indicated in severe rigid recurrent clubfoot in children with […]
arthrogryposis
What is the goal of serial Ponseti casting?
rotate foot laterally around a fixed talus
In congenital talipes equinovarus (clubfoot), heel cord tenotomy needed in at least […] percent of children.
80-90%
What is the biggest risk factor for clubfoot deformity recurrence?
FAO noncompliance
FAO use following Ponseti clubfoot correction is full-time for […] months and then at night/naps for […] years.
3 months; 2-4 years
Following Ponseti casting for clubfoot, an AFO is used to hold the foot in […] degrees of external rotation
60
Tibialis anteriror tendon transfer to lateral cuneiform is indicated in clubfoot in a patient that demonstrates […] during gait.
supination
Clubfoot relapse under the age of 2 is treated with […].
Repeat casting
Dynamic supination of clubfoot is seen in what phase of gait?
Swing
Rockerbotton deformity following clubfoot correction occurs from what mistake?
correction of equinus before full correction of hind foot varus
In rockerbottom deformity following clubfoot correction, dorsiflexion occurs through the […]-foot.
mid
Tarsal Coalition is a common congenital condition caused byfailure of […]
embryonic (mesenchymal) segmentation
What is the most common tarsal coalition?
Calcaneonavicular
Subtalar joint will normally rotate 10 degrees […] during stance phase, in the presence of tarsal coalition, […] rotation does not occur
internally; internal
What is the inheritance pattern of tarsal coalition?
Autosomal dominant
In tarsal coalition, pain distal to medial malleolus or medial foot suggests […] coalition.
talocalcaneal
What is the initial treatment for tarsal coalition?
walking cast x 6 weeks
In congenital vertical talus, neonates present with a rigid […] deformity
flatfoot
In congenital vertical talus, the navicular dislocates […]
dorsolateral
In congenital vertical talus, which muscles are displaced and function as dorsiflexors rather than plantarflexors?
Tibialis posterior tendon and peroneus longus
On physical exam of congenital vertical talus, there is fixed hindfoot […], rigid midfoot […], and forefoot [… and …].
equinovalgus, dorsiflexion, dorsiflexion and abduction
In congenital vertical talus, the forefoot abduction and dorsiflexion is due to contractures of which muscles?
EDL, EHL and tibialis anterior
Before ossification of navicular at age 3, the […] is used as a proxy for the navicular on radiographic evaluation
first metatarsal
In congenital vertical talus, the talocalcaneal angle on an AP radiograph will be greater than […] degrees
40; (20-40 degrees is normal)
What radiograph is diagnostic of congenital vertical talus?
forced plantar flexion lateral radiograph
Beyond foot radiographs, what additional imaging should be obtained in congenital vertical talus, and why?
MRI; rule out neurologic disorder
Serial manipulation and casting of congenital vertical talus is indicated preoperatively to stretch the […] soft-tissue structures
dorsolateral
In the surgical release and talonavicular reduction for congenital vertical talus, which muscle is concomitantly transferred to the talar neck?
tibialis anterior
LLD leads to osteoarthritis of the hip due to decreased coverage of femoral head on […] side.
long leg
The leg grows […] mm/year, with most of that coming from the […] joint.
23; knee
The proximal femur grows […] mm/year.
3
The distal femur grows […] mm/year.
9
The proximal tibia grows […] mm/year.
6
The distal tibia grows […] mm/year.
5
Shoe lift for treatment of LLD is indicated for less than […] projected LLD at maturity.
2 cm
Shortening of the long limb is indicated in LLD when the projected LLD is […] at maturity.
2-5 cm
Limb lengthening of the short size is indicated in LLD when the projected LLD is […] at maturity.
Greater than 5 cm
What are the indications for a physeal bar excision?
bony bride involves less than 50% of the physis and at least 2 years of growth left
In distraction osteogenesis, distraction begins after […] days, and distracts […] mm/day.
5-7; 1
Lengthening along the anatomical axis of the femur leads to […] MAD
lateral
Shortening along the anatomical axis of the femur leads to […] MAD
medial
What is the most common risk factor for cerebral palsy?
