Pediatrics 2014 Flashcards
- A 13-year-old girl has a 6-month history of painful popping in the anterior left groin. Her symptoms began insidiously and are not associated with any antecedent trauma or systemic illness. The popping is redproduced when she is lying supien and actively moves her left lower limb from a position of hip flexion- abduction-external rotation to a neutral position. Images from the curative hip arthroscopic procedure are shown in Video 3a and Figures 3b and 3c. Successful treatment entails division of the
- psoas tendon.
- ligamentum teres.
- acetabular labrum.
- orbicular ligament.
- transverse acetabular ligament
- psoas tendon.
RECOMMENDED READINGS
Dobbs MB, Morcuende JA. Other conditions of the hip. In: Morrissy RT, Weinstein SL, eds. Lovell and Winter’s Pediatric Orthopaedics. 6th ed. Philadelphia, PA:Lippincott Williams & Wilkins:2006: 1125- 1156.
Márquez Arabia WH, Gómez-Hoyos J, Llano Serna JF, Aguilera Bohorquez B, Nossa Barrera JM, Márquez Arabia JJ, Clavijo Rodríguez MP, Gallo Villegas JA. Regrowth of the psoas tendon afterarthroscopic tenotomy: a magnetic resonance imaging study. Arthroscopy. 2013 Aug;29(8):1308-13. doi: 10.1016/j.arthro.2013.05.002. PubMed PMID 23906271.
Ilizaliturri VM Jr, Chaidez C, Villegas P, Briseño A, Camacho-Galindo J.Prospective randomized study of 2 different techniques for endoscopic iliopsoas tendon release in the treatment of internal snapping hip syndrome. Arthroscopy. 2009 Feb;25(2):159-63. doi: 10.1016/j.arthro.2008.08.009. Epub 2008 Oct 10. PubMed PMID: 19171275.
- A 2-week-old infant is noted to have a dislocated (Ortolani positive) left hip and is placed in a Pavlik harness. After 3 weeks of full-time harness treatment, the hip remains Ortolani positive. At this point the clinician should
- perform a varus osteotomy.
- perform an open reduction.
- perform closed reduction in the clinic.
- switch to a semirigid abduction orthosis.
- tighten the abduction straps and continue for 3 more weeks.
- switch to a semirigid abduction orthosis.
RECOMMENDED READINGS
Guille JT, Pizzutillo PD, MacEwen GD. Development dysplasia of the hip from birth to six months. J Am Acad Orthop Surg. 2000 Jul-Aug;8(4):232-42. Review. PubMed PMID: 10951112.
- A 2-year-old child with a FGF3R gene defect has the spinal deformity shown in Figure 21. What is the most likely outcome?
- Worsen with time
- No change with time
- Resolution at adulthood
- Resolution at adolescence
- Resolution with walking ambulation
- Resolution with walking ambulation
RECOMMENDED READINGS
Shirley ED, Ain MC. Achondroplasia: manifestations and treatment. J Am Acad Orthop Surg. 2009 Apr;17(4):231-41. Review. PubMed PMID: 19307672.
Engberts AC, Jacobs WC, Castelijns SJ, Castelein RM, Vleggeert-Lankamp CL. The prevalence of thoracolumbar kyphosis in achondroplasia: a systematic review. J Child Orthop. 2012 Mar;6(1):69-73. doi: 10.1007/s11832-011-0378-7. Epub 2011 Dec 3. PubMed PMID: 22442656; PubMedCentral PMCID: PMC3303017.
- Figures 29a through 29c are the coronal, sagittal, and axial MR images of a 12-year-old boy from upstate New York who has had right knee swelling for 1 month. He denies significant pain, fever, illness, or any recent injury. He is an avid hiker and camper. Examination reveals a large effusion and painless knee range of motion. Which organism most likely is responsible for his symptoms?
- Staphylococcus aureus
- Bartonella henselae
- Borrelia burgdorferi
- Neisseria gonorrhoeae
- Mycobacterium tuberculosis
- Borrelia burgdorferi
RECOMMENDED READINGS
Jouben LM, Steele RJ, Bono JV. Orthopaedic manifestations of Lyme disease. Orthop Rev. 1994 May;23(5):395-400. Review. PubMed PMID: 8041573.
