Peds (2008-2019)

Question 1

What are 4 poor prognostic factors in a radial neck fracture in children? (2012, 2013)

Answer 1

• Older patient (age>10y) *
• Requires open reduction *
• Associated Injuries *
• Delayed treatment *
• Internal fixation
• Poor reduction
• Angulation >30deg *
• Translation >3mm *
• *denotes presence of list in Lovell and Winter p1738

Question 2

2. What are 4 indications for percutaneous pinning of a distal radius fracture in the pediatric population. (2010, 2011, 2013)

Answer 2

• Floating elbow
• Late displacement/failure to maintain reduction in cast
• Open fracture
• Associated Acute compartment syndrome
• Displaced intra-articular fracture
• Severe soft tissue injury precluding cast

Question 3

3. What are three intra-operative techniques to reduce avascular necrosis during antegrade, locked, rigid femoral nail for an adolescent fracture? (2011, 2013)

Answer 3

• Trochanteric/lateral start point
• Smallest nail size
• Minimal dissection (posterior dissection)
• Percutaneous
• Sharp reamers

Question 4

4. In a type II tibial eminence fracture (2015)

• What is the block to reduction?
• What are the consequences of failed reduction? (2 points)

Answer 4

• What is the block to reduction?
  
  • Meniscus (usually anterior horn of lateral meniscus) - MEDIAL
  • Inter-meniscal ligament
• What are the consequences of failed reduction? (2 points)
  
  • ACL Instability
  • Stiffness/Notch Impingement

Question 5

5. 3 complications associated with pediatric tibial tubercle fracture (2012, 2014)

Answer 5

JAAOS 2002 - Fractures around the knee in children

• Compartment Syndrome
• Recurvatum Deformity
• Leg Length Discrepancy
• Hardware Irritation
• Re-fracture
• Stiffness
• Patella Baja
• Saphenous neuroma
• Non-union
• Skin Necrosis

Question 6

6. What volume of crystalloid do you bolus a peds trauma pt (in cc/kg)?
7. 10
8. 20
9. 30
10. 40

Answer 6

ANSWER: B (20cc/kg)

2009

Confirmed with ATLS manual

 

Question 7

7. 13 yr F with proximal humerus 60% displaced, 45 degrees angulated. What is the best treatment
8. ORIF
9. CRPP
10. Sling
11. Thoracobrachial cast

Answer 7

ANSWER: B (CRPP)

• 2012
• JAAOS - Pediatric Proximal Humerus Fractures
• Acceptable reduction over age 10
  
  • <20-30o angulation
  • 50% displacement
• Lovell and Winter p1700
  
  • Dobbs et al. (28) used >2/3 width displacement (Neer grade III or IV) and angulation >45 degrees in older adolescents (>12 years) as indications for attempted closed reduction under general anesthesia. If a successful reduction could be obtained (to grade II or less displacement and <45 degrees angulation), then stability was tested. If unstable, the fracture was treated with percutaneous pin fixation and immobilization. If an acceptable reduction could not be achieved closed, an open reduction was performed using a deltopectoral approach.

Question 8

8. 9 yo boy sustains completely displaced irreducible proximal humerus #. Intraoperatively, what is the block to reduction? REPEAT
9. periosteum
10. Supraspinatus
11. LHB
12. SHB
13. Prism weakness

Answer 8

ANSWER: C (LHB)

• 2010, 2012
• JAAOS - Pediatric Proximal Humerus Fractures
  
  • “it should be noted that, in up to 9.4% of surgical cases, the biceps tendon can be interposed in the fracture site and may require an open incision to successfully reduce the fracture before pinning”

Question 9

9. 16yo female with isolated forearm fracture. You are shown an xray of patient with closed physes, anterior radial head dislocation, middle 1/3 ulna fracture and very distal ulna fracture (about 2 cm from distal ulna). What is the best treatment?

(This pic but also a distal ulna fracture)

1. Closed reduction of ulna and radial head with a well molded above elbow cast in supination
2. Closed reduction and intramedullary nail ulna and closed reduction of radial head
3. Open reduction and internal fixation of ulna and radius
4. Closed reduction and intramedullary nail fixation of ulna with closed redution of radius.