Prematurity
Brain MRI of a patient with CP most commonly demonstrates […].
periventricular leukomalacia (PVL) white matter lesions most frequent (56%)
What is the MOA of botox (botulinum toxin A)
competitive inhibitor of presynaptic cholinergic receptors
Botox is a […] inhibitor of presynaptic cholinergic receptors.
competitive
What are the characteristics of baclofen withdrawal?
severe fevers, hyperkalemia, and elevated CPK levels
In cerebral palsy, tendon transfers in the upper extremity show the best improvement in function in patients with […] motor control
voluntary
What are the two absolute contra-indications to selective dorsal rhizotomy in patient’s with CP?
athetoid CP & nonambulatory patients with spastic quadriplegia
What is the most reliable predictor for ability to walk in a patient with cp?
independent sitting by age 2
What muscle most commonly causes a dynamic deformity in the swing phase of gait following Ponseti casting?
Tibialis anterior
In a patient with club foot, a dynamic swing phase supination deformity may develop as a result of medial overpull of the […] tendon.
anterior tibialis
In a patient with club foot, a dynamic swing phase […] deformity may develop as a result of medial overpull of the anterior tibialis tendon.
supination
Incomplete reduction of the navicular onto the talar head results in changing the anterior tibialis muscle from predominately a strong […] to a strong […] force.
dorsiflexing; supinating
In treatment of excessive supination occuring during the swing phase of gait following Ponseti casting, the tibialis anterior tendon is transferred where?
Lateral cuneiform
A dorsal bunion can form after treatment of clubfoot due to overpowering of which muscles and weakness of?
overpowering: FHB, Abductor hallucis, tib ant; weakness of peroneus longus
Congenital vertical talus has a high association with what congenital diseases?
Neuromuscular or chromosomal abberations
A talocalcaneal coalition is a coalition between the calcaneus and what portion of the talus?
Talar dome
Pediatric lateral condyle fractures are most commonly Salter-Harris […] fracture patterns
IV
Lateral condyle fractures extending into the trochlear are […] stable
less
In lateral condyle fractures, lateral ecchymosis implies a tear in the aponeurosis of the […] and signals an unstable fracture
brachioradialis
[…] oblique view most accurately shows lateral condyle fracture displacement
internal
What are the indications for treating lateral condyle fractures in a long arm cast?
less than 2 mm displacement
Lateral condyle fractures with […] of displacement and have intact articular cartilage and can be treated with CRPP
2-4 mm
Lateral condyle fractures with […] of displacement, and/or joint incongruity are treated with open reduction and internal fixation
greater than 4 mm
What is the most common complication following lateral condyle fractures?
Stiffness
Cubitus valgus after lateral condyle fracture is due to […]
lateral physeal arrest, or more commonly a nonunion
Tardy ulnar nerve palsy following lateral condyle fracture is due to what elbow deformity?
Cubitus valgus
In lateral condyle fractures, lateral periosteal realignment can prevent […] from occurring.
lateral overgrowth/prominence (ie spurring)
What is the most common neuropraxia in pediatric supracondylar humerus fractures?
AIN
What is the second most common neuropraxia in pediatric supracondylar humerus fractures?
Radial nerve palsy
What is the last ossification center of the elbow to fuse?
Medial epicondyle
In pediatric supracondylar humerus fractures, medial comminution can lead to […] deformity
gunstock/cubitus varus
Deviation of Baumann angle by greater than […] degrees indicates coronal plane deformity and should not be accepted
5-10
A pediatric supracondylar humerus fracture with ecchymosis, dimpling/puckering antecubital fossa indicates proximal fragment buttonholed through […]
brachialis
In pediatric supracondylar humerus fractures, pins should be inserted with elbow in […] for extension-type injury and elbow in […] for flexion-type injury
flexion; extension
In pediatric supracondylar humerus fractures, 3 lateral pins is biomechanically stronger in […] and […] than 2-pin constructs.
bending; torsion
In pediatric supracondylar humerus fractures, crossed pins are biomechanically strongest to […] stress.
torsional
In pediatric supracondylar humerus fractures, crossed pins have a […] percent risk of ulnar nerve injury.
