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Millers > Peds 1 > Flashcards

Peds 1 Flashcards

1
Q

Name 5 fractures that should trigger NAT workup

A

Spiral humerus
Transverse > spiral femur - nonamb pts
Corner frx
Distal humeral transphyseal frx
Posterior rib frx

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2
Q

3 step workup for NAT

A

Skeletal survey
Admit to peds
CPS

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3
Q

What is special about a peds C spine board

A

Occiput is cut out - kids have huge heads
Flat board hyper flexes

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4
Q

Physeal frx:
What part of the growth plate affected
Name the SH classification
Which SH are intra-artic frx

A

ZPA within zone of hypertrophy
SH: SALTR
1 Straight through
2 Above (metaphysis)
3 beLow (epiphysis) *intra-artic
4 Through (meta + epi) *intra-artic
5 cRushed
Complications increase through the classification

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5
Q

What are the 2 presentations of physeal arrest after SH frx
3 ways to trt

A

LLD vs angular deformity
Trt
1 >2cm growth remaining OR <50% physis involved = bar resection w/ interposition
2 Shut down the whole growth plate
3 Address the other limb to match

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6
Q

What kind of injuries are SC dislocations in kids?

A

Physeal frx dislocation
Not actually a dislocation

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7
Q

Acceptable reduction for proximal humerus frx

A

<5yo: 70deg, 100% disp
5-12yo: <70deg
>12yo: <40deg, 50% disp

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8
Q

Prox hum
How much total humerus growth from prox hum physis
Non op mgmt
Op mgmt

A

80%
Hanging arm cast
Op pins - watch for pin migration

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9
Q

Humeral shaft
- Workup
- Non op parameter and method
- Op method

A

Beware NAT
<30deg ang - sling and swathe
Op: flex nail

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10
Q

SCH
Most common nerve palsy
Less common nerve palsy
Describe typical malunion

A

AIN > radial - ext type
Ulnar - flex type
- Medial gapping may indicate entrapment and a reason for open reduction
Varus + extension malunion 2/2 medial comm

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11
Q

Name Gartland classification and treatment

A

1: ND, LAC 3-4wks
2: angulated, LAC vs CRPP
3: completely displaced, OR vs CRPP
4: globally unstable, OR vs CRPP

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12
Q

Walk through the algorithm for pink pulseless
+ perfused
+ non perfused (white)

A

Perfused -> go to CRPP, monitor 24hr
Non perfused
1. Reduce
If now pink, pin and observe (even w/o pulse)
2. Still white, open

NO indication for a-gram, you know where the problem is (at frx site)

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13
Q

RF for infx in SCH

A

Younger age

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14
Q

Lat cond frx:
Best XR
Milch classification
What is your key to det displaced?
Trt displaced vs non displaced

A

Int oblique
Displacement - look for a metaphyseal fleck on the lat condyle, can’t look at the distal hum since mostly cartilage
Milch:
1: frx lat to trochlea
2: frx into trochlea
ND - LAC
Disp
1. Arthrogram to figure out if articular displacement
2. ORIF - anatomic reduction since articular

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15
Q

Ways to ORIF lat cond frx

A

Screw > pins
Pro : faster ROM
Con: 2nd OR to ROH

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16
Q

Name 4 complications of lat cond frx

A

1 Nonunion - higher risk than other elbow frx
2 Cubitus valgus - tardy ulnar nerve palsy
3 AVN
- Posterior BS goes into capitellum
- Mostly impt so if you have to address a nonunion, don’t dissect posterior
4 Physeal growth arrest

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17
Q

Medial condyle frx:
Associated with what other injury
Best XR
Possible sequelae

A

Elbow dislocation - post reduction see this incarcerated in the joint
Distal humeral axial view (flexed PA elbow)
Possible valgus instability bc UCL attached

Usually do much better than lat condyle

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18
Q

Transphyseal distal hum frx:
What SH classification
How to differentiate from elbow dislocation
Trt
Complications (2)