Answer 9

ANSWER: C (ORIF since closed physis = adult)

2013

• JAAOS 1998 - Monteggia Fractures in Children and Adults
  
  • Transverse and short oblique fractures are adequately treated with intra-medullary wire fixation
  • Intramedullary fixation rarely provides the precise anatomic reduction that can be achieved with a plate and should not be used in adult Monteggia injuries

Question 10

10. Type 2 Monteggia in 10 yr old, radial head dislocated posteriorly (no x-ray). How to treat.
11. reduce with flexion and pronation and pressure on radial head, above elbow cast in flexion and pronation
12. reduce in flexion/supination with pressure on radial head, cast above elbow in flexion/supination
13. reduce with extension and pressure on radial head, cast above elbow in extension
14. open reduction with k-wire across radiocapitellar joint

Answer 10

ANSWER: C (in extension and direct post pressure)

• 2009
• Rockwood and Greens:
  
  • Anterior and Lateral Dislocations –> Flexion and supination for reduction
  • Posterior –> longitudinal traction, direct pressure
• Lovell and Winter Page 1755
  
  • Treatment depends on the character of the ulnar fracture because stable, anatomic reduction of the ulna can maintain anatomic reduction of the radial head. Most Monteggia injuries in children younger than 12 years can be managed successfully by closed reduction and above-elbow casting. For a type I injury, the elbow is flexed >90 degrees with the forearm supinated. For a type II injury, the radial head may be best located in elbow extension and forearm supination (148, 149). Type III injuries are treated with a varus reduction, but are often difficult to treat with casting alone. Weekly follow-up with good quality elbow radiographs is suggested for 2 to 3 weeks to detect any recurrent radial head subluxation. Transient nerve palsies, most commonly of the posterior interosseous nerve, occur in approximately 10% of patients.

Question 11

11. Undisplaced lateral condyle fracture in a child. What is the next best treatment?
12. Cast and follow up within a week
13. Arthrogram
14. ORIF
15. MRI

Answer 11

ANSWER: A (Cast and f/u)

• 2008, 2013
• JAAOS 2011 - Lateral Condyle Fractures
  
  • Undisplaced fractures (<2mm)
    
    • Unclear prevalence: 6-69% of fractures
    • Some argue for fixation no matter what –> state that the undisplaced fracture is exceedingly rare, just an imaging problem (Flynn JPO 1989, hardacre JA JBJS 1971, Badelon O JPO 1988)
    • Some also claim they should be fixed for high rates of non-union (Flynn JPO 1989, Conner AN JBJS 1970, Speed J JBJS 1933, Fontanetta P J Trauma 1978)
• Displaced (>2mm) or rotated
  
  • CRPP:
    
    • 2-4mm displacement
    • Avoids soft tissue stripping (non-union, osteonecrosis)
  • ORIF
    
    • Significantly rotated or displaced
    • Usually Kocher approach
    • Risk of non-union due to soft tissue stripping
    • No stripping posteriorly!!
    • Fixation with wires usually
    • Be careful with 3 wires –> increased loss of motion and lateral spurs
    • Charles - Dissection is usually done for you

Question 12

12. 6 year-old girl presents to your emergency department with a type III supracondylar fracture of the elbow. She has a cold, blue hand with no pulses. She is also unable to flex her thumb. You do your closed reduction and pinning in the operating room. When you seen her in the PACU, her hand is warm, pink, and has no pulse. She is still unable to flex her thumb. What is the best treatment at this point?
13. Observe with close follow-up
14. Bring back to OR for artery and nerve exploration
15. Angio
16. Remove K-wires

Answer 12

ANSWER: A (Observe with close f/u)

2012

JAAOS 2012 - Management of Supracondylar Humerus Fractures In Children

Question 13

13. A 4 yo boy has a Type III supracondylar fracture with a cold and pulseless hand. What is most true?
14. After closed reduction, an angiogram is always needed
15. It often takes 24 hours after reduction for a Doppler pulse to return.
16. If a pulse doesn’t return, it can be ignored if the hand is otherwise well perfused.
17. A complete occlusion of the brachial artery necessitates immediate reconstruction.

Answer 13

ANSWER: C (ok if warm perfused hand)

2008, 2013

Don’t like the wording here.