3-8
In pediatric supracondylar humerus fractures, medial cross pin placed with the elbow in hyperflexion […] the risk for iatrogenic ulnar nerve injury.
increases
In pediatric supracondylar humerus fractures, there is an increased risk of infection in age less than […] years.
4.5
In pediatric supracondylar humerus fractures, cubitus valgus deformity is caused by what?
Fracture malunion
In pediatric supracondylar humerus fractures, cubitus varus is caused by what?
Fracture malunion
In pediatric supracondylar humerus fractures, […] comminution increases the risk for cubits […] deformity.
Medial; varus
Volkmann ischemic contracture following casting for pediatric supracondylar humerus fractures is due to increase in […] forearm compartment pressures
deep volar
Following pinning for pediatric supracondylar humerus fractures, the pins should be removed at […] post op
3 weeks
Cubitus varus following a pediatric supracondylar humerus fracture can be associated with […] instability.
posterolateral
Pediatric medial epicondylar elbow fractures are associated with elbow dislocations in approximately […] percent of cases
50-60
Displacement of medial epicondyle fractures can be seen on […] oblique views of the elbow
internal
Distal humerus axial view may best demonstrate the degree of displacement of […] pediatric elbow fractures
distal humerus axial view
Radiographic nonunion (or fibrous union) of pediatric medial epicondylar fractures are often […]
asymptomatic
Non-operative treatment of pediatric medial epicondylar fractures demonstrate […] rate of osseous union rate compared to surgically treated patients.
lower
The […] nerve is at risk with bicortical screw fixation in the treatment of pediatric medial epicondyle fracture.
radial
[…] elbow fractures are the most common fractures patterns associated with elbow dislocations in a child.
Medial epicondyle
For pediatric flexion-type supracondylar injuries, pinning should be performed with the elbow in […].
extension
The mechanism of pediatric radial head/neck fractures is usually associated with a […] and […] loading injury of the elbow.
valgus; extension
Radial head fuses with radial shaft between ages of […] years
16-18
Pediatric radial/head neck fractures can be treated with immobilization alone if there is less than […] degrees of angulation
30
Pediatric radial/head neck fractures can be treated with closed reduction if there is greater than […] degrees of angulation
30
Pediatric radial/head neck fractures can be treated with with closed percutaneous reduction if there is greater than […] of residual angulation following closed reduction, greater than […] mm of translation, or less than […] degrees of pronosupination.
30; 3-4; 45
Is loss of pronation or supination more common following a pediatric radial head/neck fracture?
loss of pronation
When performing open reduction of a radial head/neck fracture through an anterolateral approach, the forearm should be kept in […] to decrease risk of injury to the PIN.
pronation
Age greater than […] years of age portends for worse outcomes in pediatric radial head/neck fractures.
10
The distal radial physis contributes to […] percent growth of the radius
75
The distal radial physis contributes to […] percent growth of the entire upper extremity
40
The distal radial physis grows at about […] mm/year
5
What is a Monteggia fracture?
Ulnar shaft fracture with radiocapitellar dislocation
What is a Galeazzi fracture?
distal third radius fracture with DRUJ injury
Do pediatric pelvic fractures have higher or lower rates of hemorrhage compared to adults?
lower
In pediatric pelvic fractures, there is a high rate (>50%) of associated […] and […] injury.
CNS and abdominal visceral injury
The pelvis undergoes […] ossification with […] primary ossification centers.
endochondral; three
The acetabulum has […] secondary ossification centers.
three
The ossification center “os acetabuli” forms the […]
anterior wall
The ossification center “acetabular epiphysis” forms the […]
superior wall
The secondary ossification center of ischium forms the […]
posterior wall
plain radiographs will miss approximately […] percent of all pediatric pelvic fractures
50
Pediatric pelvic avulsion injuries with less than […] of displacement can be treated with PWB.
2 cm
Pediatric iliac wing fractures with less than […] of displacement can be treated with PWB.
2 cm
Open reduction internal fixation of pediatric acetabulum fractures is indicated when there is greater than […] of displacement.