- A 2-year-old boy has a fixed flexion contracture of 1 thumb. His parents state that the contracture has been present for several months. He lacks 40 degrees of passive and active extension of the interphalangeal joint from the neutral position. A firm mass is detected in the volar aspect of the thumb just distal to the metacarophalangeal flexion creas. The physician should recommend
- excision of the mass.
- corticosteroid injection.
- release of the A1 pulley.
- flexor tendon lengthening
- needle biopsy of the mass.
- release of the A1 pulley.
RECOMMENDED READINGS
Baek GH, Kim JH, Chung MS, Kang SB, Lee YH, Gong HS. The natural history of pediatric trigger thumb. J Bone Joint Surg Am. 2008 May;90(5):980-5. doi: 10.2106/JBJS.G.00296. PubMed PMID:18451388.
- When performing posterior spinal fusion with pedicle screws to treat adolescent idiopathic scoliosis, resistance to screw pullout is improved by
- using screws with a shorter length.
- using screws with a smaller diameter.
- using a tap that is the same size as the screw diameter.
- using a tap that is 1 mm smaller than the screw diameter.
- placing screws in the pedicles using an anatomic trajectory rather than a straightforward
trajectory.
- using a tap that is 1 mm smaller than the screw diameter.
RECOMMENDED READINGS
Kuklo TR, Lehman RA Jr. Effect of various tapping diameters on insertion of thoracic pedicle screws: a biomechanical analysis. Spine (Phila Pa 1976). 2003 Sep 15;28(18):2066-71. PubMed PMID: 14501915.
- A 10-year-old girl had a brachial plexus birth palsy. She has active abduction of her shoulder, but passive external rotation of her shoulder is 10 degrees short of neutral. Axillary radiographs reveal a deformity and subluxation of the glenohumeral joint. What is the best next step?
- Glenohumeral arthrodesis
- Rotational osteotomy of the humerus
- Partial epiphysiodesis of the humerus
- Open reduction and glenoid osteotomy
- Physical therapy and an external rotation orthosis
- Rotational osteotomy of the humerus
RECOMMENDED READINGS
Pearl M. Shoulder problems in children with brachial plexus birth palsy: evaluation and management. J Am Acad Orthop Surg. 2009 Apr;17(4):242-54. Review. PubMed PMID: 19307673.
Waters PM, Bae DS. The early effects of tendon transfers and open capsulorrhaphy on glenohumeral deformity in brachial plexus birth palsy. J Bone Joint Surg Am. 2008 Oct;90(10):2171-9. doi:10.2106/ JBJS.G.01517. PubMed PMID: 18829915.
- Which blood test result commonly is found in association with the radiograph seen in Figure 49?
- Levels within defined limits
- Decreased collagen 1 levels
- Elevated Lyme titers
- Elevated C-reactive protein
- Elevated white blood cell count
- Levels within defined limits
RECOMMENDED READINGS
Jain N, Sah M, Chakraverty J, Evans A, Kamath S. Radiological approach to a child with hip pain.Clin Radiol. 2013 Nov;68(11):1167-78. doi:10.1016/j.crad.2013.06.016. Epub 2013 Aug 12. Review. PubMed PMID: 23937827.
Canavese F, Wright JG, Cole WG, Hopyan S. Unicameral bone cysts: comparison of percutaneous curettage, steroid, and autologous bone marrow injections. J Pediatr Orthop. 2011 Jan-Feb;31(1):50-5. doi: 10.1097/BPO.0b013e3181ff7510. PubMed PMID: 21150732.
- Figure 64 is the clinical photograph of a child with a foot deformity. What is the best next step?
- Spine imaging
- Physiotherapy
- Assessment of the upper extremity
- Assessment of the hip and knee
- Ponseti manipulation and casting
- Assessment of the hip and knee
RECOMMENDED READINGS
Stevens PM, Arms D. Postaxial hypoplasia of the lower extremity. J Pediatr Orthop. 2000 Mar- Apr;20(2):166-72. PubMed PMID: 10739276.
