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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
Q

Peds hip dislocation:
Comp
Post reduction test

A

Comp = SH frx prox fem physis if to aggressive with reduction
+/- MRI post reduction if any concern for non-concentric

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26
Q

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

A

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

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27
Q

Femoral shaft trt for kids <6mo

A

Pavlik

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28
Q

Femoral shaft trt for kids 6mo-5yo

A

Spica (1 or 2 legs)
Up to 2cm shortening ok because can expect some overgrowth

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29
Q

Describe how to apply spica cast
How much time in the cast
Complications

A

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

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30
Q

Femoral shaft trt kids >5yo (3 options)

A

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

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31
Q

Distal femur frx:
How much growth from this physis
What injury can be confused for this
Trt

A

9mm/yr - high rate physeal closure
Don’t confuse MCL/LCL sprains - physis is weaker
CR vs OR - watch for vascular injuries

32
Q

Tib tubercle frx:
What is BS
Best tests
Associated knee injury
Order of physis closure

A

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
Q

Classification tibial spine frx + trt

A

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
Q

Complications peds tibial spine frx

A

Stiffness
Late ACL instability 2/2 plastic deformation

35
Q

Sequelae of a Cozen frx

A

Cozen = proximal tibia frx
Late valgus deformity abt 6mo after injury for no good reason
Auto corrects over 1-2yrs - monitor clinically

36
Q

Trt tibial shaft frx vs toddler frx

A

Tibial shaft
Acceptable alignment 5-10deg V/V
LLC vs flex nails w/ cast if physes open

Toddler - SLC vs CAM

37
Q

Describe treatment and complications of distal tibia frx by SH classification

A

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
Q

What is a Tillaux frx
Additional imaging
Trt

A

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
Q

What is a triplane frx
How does the distal tibial physis close

A

AP XR = SH 3
Lat XR = SH 2
Really SH 4

Distal tibial physis closes central -> medial -> lateral

40
Q

Peds spine:
Number and weight for halo pins
Trt an AO dissociation
Why are odontoid frx common? Trt
Trt TL flexion/distraction injury

A

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
Q

Name the 4 physes for hematogenous spread

A

Intra-articular metaphyses:
Shoulder
Elbow
Hip
Ankle

42
Q

Osteo:
Most common bug
Bug for neonates
Bug for late presenting with odd sx

A

Common: S.aureus
Neonates: GBS
Late: Kingella - on blood culture medium or PCR

43
Q

Define involucrum vs sequestrum

A

Involucrum = new bone
Sequestrum = necrotic bone that can be nidus for continued infection

44
Q

Osteo:
Describe CRP trend for kids
Describe MR findings
What is a complication unique to MRSA, why

A

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
Q

Name the 4 Kocher criteria
What is the likelihood of septic joint w/ 3/4 vs 4/4

A

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
Q

Trt Lyme

A

Young = amox
Older = doxy

47
Q

Bug for foot punctures, treat

A

Pseudomonas
Surg debride + IV abx

48
Q

Why do kids get diskitis
XR findings

A

BV extend from the cartilaginous region of the end plate into the disc
XR: loss lordosis

49
Q

Name the disease:
LLD
Culture negative
Treated w/ NSAIDS

A

Chronic recurrent multifocal osteo (CRMO)
Considered a rheum condition

50
Q

CP:
Cause
Pathology
MR findings
Medical mgmt goals
Botox mechanism

A

Anoxic brain injury (<2yo)
- 1 insult so not progressive
- Brian injury = UMN
MR: periventricular leukomalacia
Goal = control spasticity
Botox Xs presynaptic ACH release

51
Q

Describe the gross motor functional classification system for CP

A

1 - almost normal
2 - trouble with uneven surfaces
3 - rolling walker, self propelled WC
4 - powered WC
5 - 100% dependent

52
Q

Describe 3 gait issues + treatment for CP kids

A

Toe walkers - AFO, casting, TAL
Crouched gait - multi level tendon release
Stiff knee gait - HS lengthening, rectus transfer

53
Q

How is CP scoli different from AIS

A

Bracing less effective
Really treating for the caregivers
If operate, higher complication rate

54
Q

Describe CP hip problems + treatment options

A

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
Q

CP kids can get both equinovalgus and varus - which is more common and why do each happen

A

Varus > valgus - both from spastic overpull

Varus - PT

Valgus - peroneals

56
Q

Pathology of arthrogryposis
Treatment considerations

A

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
Q

Cause, pathology, and maternal RF for spina bifida

A

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
Q

Spina bifida
- Associated condition (allergy)

A

IgE mediated latex allergy

59
Q

Sacral agenesis
- Associated maternal condition

A

Maternal DM

60
Q

Genetics for DMD
Protein mutated
How is Becker different from DMD

A

DMD
- XLR
- Dystrophin protein
- Elevated CK

Becker overall less severe, still XLR

61
Q

What medication can slow signs of DMD
Which muscle groups affected first

A

Corticosteroids

Prox motor 1st (Gower sign)

62
Q

Freidrich ataxia
- Inheritence
- Gene
- Presentation

A

AR
Frataxin gene (GAA)
Spinocerebellar and post col degeneration
Wide based gait
Cardiomyopathy
Cavus foot
Scoli
Early mortality (50yo)

63
Q

CMT
- Inheritance
- Pathology

A

Hereditary motor sensory neuropathy 2/2 myelin degeneration
AD
PMP 22 on chr 17

64
Q

Describe why CMT pts get cavus feet, treat

A

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
Q

Myasthenia gravis
- Pathology
- Trt

A

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
Q

Pathology behind polio

A

Viral destruction of anterior horn cells - muscle weakness, normal sensation

67
Q

Inheritance, gene and protein for spinal muscular atrophy

A

AR
SMN gene -> lack SMN-1 protein
Anterior horn cell disease

68
Q

Infantile blount
- Age
- Associated with
- XR findings

A

Infantile blount
<4yo
Int tib torsion
XR: metaphyseal diaphyseal angle >16
Metaph beaking

69
Q

Adolescent Blount
- RF
- XR finding
- Trt

A

Obesity
Prox medial tibial metaphysis widening
Surg - bracing not effective

70
Q

Name amt of growth per year
Prox fem
Dist fem
Prox tib
Dist tib

Age for end of growth girls vs boys

A

Prox fem 3 mm/yr
Dist fem 9
Prox tib 6
Dist tib 5

14 F / 16 M

71
Q

Trt LLD
<2cm
2-5cm
>5cm

A

<2cm - obs/shoe lift
2-5cm
- Epiphysiodesis of long side
- Short vs lengthening
>5cm
- Shortening vs lengthening

72
Q

Post-med bowing
- Associated
- Trt
- Comp

A

Associated calcaneovalgus foot - treat w/ stretching only!
CORRECTS on own!
Watch for LLD

73
Q

Ant-med tibial bowing
- Associated with 3 things

A

Fib hemi
PFFD
Cox vara

74
Q

AL tibial bowing
- Associated with 2 things
- Trt

A

Pseudoarthrosis of tibia
NF
Brace to prevent frx bc hard to get to heal once broken

75
Q

Genetics for fib hemi
What determines treatment

A

SHH gene
Trt based on foot deformity
Less than 3 toes amputate
4-5 toes limb salvage

76
Q

Inheritance for tib hemi
What determines treatment

A

AD
Trt based on quad function: knee disartic vs BKA

77
Q

Inheritance for toe polydactyly

A

AD

Millers (29 decks)

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