2 mm
In pediatric pelvic/acetabular fractures, increased width acetabular wall with lateral displacement of the femoral head suggests […].
premature closure of triradiate
Age less then […] is a risk factor for pre-mature closure of the triradiate cartilage in pediatric pelvic injuries.
10
Unstable pediatric pelvis fractures with vertical displacement of the hemipelvis greater than […] is a risk factor for LLD.
2 cm
In pediatric radial head/neck fractures, residual angulation of greater than […] after closed reduction attempt is an indication for percutaneous reduction and pinning.
30 degrees
In Spica casting for pediatric femoral shaft fractures, the cast is molded into […] and […] to counteract muscle forces
recurvatum; valgus
Spica casting is contraindicated in femoral shaft fractures with greater than […] of shortening.
2-3 cm
The goal of reduction with Spica casting for femoral shaft fractures is less than […] of coronal plane deformity, and less than […] of sagittal plane deformity.
10 degrees; 20 degrees
Proximal tibial traction can cause […] deformity in femoral shaft fractures due to damage to the tibial tubercle apophysis
recurvatum
Flexi nail size is determined by multiplying the width of the isthmus of femoral canal by […]
0.4
For retrograde flexi nails, the starting point is […] proximal to the distal physis
2 cm
The goal of Flexi nails is […] percent canal fill
80
The most common complication of Flexi nails is […]
pain at the insertion site near the knee
Coxa […] deformity can be seen following a greater trochanter antegrade nailing for pediatric femur fractures.
valga
The most common complication of patients with a femur fracture under the age of 10 is […]
overgrowth
Age less than […] increases the risk for femur overgrowth following a femur fracture
10
Femoral overgrowth following a pediatric femur fracture typically occurs within […] years of injury
2
In pediatric tibial tubercle fractures, the […] artery can be lacerated and cause compartment syndrome.
recurrent anterior tibial
What deformity can be seen following tibial tubercle fractures?
recurvatum
A Tillaux fracture is a SH type […] fracture
III
A triplane ankle fracture is a SH type […] fracture
IV
The distal tibia accounts for […] percent of overall tibial growth
35-40
The distal tibia physis grows at a rate of […] mm/year
3-4
What ankle ligament attaches from the Chaput tubercle to the Wagstaffe tubercle?
AITFL
What syndesmotic ligament attaches to the Volkmann’s tubercle?
PITFL
Acceptable reduction for distal tibia physeal fractures is less than […] of displacement
2 mm
Which pediatric ankle fractures have the highest rate of growth disturbance?
medial malleolus SH IV fractures
Osteomyelitis in the pediatric population is most often the result of […] seeding of bacteria to the metaphyseal region of bone.
hematogenous
What is the most common organism of pediatric osteomyelitis?
S aureus
Panton-Valentine leukocidin cytotoxin is seen in what organism?
MRSA
What is the most common organism of neonatal osteomyelitis?
Group B strep
Septic arthritis from osteomyelitis can affect large joints except for which large joint?
THE KNEE
What is a sequestrum?
necrotic bone; usually seen in chronic osteomyelitis
A […] is the necrotic bone which has become walled off from its blood supply and can present as a nidus for chronic osteomyelitis
sequestrum
The […] is a layer of new bone growth outside existing bone seen in osteomyelitis
involucrum
What is the MOA of vancomycin?
binding to the D-Ala D-Ala moiety in bacterial cell walls
Coagulase + bacteria can cause DVTs in children by activation of […] and […] clot formation
thrombin and fibrin
Which joints have intra-articular metaphyses?
hip, shoulder, elbow, ankle
What antibiotic modality is used for treatment of N gonorrhea hip septic arthritis?
Large dose penicillin
What is the most common organism in pediatric hip septic arthritis followingvaricella infection?
Group A beta-hemolytic strep
Kingella is best isolated on what agar?
blood agar
CRP greater than […] in combination with refusal to bear weight yields a 74% probability of septic arthritis
> 2.0 (mg/dl)
What is the most sensitive finding for septic arthritis?
fever
What are the four Kocher criteria?