Robb JE (JBJS Br 2009) The pink, pulseless hand after supracondylar fracture of the humerus in children

Mangat described 19 kids with grade III treated at 6 hours from injury

11 were observed –> pulse returned at 24 hours (2), 3 weeks (3), 1-3 months (2)

Question 14

14. What is true regarding a type III supracondylar humerus fracture in a pediatric patient?
15. Limited remodeling for translational deformity
16. Splinting in 120 degrees of flexion to maintain reduction is acceptable
17. Equivalent outcomes with lateral and crossed pinning
18. These require emergent surgical management

Answer 14

• ANSWER - A (limited remodelling for translational deformity)
• 2014
• Urgent, but not emergent management
• The Treatment of Pediatric Supracondylar Humerus Fractures J Am Acad Orthop Surg 2012;20:320-327
  
  • 2 lateral pins are clinically but NOT biomechanically equivalent to a crossed-pin construct - 3 lateral pins are equally strong as a crossed-pin construct; medial pin has an increased risk of ulnar nerve injury (NNH = 20)
  • Translational deformity has minimal remodelling potential and can lead to cubitus varus - the only acceptable deformity is angulation; rotation is also bad
  • Splinting in hyperflexion increases the risk of compartment syndrome 
  • The AAOS guideline suggests closed reduction with pin fixation for patients with displaced (eg, Gartland types II and III and displaced flexion) pediatric supracondylar fractures of the humerus. 
  • The AAOS guideline suggests the practitioner might use two or three laterally introduced pins to stabilize the reduction of displaced pediatric supracondylar fractures of the humerus. Considerations of potential harm indicate that the physician might avoid the use of a medial pin.

 

Question 15

15. Which of the following does not cause cubitus varus following SC #?
16. Flexion type
17. Inadequate reduction
18. Loss of fixation
19. Underappreciation of medial comminution

Answer 15

ANSWER: A (flexion type)

• 2009
• Flexion type supra-condylars develop cubitus VALGUS

Question 16

16. All of the following are true regarding a fishtail deformity of the distal humerus, except:
17. Associated with supracondylar humerus fracture
18. Results from central physeal growth arrest
19. Predisposes to early ulnohumeral degenerative changes
20. Results in significant humeral length deficiency

Answer 16

• ANSWER: D (not true - it does not result in sig humeral length deficiency)
• 2015
• Glotzbecker MP (JPO 2013) Fishtail deformity of the distal humerus: a report of 15 cases
  
  • Proposed etiologies for fishtail deformity include avascular necrosis of traumatic and idiopathic origin and/or premature physeal arrest.
  • It can occur after displaced or minimally displaced supracondylar humerus fractures, lateral condylar fractures, physeal separations, or medial condylar fractures
  • It can also be caused iatrogenically from excessive soft tissue stripping posteriorly, posterior approaches to the lateral distal humerus, or misdirected pin passes or instrumentation placed posteriorly on the humerus.
  • Despite the fact that multiple different types of fractures may lead to this complication, the humeral deficiency seen in cases of fishtail deformity generally develops in the lateral aspect of the medial crista, trochlear groove and/or apex, which lends further support to a vascular etiology
  • In the short term, there are often minimal or no symptoms. When patients present, they may present with joint malalignment, and they often complain of pain and loss of motion secondary to joint incongruity and locking, which is related to loose body formation and joint instability.The few studies with long-term follow-up have demonstrated a high incidence of functional disability including pain and/or loss of motion.
  • Radiographically, in our series, loss of motion was associated with subluxation of the radial head. With proximal migration of the ulna, the coronoid impinges anteriorly and olecranon impinges posteriorly, leading to progressive loss of motion. Furthermore, the finding of radial head subluxation/dislocation is a radiographic sign that the proximal migration of the ulna is substantial enough to cause both loss of flexion-extension as well as radial head dislocation.
  • Joint incongruity leads to osteochondral impingement and risk of loose bodies and arthrosis.
  • Gross, I actually read this paper yesterday and thought I totally wasted my time. Glad to see there is actually a question from it!

Question 17

17. 12 yo boy shows up at your cast clinic 10 days after an injury with a SH II distal radius fracture. He is splinted and has 15 degrees inclination and 50 degrees apex volar angulation. What do you do?
18. Molded short arm cast and follow up regularly
19. Closed reduction and Molded short arm cast and follow up regularly
20. Open reduction and pinning
21. Open reduction and plate

Answer 17

ANSWER: A

• 2009, 2012
• Difficult to find evidence….pretty much assuming this is a SHII injury
• Late re-reduction associated with damage to physis but time course difficult to sort out..7-14 days.
• If not a physeal injury then reduction would be appropriate
• If it is a physeal injury then ideally would do CRPP with the reduction, so I prefer A

Question 18

18. What is the best predictor of re-displacement in a distal radius and ulna fracture in a 7yo:
19. Ulnar styloid fracture
20. Cast index of 0.7
21. Bayonet apposition
22. Triple point index/Three point mould

Answer 18

ANSWER: D

• 2015
• Alemdaroglu KB (JBJS 2006) Risk Factors in Redisplacement of Distal Radius Fractures in Children
• Kamat AS (JPO 2012) Redefining the cast index: the optimum technique to reduce re-displacement
  
  • “In patients with CIs of ≤ 0.8, the displacement rate was only 5.58%. However, in patients with CIs of ≥ 0.81, the displacement rate was 26%. A high CI was the sole factor that was significantly higher in the redisplacement group. No statistically significant difference was seen for age, sex, or surgeon seniority. Statistical differences were not noted in initial angular deformity or initial displacement.”