Oberc A, Sulko J. Fibular hemmimelia- diagnostic management principles, and results of treatment. J Pediatr Orthop B. 2013 Sep;22(5):450-6. doi: 10.1097/BPB.0b013e32836330dd. PubMed PMID: 23807497.
- Figure 70 is a radiograph of a 12-year-old boy with Duchenne muscular dystrophy. He discontinued steroids several years ago because of weight gain. He has not ambulated independently for about 4 years and has no back pain. What is the best next step?
- Referral to reinitiate corticosteroids
- Observation and repeat radiograph in 1 year
- Posterior spinal fusion to prevent curve progression
- A thoracolumbosacral orthosis to be worn 23 hours per day
- A thoracolumbosacral orthosis to be worn during sleeping hours
- Posterior spinal fusion to prevent curve progression
RECOMMENDED READINGS
Smith AD, Koreska J, Moseley CF. Progression of scoliosis in Duchenne muscular dystrophy. J Bone Joint Surg Am. 1989 Aug;71(7):1066-74. PubMed PMID: 2760082.
Oda T, Shimizu N, Yonenobu K, Ono K, Nabeshima T, Kyoh S. Longitudinal study of spinal deformity in Duchenne muscular dystrophy. J Pediatr Orthop. 1993 Jul-Aug;13(4):478-88. PubMed PMID: 8370781.
- Figure 81 is the radiograph of a 15-year-old boy who sustained this injury while playing soccer. He cannot bear weight on the affected extremity. What is the best next step?
- Urgent open reduction and internal fixation
- Crutches and progressive weight-bearing activity as tolerated
- Admission and measurement of compartment pressures
- Excision of bone fragments with reattachment of muscular origins
- CT imaging of the pelvis
- Crutches and progressive weight-bearing activity as tolerated
RECOMMENDED READINGS
White KK, Williams SK, Murbarak SJ. Definition of two types of anterior superior iliac spine avulsion fractures. J Pediatr Orthop. 2002 Sep-Oct;22(5):578-82. Review. PubMed PMID: 12198457.
Holden CP, Holman J, Herman MJ. Pediatric pelvic fractures. J Am Acad Orthop Surg. 2007Mar;15(3):172-7. Review. PubMed PMID: 17341674.
- A 14-year-old boy sustained the injury shown in Figures 86a and 86b. Upon sedated examination, stability to varus and valgus stress and to the posterior drawer/posterior-directed Lachman test is confirmed; however the knee cannot fully extend. After a review of the arthroscopic findings shown in Figures 86c through 86e and Video 86f, what is the most appropriate treatment?
- Fracture reduction and fixation
2. Fracture reduction adn fixation and medial meniscus repair
- Fracture fragment excision and lateral meniscus repair
- Fracture fragment fixation and anterior cruciate ligament (ACL) reconstruction
- Fracture fragment excision and ACL reconstruction
- Fracture reduction and fixation
RECOMMENDED READINGS
Willis RB. Sports medicine in the growing child. In: Morrissy RT, Weinstein SL, eds. Lovell and Winter’s Pediatric Orthopaedics. 6th ed. Philadelphia, PA:Lippincott Williams & Wilkins;2006:1383-1428.
Tudisco C, Giovarruscio R, Febo A, Savarese E, Bisicchia S. Intercondylar eminence avulsion fracture in children: long-term follow-up of 14 cases at the end of skeletal growth. J Pediatr Orthop B. 2010 Sep;19(5):403-8. doi:10.1097/BPB.0b013e32833a5f4d. PubMed PMID: 20473183.
Wilson PL. Lower extremity injuries. In: Jerring JA, ed. Tachdjian’s Pediatric Orthopaedics. 3rd ed. Philadelphia, PA:WB Saunders;2002:2251-2438.
- Figure 92 is the radiograph of a 15 1/2-year-old boy who sustained an injury while playing basketball. The treating physician should be mindful of the need for restoration of the extensor mechanism and the articular surface as well as risk for
- genu recurvatum.