A

SH 1 (through) or 2 (above)
Radius and capitellum are reduced (vs dislocation)
CRPP if displaced
Comp:
1. Cubitus varus 2/2 malreduction
2. Medial condyle AVN

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19
Q

What is the key to treating Monteggia frx

A

Restore ulnar length to get and keep radial head reduced

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20
Q

Proximal radius frx:
How much displacement requires a reduction?
Reduction options (2)
Complications (3)

A

Reduce if >30-45deg
Reduction:
1. Closed = varus force in sup + ext, traction, then flex pronate
2. IMN via Metaizeau technique
Comp: avoid open reduction at all costs bc
1. Stiffness
2. AVN
3. Synostosis

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21
Q

Both bone forearm fractures:
Acceptable reduction parameters under vs over 9yo
How tell good AP and lat XRs

A

Bayonet apposition OK!
<9yo - 15 angulation, 45 rotation
>9yo - 30 rotation
10 prox angulation
15 distal angulation

AP: radial styloid and biceps tub 180deg
Lat: ulnar styloid and coronoid 180deg

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22
Q

Distal radius fractures
Trt torus frx
Greenstick parameters that need CR

A

Torus frx = buckle frx = removable brace

Greenstick w/ >10-15deg needs CR

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23
Q

Pelvis avulsion frx
Non-op vs op trt
Name the muscle:
ASIS
AIIS
Ischial tuberosity
LT
Crest

A

Non op = 4-6wks PWB
Op only if sciatic n sx

ASIS - sartorius
AIIS - rectus
Ischial tuberosity - HS
LT - IP
Crest - ext obliques

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24
Q

Peds pelvis frx:
How many frx lines
Complication

A

Can be only 1 fracture line since ring more ductile
Comp = premature triradiate closure when involving the tab -> hip dysplasia