ESR >40, fever, WBC >12,000, inability to bear weight
Probability of septic arthritis may be as high as […] when all four Kocher criteria above are present
99.6%
There is a […] percent incidence of septic arthritis when 3/4 Kocher criteria are met.
93
The Kocher criteria are only sensitive for diagnosing pediatric septic arthritis of the […] joint.
hip
In pediatric hip septic arthritis, age less than […] is a poor prognostic indicator.
6 months
In pediatric hip septic arthritis, delay in treatment greater than […] is a poor prognostic indicator.
4 days
Which brachial plexus injury is frequently associated with a preganglionic injury and Horner’s Syndrome?
Lower (Klumpke’s Palsy)
Microsurgical nerve grafting for brachial plexopathy is indicated when there is lack of antigravity […] function between 3-9 months of age, and the injury is […]-ganglionic.
biceps; postganglionic
Nerve transfer or neurotization for brachial plexopathy is indicated when there is lack of antigravity […] function between 3-9 months of age, and the injury is […]-ganglionic.
biceps; preganglionic (nerve root avulsion)
A latissamus/teres major transfer can be done in brachial plexopathy with persistent internal rotation contracture or external rotation weakness […] glenohumeral dysplasia
without
Serial nighttime extension splinting can be performed when the elbow flexion contracture is less than […] degrees
40
Serial elbow casting can be performed when the elbow flexion contracture is greater than […] degrees
40
Muscle force is preportional to […] area of the muscle
cross-sectional
Muscle amplitude is proportional to the […] of the muscle
length
What tendon transfer can be performed to help with wrist drop in brachial plexopathy?
Pronator teres to ECRB
What tendon transfer can be performed to help with finger extension in brachial plexus injury?
FCR or FCU to EDC 2-5
What tendon transfer can be performed to help with thumb abduction in brachial plexus injury?
EIP to abductor pollicis brevis
In obstetric brachial plexopathy, […] percent of cases will resolve without intervention and may take up to […] years.
90 percent; 2 years
In obstetric brachial plexopathy, return of […] is associated with recovery in vast majority
elbow flexion (biceps) by three months
Lack of […] function by […] months is a poor prognostic indicator in obstetric brachial plexopathy.
biceps; 3
In obstetric brachial plexopathy, lack of rhomboid function or elevated hemidiaphram is an indicator for […]ganglion injury.
pre
In Blount’s disease, there is excessive medial pressure that produces […] of the medial proximal tibial physis and epiphysis
osteochondrosis
Genu varum (bowed legs) is normal in children less than […] years
2
Peak genu valgum (knocked knees) occurs at […] years of age
about 3
In infantile Blount’s the proximal medial tibia physis, produces genu varus, flexion, internal rotation, AND may have compensatory distal femoral […]
VALGUS
In adolescent Blount’s the proximal tibia physis is involved, AND may have distal femoral […] and distal tibia […]
VARUS; valgus
A proximal tibia metaphyseal-diaphyseal angle (Drennan) of greater than […] is considered abnormal
16 degrees
In infantile Blount’s, bracing can be used if in early stages and patient is less than […] years
3
If successful, improvement with bracing for Blount’s should occur within […]
one year
Proximal tibia/fibula valgus osteotomy for Blount’s is more successful if performed before age […]
4
A proximal tibia/fibula valgus osteotomy for Blount’s is performed […] of the tibia tubercle
below the level
The goal of a proximal tibia/fibula valgus osteotomy for Blount’s is overcorrect into […] degrees of valgus
10-15
What is the inheritance pattern for NF-1?
Autosomal dominant
What chromosome is affected by NF-1?
17q11.2
The NF-1 gene codes for what protein?
Neurofibromin
Neurofibromin […] regulates Ras signaling pathway
negatively
In NF-1, there is […] Ras activity
increased
NF-1 affects the Ras-dependent MAPK activity which is essential for […] function and survival
osteoclast
In NF-1 there is […] bowing of the tibia.
anterolateral
Inoperable neurofibromas in NF-1 may be treated with […]
selumetinib
Neurofibromas can undergo malignant transformation to […]
neurofibrosarcoma
What is the most common site of skeletal involvement in NF-1?
spine
Scoliosis is associated with what type of neurofibromatosis?