- leg-length discrepancy.
- compartment syndrome.
- anterior cruciate ligament injury.
- medial collateral ligament injury.
- compartment syndrome.
RECOMMENDED READINGS
Pape JM, Goulet JA, Hensinger RN. Compartment syndrome complicating tibial tubercle avulsion. Clin Orthop Relat Res. 1993 Oct;(295):201-4. PubMed PMID: 8403649.
- Munchausen syndrome (a factitious disorder by proxy) most often is perpetrated by which family
member?
- Biologic father who has knowledge of law
- Biologic father who has knowledge of medicine
- Biologic mother who has knowledge of medicine
- Stepmother who has knowledge of law
- Stepfather who has knowledge of medicine
- Biologic mother who has knowledge of medicine
RECOMMENDED READINGS
Campbell RM, Schrader T. Child abuse. In: Beaty JH, Kasser JR, eds. Rockwood and Wilkins’ Fractures in Children. 6th ed. Philadelphia, PA: Lippincott-Williams & Wilkins;2001:223-253. Flaherty EG, Macmillan HL; Committee On Child Abuse And Neglect. Caregiver-fabricated illness in a child: a manifestation of child maltreatment. Pediatrics. 2013 Sep;132(3):590-7. doi: 10.1542/peds.2013- 2045. Epub 2013 Aug 26. PubMed PMID: 23979088.
- Figures 104a through104c are the radiographs of an infant who has right-arm and left-ankle discomfort. Further investigation may include a workup for
- rickets.
- child abuse.
- lead toxicity.
- osteoporosis.
- osteogenesis imperfecta.
- child abuse.
- Figure 129 is the anteroposterior pelvic radiograph of a 15-year-old boy who injured his right hip 1 week ago while playing football. He felt a pop in his right leg and immediate pain and swelling in his right hip and had difficulty walking. He was placed on crutches and weight-baring activity was prohibited. The injury is attributable to traction from the
- sartorius muscle.
- iliopsoas muscle.
- rectus femoris muscle.
- abductor musculature.
- proximal hamstring insertion
- rectus femoris muscle.
RECOMMENDED READINGS
Rossi F, Dragoni S. Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location and sports distribution of 203 cases collected. Skeletal Radiol. 2001 Mar;30(3):127-31. PubMed PMID: 11357449.
Reina N, Accadbled F, de Gauzy JS. Anterior inferior iliac spine avulsion fracture: a case report in soccer playing adolescent twins. J Pediatr Orthop B. 2010 Mar;19(2):158-60. doi: 10.1097/ BPB.0b013e32833399a4. PubMed PMID: 19934773.
- A 20-month-old boy has a 10-day history of intermittent temperature elevations to 39 degrees C and intermittent refusal to bear weight on his right lower limb. His peripheral white blood cell count and differential levels are within defined limits, but his erythrocyte sedimentaiton rate is 42 mm/h (reference range [rr], 0-20 mm/h) and C-reactive protein is 13.7 mg/dl ([rr], <0.6 mg/dl). Comparative right and left hip ultrasound studies are shown in Figures 138a and 138b. Selected sagittal short tau inversion recovery images are shown in Figures 138c through 138e. Axial T2 images in Figures 138f and138g from a right lower-limb MR image are shown. After undergoing successful treatment for his acute problem, the boy should be monitored for which late complication?
- Chondrolysis of the hip joint
- Osteonecrosis of the femoral head
- Osteochondritis dissecans of the medial femoral condyle
- Radiation-induced sarcoma of the femur
- Distal femoral angular deformity with limb-length inequality
- Distal femoral angular deformity with limb-length inequality
RECOMMENDED READINGS
Herring JA. Bone and joint infections. In: Herring JA, ed. Tachdjian’s Pediatric Orthopaedics. 3rd ed. Philadelphia, PA:WB Saunders;2002: 1841-1877.