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25
Peds hip dislocation: Comp Post reduction test
Comp = SH frx prox fem physis if to aggressive with reduction +/- MRI post reduction if any concern for non-concentric
26
Prox fem frx: Comp of frx through the prox fem physis Key for good outcomes frx through fem neck IT frx - What path frx - Trt stable vs unstable
Prox fem physis - AVN Neck frx = reduction timing (more so than for adults!) IT - ABC/UBC path frx - Stable + young = spica - Unstable or older = ORIF
27
Femoral shaft trt for kids <6mo
Pavlik
28
Femoral shaft trt for kids 6mo-5yo
Spica (1 or 2 legs) Up to 2cm shortening ok because can expect some overgrowth
29
Describe how to apply spica cast How much time in the cast Complications
Apply long leg first (pulling traction through short leg can cause pop fossa compression) +valgus mold Time in cast = age (yrs) + 3 wks Comp: compartment syndrome
30
Femoral shaft trt kids >5yo (3 options)
ORIF Flex nail - <11yo - <50kg (100lbs) - Goal = 80% canal fill Rigid nail - older or heavier kids 2/2 nonunion risk Submuscular plates for length unstable patterns, but ROH to prevent genu valgum at knee
31
Distal femur frx: How much growth from this physis What injury can be confused for this Trt
9mm/yr - high rate physeal closure Don't confuse MCL/LCL sprains - physis is weaker CR vs OR - watch for vascular injuries
32
Tib tubercle frx: What is BS Best tests Associated knee injury Order of physis closure
Ant recurrent br = why compartment syndrome CT or MR to eval intra articular extension Meniscus entrapment, lat>med Growth plate closure: P -> A Med -> lat Anterolateral is last to close
33
Classification tibial spine frx + trt
1 - ND, LLC 2 - ant 1/3 is elevated, try to reduce w/ extension, LLC 3 - complete avulsion 4 - flipped up into joint 3/4 - scope vs open reduction, ORIF somehow (anchors vs screws vs pins)
34
Complications peds tibial spine frx
Stiffness Late ACL instability 2/2 plastic deformation
35
Sequelae of a Cozen frx
Cozen = proximal tibia frx Late valgus deformity abt 6mo after injury for no good reason Auto corrects over 1-2yrs - monitor clinically
36
Trt tibial shaft frx vs toddler frx
Tibial shaft Acceptable alignment 5-10deg V/V LLC vs flex nails w/ cast if physes open Toddler - SLC vs CAM
37
Describe treatment and complications of distal tibia frx by SH classification
SH 1/2 - CR + LLC - RF for arrest = post reduction frx gap >3mm (ORIF doesn't change this risk....) SH 3/4 - Intra articular -> anatomic reduction -> ORIF physeal sparing fixation
38
What is a Tillaux frx Additional imaging Trt
ER force on ankle - avulse the ant lat distal tibia (last part of the physis open) CT to check displacement (2mm) if unsure Anatomic reduction, internal fixation, no need for physeal sparing fixation since other than the frx it is closed
39
What is a triplane frx How does the distal tibial physis close
AP XR = SH 3 Lat XR = SH 2 Really SH 4 Distal tibial physis closes central -> medial -> lateral
40
Peds spine: Number and weight for halo pins Trt an AO dissociation Why are odontoid frx common? Trt Trt TL flexion/distraction injury
6-8 pins, 2-4lbs torque (more pins, less torque) Fuse AO dissociation Odontoid frx common bc fuses at 6 - CR + halo TL flex/dist injury see w/ seatbelt injuries - Extension brace if stable - OR if not
41
Name the 4 physes for hematogenous spread
Intra-articular metaphyses: Shoulder Elbow Hip Ankle
42
Osteo: Most common bug Bug for neonates Bug for late presenting with odd sx
Common: S.aureus Neonates: GBS Late: Kingella - on blood culture medium or *PCR*
43
Define involucrum vs sequestrum
Involucrum = new bone Sequestrum = necrotic bone that can be nidus for continued infection
44
Osteo: Describe CRP trend for kids Describe MR findings What is a complication unique to MRSA, why
CRP peaks and normalizes faster T1 dark / T2 bright Bright T2 = pathology, don't confuse tumor Complication MRSA = DVT 2/2 PVL gene variant
45
Name the 4 Kocher criteria What is the likelihood of septic joint w/ 3/4 vs 4/4
NWB ESR > 40 Fever (*most predictive, even over CRP*) WBC > 12 3/4 = 83% 4/4 = 93%, 99% for septic hip although paper hasnt been repeated
46
Trt Lyme
Young = amox Older = doxy
47
Bug for foot punctures, treat
Pseudomonas Surg debride + IV abx
48
Why do kids get diskitis XR findings
BV extend from the cartilaginous region of the end plate into the disc XR: loss lordosis
49
Name the disease: LLD Culture negative Treated w/ NSAIDS