NF-1 (NOT NF-2)
Penciling of […] ribs in NF-1 scoliosis is a poor prognostic finding and associated with rapid curve progression
3 or more
In NF-1 scoliosis, an MRI is obtained to identify […] and […]
dural ectasia; dumbbell lesion
Posteromedial tibia bowing is associated with what foot deformity?
calcaneovalgus
Anteromedial tibia bowing is associated with what?
fibular hemimelia
What are the indications for treating anterolateral tibia bowing in NF-1 with bracing?
no psuedoarthrosis or fracture
When treating anterolateral bowing in NF-1 with IMN, the nail should be extended to the […] if age is less than 4
calcaneus
The incidence of hip subluxation by age […] is higher in more severe forms of cerebral palsy
7
In cerebral palsy, strong tone in hip […] and […] lead to scissoring and predisposes to hip subluxation and dislocation
adductor; flexors
A Reimer’s index of less than […] percent with a hip abduction anlge of less than 45 deg with partial uncovering of the femoral head is considered a hip at risk
33
A Reimer’s index greater than […] percent with disrupted Shenton’s line is considered hip subluxation
33
In Spastic hip dysplasia seen in cerebral palsy, the acetabular deficiency is usually […]
posterosuperior
In DDH, the acetabular deficiency is usually […]
anterior or anterolateral
In cerebral palsy hip dysplasia, abduction bracing alone does not reduce dislocations and may cause […] deformity
windswept
In cerebral palsy hip dysplasia, a proximal femoral osteotomy with shelf-producing (Dega) osteotomy and soft-tissue release is indicated in children older than […] or a Reimer’s index greater than […]
60 degrees
In cerebral palsy hip dysplasia, soft tissue procedures with bracing is indicated in children less than age […] with a Reimer’s index between […] percent
6; 33-60
Goal of hip adductor and psoas release in cerebral palsy hip conditions is to achieve greater than […] degrees of hip abduction
45
When performing adductor tenotomies in a patient with cerebral palsy, begin with tenotomy of the […], sequentially release […] and […] as needed
adductor longus, gracilis, adductor brevis
When performing a psoas release in a patient with cerebral palsy, in non-ambulatory patients, the tendon is released at […]
the level of insertion
When performing a psoas release in a patient with cerebral palsy, in ambulatory patients, the tendon is released at […]
pelvic brim in the myotendonous junction
What nerve is at risk when releasing adductor brevis?
obturator nerve
Abduction contracture may occur with neurectomy of […] nerve during adductor releases
anterior branch of obturator
Is DDH more common in males or females?
females
Is DDH more common on the left or right hip?
left
Repetitive hip subluxation of the femoral head leads to the formation of a ridge of thickened articular cartilage called the […]
limbus
In DDH, chronic hip dislocation leads to […] femoral anteversion
increased
In DDH, chronic hip dislocation leads to […] acetabular anteversion
increased
What foot deformity is associated with DDH?
metatarsus adducts
Barlow and Ortolani are rarely positive after […] age because of soft-tissue contractures that form around the hip
3 months
The most sensitive test for DDH from 3 months to one year is limited hip […]
abduction
Radiographs become primary imaging modality for DDH at […] mo ,after the femoral head begins to ossify
4-6
Femoral head ossification should be […] to Hilgenreiner’s line
inferior
Femoral head ossification should be […] to Perkin’s line
medial
Acetabular index should be less than […] degrees in patients older than 6 months
25
AAP recommends an US study at age […] in patients who are considered high risk (family history or breech presentation) despite normal exam
6 weeks
A normal α angle on hip US is greater than […] degrees
60
A normal beta angle on hip US is less than […] degrees
55
An α angle less than […] degrees on hip US is indicative of subluxation and treatment with Pavlik harness
43
A beta angle greater than […] degrees on hip US is indicative of subluxation and treatment with Pavlik harness
77
What are the contraindications to Pavlik harness for the treatment of DDH?
spina bifida, teratologic hip, spasticity
What are the indications for treating DDH with Pavlik harness?