Langenskiöld A. Growth disturbance after osteomyelitis of femoral condyles in infants. Acta Orthop Scand. 1984 Feb;55(1):1-13. PubMed PMID: 6702420. Stans AA. Osteomyelitis and septic arthritis. In: Morrissy RT, Weinstein SL, eds. Lovell and Winter’s Pediatric Orthopaedics. 6th ed. Philadelphia, PA:Lippincott Williams & Wilkins;2006:439-492
- Figure 143 is the clinical photograph of a 3-year-old child. What associated condition would you expect?
- Scoliosis
- Torticollis
- Foot deformity
- Hand deformity
- Developmental dysplasia of the hip
- Hand deformity
RECOMMENDED READINGS
Kramer RC, Hildreth DH, Brinker MR, Bennett JB, Thompson L, Lumsden RM 2nd, Cain TE. A comparison of patients with different types of syndactyly. J Pediatr Orthop. 1998 Mar-Apr;18(2):233-8. PubMed PMID: 9531408.
Van Heest AE. Congenital disorders of the hand and upper extremity. Pediatr Clin North Am. 1996 Oct;43(5):1113-33. Review. PubMed PMID: 8858076.
- Figure 162 is the radiograph of a 2-year-old boy. His mother reports that when she returned home from work yesterday, the babysitter said the child was not walking or moving his left leg. An examination in the emergency department reveals the boy still will not move his leg or walk and he is afebrile. He has had no recent fevers or illnesses. What is the best next step?
- Apply a splint and schedule an outpatient evaluation.
- Perform a closed manipulation and spica casting.
- Perform a cranial CT scan to evaluate for intracranial hemorrhage.
- Involve child protective services in the boy’s evaluation.
- Obtain a radiograph of the contralateral femur to evaluate for differences in alignment.
- Involve child protective services in the boy’s evaluation.
RECOMMENDED READINGS
Hui C, Joughin E, Goldstein S, Cooper N, Harder J, Kiefer G, Parsons D, Howard J. Femoral fractures in children younger than three years: the role of nonaccidental injury. J Pediatr Orthop. 2008 Apr-May;28(3):297-302. doi: 10.1097/BPO.0b013e3181653bf9. PubMed PMID: 18362793.
Baldwin K, Pandya NK, Wolfgruber H, Drummond DS, Hosalkar HS. Femur fractures in the pediatric population: abuse or accidental trauma? Clin Orthop Relat Res. 2011 Mar;469(3):798-804. doi: 10.1007/ s11999-010-1339-z. PubMed PMID: 20373153; PubMed Central PMCID: PMC3032851
- The overall appearance of the patient who has the condition shown in Figure 169 would be
- short stature and proportionate limbs.
- short stature and disproportionate limbs.
- normal stature and proportionate limbs.
- normal stature and disproportionate limbs.
- normal stature and limb-length inequality.
- short stature and disproportionate limbs.
RECOMMENDED READINGS
Shirley ED, Ain MC. Achondroplasia: manifestations and treatment. J Am Acad Orthop Surg. 2009 Apr;17(4):231-41. Review. PubMed PMID: 19307672.
Schiedel F, Rödl R. Lower limb lengthening in patients with disproportionate short stature with achondroplasia: a systematic review of the last 20 years. Disabil Rehabil. 2012;34(12):982-7. doi: 10.3109/09638288.2011.631677. Epub 2011 Nov 23. Review. PubMed PMID: 22112021.
- A child with the spinal radiograph shown in Figure 174 most likely has which associated abnormality?
- Amniotic bands
- Clotting disorders
- Cortical blindness
- Genitourinary anomalies
- Cutaneous hyperpigmentation
- Genitourinary anomalies
RECOMMENDED READINGS
Hedequist D, Emans J. Congenital scoliosis. J Am Acad Orthop Surg. 2004 Jul-Aug;12(4):266-75. Review. PubMed PMID: 15473678.
Richards BS, Sucato DJ, Johnston CD. Scoliosis. In: Herring JA, ed. Tachdjian’s Pediatric Orthopaedics. 4th ed. Philadelphia, PA: Saunders; 2008, Ch 12.