Chronic recurrent multifocal osteo (CRMO) Considered a rheum condition
50
CP: Cause Pathology MR findings Medical mgmt goals Botox mechanism
Anoxic brain injury (<2yo) - 1 insult so not progressive - Brian injury = UMN MR: periventricular leukomalacia Goal = control spasticity Botox Xs presynaptic ACH release
51
Describe the gross motor functional classification system for CP
1 - almost normal 2 - trouble with uneven surfaces 3 - rolling walker, self propelled WC 4 - powered WC 5 - 100% dependent
52
Describe 3 gait issues + treatment for CP kids
Toe walkers - AFO, casting, TAL Crouched gait - multi level tendon release Stiff knee gait - HS lengthening, rectus transfer
53
How is CP scoli different from AIS
Bracing less effective Really treating for the caregivers If operate, higher complication rate
54
Describe CP hip problems + treatment options
Dislocation RF = contractures that limit abduction Therefore, treat with ST releases to maximize abduction for more concentric hip Goal to prevent irreducible/chronic dislocation
55
CP kids can get both equinovalgus and varus - which is more common and why do each happen
Varus > valgus - both from spastic overpull Varus - PT Valgus - peroneals
56
Pathology of arthrogryposis Treatment considerations
Congenital decrease in anterior horn cells Normal IQ Not progressive Correct knees 1st - then hips (often dislocated and don't respond to Pavlik) Goal feet = stiff platigrade foot - Clubfeet or vertical tali that don't respond to casting
57
Cause, pathology, and maternal RF for spina bifida
Low maternal folic acid Incomplete neural tube closure -> high alpha fetoprotein in mothers blood (how you can test in addition to US) Level of defect dets fxn RF: Mat DM Valproic acid Mat hyperthermia
58
Spina bifida - Associated condition (allergy)
IgE mediated latex allergy
59
Sacral agenesis - Associated maternal condition
Maternal DM
60
Genetics for DMD Protein mutated How is Becker different from DMD
DMD - XLR - Dystrophin protein - Elevated CK Becker overall less severe, still XLR
61
What medication can slow signs of DMD Which muscle groups affected first
Corticosteroids Prox motor 1st (Gower sign)
62
Freidrich ataxia - Inheritence - Gene - Presentation
AR Frataxin gene (GAA) Spinocerebellar and post col degeneration Wide based gait Cardiomyopathy Cavus foot Scoli Early mortality (50yo)
63
CMT - Inheritance - Pathology
Hereditary motor sensory neuropathy 2/2 myelin degeneration AD PMP 22 on chr 17
64
Describe why CMT pts get cavus feet, treat
Lose tib ant + per brevis Over active PL = PF 1st ray Overactive PT = varus Trt: 1. PF release + 1st MT osteotomy 2. Hindfoot Flexible = PT transer Rigid = calc osteotomy
65
Myasthenia gravis - Pathology - Trt
Auto-immune Thymus makes Ab - competitively binds Ach-R Presents as prox muscle weakness worse with activity Trt Crisis: IVIG Other: steroids, pyridostigmine (Ach-esterase inhibitor, don't break down Ach so can compete with the Ab) Thymectomy if applicable
66
Pathology behind polio
Viral destruction of anterior horn cells - muscle weakness, normal sensation
67
Inheritance, gene and protein for spinal muscular atrophy
AR SMN gene -> lack SMN-1 protein Anterior horn cell disease
68
Infantile blount - Age - Associated with - XR findings
Infantile blount <4yo Int tib torsion XR: metaphyseal diaphyseal angle >16 Metaph beaking
69
Adolescent Blount - RF - XR finding - Trt
Obesity Prox medial tibial metaphysis widening Surg - bracing not effective
70
Name amt of growth per year Prox fem Dist fem Prox tib Dist tib Age for end of growth girls vs boys
Prox fem 3 mm/yr Dist fem 9 Prox tib 6 Dist tib 5 14 F / 16 M
71
Trt LLD <2cm 2-5cm >5cm
<2cm - obs/shoe lift 2-5cm - Epiphysiodesis of long side - Short vs lengthening >5cm - Shortening vs lengthening
72
Post-med bowing - Associated - Trt - Comp
Associated calcaneovalgus foot - treat w/ stretching only! CORRECTS on own! Watch for LLD
73
Ant-med tibial bowing - Associated with 3 things
Fib hemi PFFD Cox vara
74
AL tibial bowing - Associated with 2 things - Trt
Pseudoarthrosis of tibia NF Brace to prevent frx bc hard to get to heal once broken
75
Genetics for fib hemi What determines treatment
SHH gene Trt based on foot deformity Less than 3 toes amputate 4-5 toes limb salvage
76
Inheritance for tib hemi What determines treatment
AD Trt based on quad function: knee disartic vs BKA
77
Inheritance for toe polydactyly
AD

Millers (29 decks)

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