less than 6 months old; reducible hip
Pavlik harness should be discontinued if hip is not reduced by […] weeks to prevent Pavlik disease
3-4
AVN due to treatment with Pavlik harness is due to impingement of the […] branch of the medial femoral circumflex artery
posterosuperior retinacular
AVN due to treatment with Pavlik harness is seen when hip abduction is greater than […] degrees
60
If Pavlik harness fails in DDH, consider converting to […] with weekly ultrasounds for an addition 3-4 weeks before considering further intervention
semi-rigid abduction brace
When performing closed reduction and spica casting for DDH, must obtain concentric reduction with less than […] mm of contrast pooling medial to femoral head and no interposition of the limbus
5
Following closed reduction and casting for DDH, an arthrogram with a medial dye pool greater than […] mm is associated with poor outcomes and AVN
7
What is the inter muscular plane for a Ludloff approach to the hip?
medial approach; performed between the pectineus and adductor longus and brevis
What is the plane for the Weinstein approach to the hip?
anteromedial approach; between NV bundle and pectineus
What is the plane for the Ferguson approach to the hip?
superficially between the adductor longus and gracilis; deep between the adductor brevis and adductor magnus
Which pelvic osteotomy is favored in neuromuscular dislocations (CP) and patients with posterior acetabular deficiency?
Dega
Acetabular […]-version and femoral […]-version are risk factors for SCFE
retro; retro
Elevation of which hormone level has been shown to increase the risk of SCFE (4.9x increased odds)
leptin
In a SCFE, the metaphysistranslates […] and […] rotates
anterior; externally
In a SCFE, the […] translates anterior and externally rotates
metaphysis
Histology sections of a SCFE reveal […] between the columns in the hypertrophic zone
granulation tissue
What is the most common etiology of nonidiopathic SCFE?
hypothyroidism
In a SCFE, an endocrine work up is indicated if the child is less than […] years old
10
In a SCFE, an endocrine work up is indicated if the child is less than […] percentile for weight
50th
What genetic syndrome is associated with SCFE?
Down syndrome
Normal proximal femur anteversion is […] degrees
10 +/- 7
At the hip joint, the […] femoral circumflex contributes to anterior arterial ring
lateral
Main blood supply to the femoral head in adolescents and adults is the […] epiphyseal artery which is derived from the […] femoral circumflex artery
lateral; medial
What is the difference between a stable and unstable SCFE on exam?
ability to bear weight
The risk of osteonecrosis in a stable SCFE is less than […] percent.
10
The risk of osteonecrosis in an unstable SCFE is between […] percent
24-47
An acute SCFE has symptoms for less than […]
3 weeks
What is the Southwick Slip Angle?
epiphyseal-diaphyseal angle
In a SCFE, the Drehmann sign, obligatory […] rotation during passive flexion of hip can be noted on exam.
external
In a SCFE, there is loss of hip […] rotation, […], and […] on ROM exam.
internal rotation, abduction, flexion
What is the metaphyseal blanch sign of Steel seen in SCFE?
overlapping of the metaphysis and posteriorly displaced epiphysis
If a patient with a SCFE is <10 years old, pre-pubertal or has short stature or weight below 50th percentile for age, which labs should be ordered?
Free T4, TSH, BUN, Cr
Multiple screws in the treatment of a SCFE increased the risk of what long-term complication?
osteonecrosis
In screw fixation for a SCFE, the starting point should […]l to intertrochanteric line to reduce the risk of impingement.
lateral
In screw fixation of a SCFE, less than […] threads engaged in epiphysis increases risk of progression of slip.
5
In a surgical hip dislocation using the Ganz technique, the interval is between the […] and […]
gluteus maximus and gluteus medius
What is the greatest predictor of osteonecrosis following a SCFE?
unstable slip
Hardware placement in […] femoral neck has the greatest risk of disrupting the vascular supply and thus osteonecrosis following SCFE fixation
posterosuperior
In SCFE fixation, pin placement into the […] quadrant of the femoral head has the highest rate of joint penetration
anterosuperior
Labral tearing following fixation of a SCFE is increased with placement of the screw […] and […] placement
anterior; medial