Figure 183a is the initial radiograph of a 7-year-old boy who fell from the monkey bars 4 hours ago. He was able to move his fingers and had normal capillary refill, but his radial pulse was not palpable. Closed reduction and pinning was performed. Postsurgical radiographs are shown in Figures 183b and 183c. Following the procedure, his hand and fingers are pink, with brisk capillary refill, but his radial pulse remains nonpalpable. What is the best next step?
- Splinting and observation
- Open exploration and repair of the brachial artery
- Perform an arteriogram to evaluate the brachial artery
- Colour flow Doppler assessment of the brachial artery.
- Pin removal and remanipulation to remove the entrapped brachial artery from the fracture site
- Splinting and observation
RECOMMENDED READINGS
Franklin CC, Skaggs DL. Approach to the pediatric supracondylar humeral fracture with neurovascular compromise. Instr Course Lect. 2013;62:429-33. PubMed PMID: 23395047.
Choi PD, Melikian R, Skaggs DL. Risk factors for vascular repair and compartment syndrome in the pulseless supracondylar humerus fracture in children. J Pediatr Orthop. 2010 Jan-Feb;30(1):50-6. doi: 10.1097/BPO.0b013e3181c6b3a8. PubMed PMID: 20032742.
- Figures 189a through 189c are the radiographs of a 15-year-old boy with incomplete resolution of a neonatal brachial plexus palsy (Erb palsy). He has very poor external rotation strength, with external rotation barely to neutral with his arm adducted against his trunk. To improve the positioning of the limb, the physician should recommend which procedure?
- External rotation osteotomy of the proximal humerus
- Lengthening of the subscapularis and release of the pectoralis major
- Lengthening of the pectoralis major and release of the subscapularis
- Anterior shoulder joint capsulotomy and posterior glenoid bone block
- Latissimus transfer to the greater trochanter and anterior shoulder joint capsulotomy
- External rotation osteotomy of the proximal humerus
RECOMMENDED READINGS
Waters PM. The upper limb. In: Morrissy RT, Weinstein SL, eds. Lovell and Winter’s Pediatric Orthopaedics. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins;2006:921-986.
Abzug JM, Chafetz RS, Gaughan JP, Ashworth S, Kozin SH. Shoulder function after medial approach and derotational humeral osteotomy in patients with brachial plexus birth palsy. J Pediatr Orthop. 2010 Jul- Aug;30(5):469-74. doi: 10.1097/BPO.0b013e3181df8604. PubMed PMID: 20574265.
Ezaki M, Carter PR, Lake A, Oishi SN. Disorders of the upper extremity. In: Herring JA, ed. Tachdjian’s Pediatric Orthopaedics. 3rd ed. Philadelphia, PA:WB Saunders, 2002:379-512.
- If the infant shown in Figure 195 stops kicking, attention should be paid to
- elevate the chest straps.
- decrease the flexion of the hips.
- decrease the abduction of the hips.
- increase the flexion of the hips.
- increase the abduction of the hips.
- decrease the flexion of the hips.
RECOMMENDED READINGS
Tibrewal S, Gulati V, Ramachandran M. The Pavlik method: a systematic review of current concepts. J Pediatr Orthop B. 2013 Nov;22(6):516-20. doi: 10.1097/BPB.0b013e328365760e. Review. PubMed PMID: 23995089.
Murnaghan ML, Browne RH, Sucato DJ, Birch J. Femoral nerve palsy in Pavlik harness treatment for developmental dysplasia of the hip. J Bone Joint Surg Am. 2011 Mar 2;93(5):493-9. doi: 10.2106/ JBJS.J.01210. PubMed PMID: 21368082.
- Figures 210a and 210b are the radiographs of an 11-year-old boy who has hip pain. His parents request home physiotherapy exercises. Your recommendation should be to
- admit for treatment.
- admit electively within 1 month for treatment.
- return for follow-up in 1 week.
- attend formal physiotherapy sessions.
- initiate home physiotherapy and return if pain increases.
- admit for treatment.
RECOMMENDED READINGS
McPartland TG, Sankar WN, Kim YJ, Millis MB. Patients with unstable slipped capital femoral epiphysis have antecedent symptoms. Clin Orthop Relat Res. 2013 Jul;471(7):2132-6. doi: 10.1007/s11999-013- 3042-3. PubMed PMID: 23657881; PubMed Central PMCID: PMC3676584.
Novais EN, Millis MB. Slipped capital femoral epiphysis: prevalence, pathogenesis, and natural history. Clin Orthop Relat Res. 2012 Dec;470(12):3432-8. doi: 10.1007/s11999-012-2452-y. Review. PubMed PMID: 23054509; PubMed Central PMCID: PMC3492592.
- The child whose radiograph is shown in Figure 229 has a defect in the metabolism of
- elastin.
- calcium.
- collagen.
- fibronectin
- phosphorus.
- collagen.
RECOMMENDED READINGS
Burnei G, Vlad C, Georgescu I, Gavriliu TS, Dan D. Osteogenesis imperfecta: diagnosis and treatment. J Am Acad Orthop Surg. 2008 Jun;16(6):356-66. Review. PubMed PMID: 18524987.
Herring JA, Ezaki M. Metabolic and endocrine bone diseases. In: Herring JA, ed. Tachdjian’s Pediatric Orthopaedics. 4th ed. Philadelphia, PA: Saunders; 2008, Ch 32.
- A 4-week-old girl had a dislocated left hip that was reduced easily with the Ortolani maneuver. She was treated with a Pavlik harness. Her hip ultrasound shown in Figure 239 was performed at age 4 months. What creates the bright image indicated by the arrow?
- Ligamentum teres
- Triradiate cartilage of the acetabulum
- Fovea centralis of the femoral head
- Developing ossific nucleus of the femoral head
- An area of avascular necrosis in the femoral head
- Developing ossific nucleus of the femoral head
RECOMMENDED READINGS
Weinstein SL. Developmental hip dysplasia and dislocation. In: Morrissy RT, Weinstein SL, eds. Lovell and Winter’s Pediatric Orthopaedics. 6th ed. Philadelphia, PA:Lippincott Williams & Wilkins;2006:987-1037.
Herring JA, Sucato DJ. Developmental dysplasia of the hip. In: Herring JA, ed. Tachdjian’s Pediatric Orthopaedics. 3rd ed. Philadelphia, PA:WB Saunders;2002:513-654.
- Figure 247 is the radiograph of a child with cerebral palsy who has painful hips. The child’s parents do not speak English and would like an explanation of the recommended treatment. For medico-legal reasons, interpretation should be provided by
- close relatives.
- hospital employee.
- certified interpreter.
- nurse fluent in the same language as he parents
- house staff fluent in the same language as the parents.
- certified interpreter.
- Figures 265a and 265b are ultrasound examinations of both hips of a 6-year-old boy who has been refusing to bear weight on his left leg. He has no history of injury; however, he had a recent ear infection and was prescribed amoxicillin. His temperature is 38.8°C. In the emergency department, the child has pain and guarding with range of motion of his left hip. Plain radiographs of the hip are unremarkable. Laboratory studies reveal a white blood cell count of 18.5, erythrocyte sedimentation rate of 45 mm/h (reference range [rr], 0-20 mm/h), and a C-reactive protein level of 6.5 mg/L (rr, 0.08-3.1 mg/L). What is the best next step?
- Aspiration of the left hip
- Arthrotomy of the left hip
- MR image to assess for myositis
- Bone scan to assess for osteomyelitis
- Administration of intravenous antibiotics
- Aspiration of the left hip
RECOMMENDED READINGS
Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am. 1999 Dec;81(12):1662-70. PubMed PMID: 10608376.
Singhal R, Perry DC, Khan FN, Cohen D, Stevenson HL, James LA, Sampath JS, Bruce CE. The use of CRP within a clinical prediction algorithm for the differentiation of septic arthritis and transient synovitis in children. J Bone Joint Surg Br. 2011 Nov;93(11):1556-61. doi: 10.1302/0301-620X.93B11.26857. PubMed PMID: 22058311.