Question 19

19. 12 yr F with # radius. Comes back with a dystrophic looking pseudoarthrosis. What would you find on exam?
20. hypoplastic thumb
21. café au lait spots
22. absent pec major
23. Clinodactyly

Answer 19

ANSWER: B (café au lait spots )

• 2008, 2011, 2012
• Presumably pseudoarthrosis associated with NF1
• Several case reports in literature
  
  • Kameyama O (JPO 1990), Gregg PJ (COR 1982)
• 50% of forearm pseudarthosis are associated with NF1 (but only a small percentage of NF1 get forearm pseudarthrosis)

Question 20

20. What is true. Both bones forearm # 10deg rotational malunion in the forearm?
21. A midshaft malunion will result in more decreased pronation
22. A midshaft malunion will result in more decreased supination
23. A distal malunion will result in more decreased pronation
24. A distal malunion will result in more decreased supination

Answer 20

ANSWER: B (A midshaft malunion will result in more decreased supination )

• 2009
• Rockwood and Greens:
  
  • “They observed a significantly greater loss of ROM in forearms with middle-third deformities than with distal-third deformities, with more supination being lost than pronation. They also observed a significant decrease of ROM with 15° of angulation. The greater decrease of ROM in middle-third deformities was attributed to the loss of the radial bow where the two forearm bones overlap at the extremes of pronation and supination”
• Charles’ theory: proximal to supinator insertion = supinator supinates distal fragment, = decrease supination

Question 21

21. What is least likely to cause compartment syndrome when putting on a hip spica cast for a femur fracture in an 8 yo
22. Placing the below knee portion first and using it to place traction on the thigh
23. Placing the spica in the seated position with the hip and knee at 90 degrees
24. Including the foot in the spica
25. Placing a spica with hip and knee flexed less than 90-90

Answer 21

ANSWER: D

• 2013
• Mubarak SJ (JPO 2006) Volkmann contracture and compartment syndromes after femur fractures in children treated with 90/90 spica casts
  
  • After child awakes from anesthesia the thigh muscles contract and the leg slips back in the cast
  • Causes pressure at the corners of the cast
• Large TM (JBJS 2003) Compartment syndrome of the leg after treatment of a femoral fracture with an early sitting spica cast
  
  • “if the foot is casted then it is not available for monitoring of the compartments
  • But doesn’t cause the compartment syndrome
• Systematic review of spica casting for the treatment of paediatric diaphyseal femur fractures (J Child Orthop 2018;12:136-144 ) - This author recommended casting the hip and knee both at 45°, not elevating the cast, and not applying traction on the below-knee cast portion during application of the cast after reduction of the fracture.

Question 22

22. What is the risk of osteonecrosis in a pediatric displaced trans-cervical hip fracture?
23. 100%
24. 60%
25. 30%
26. 15%

Answer 22

ANSWER: C (30%)

• 2014
• JAAOS 2009 - Hip Fractures in Children
  
  • Delbet Classification:
  • Trans-physeal Fractures
  • Trans-cervical Fractures
  • Cervicotrochanteric Fractures
  • Intertrochanteric Fractures
• Moon (JOT 2006) Risk Factors for Avascular Necrosis after Femoral Neck Fractures in children
  
  • 360 cases in meta-analysis
• Riley PM (JOT 2015) Earlier Time to Reduction Did Not Reduce Rates of Femoral Head Osteonecrosis in Pediatric Hip Fractures
  
  • ON Rates:
    
    • Type 1 - 67%
    • Type 2 - 31%
    • Type 3 - 14%
    • Type 4 - 25%

Question 23

23. What has increased rate of ON in pediatric femoral neck fracture?
24. age
25. Delbet IV
26. fracture displacement
27. Gender

Answer 23

ANSWER: A and C

• 2011
• Moon (JOT 2006) Risk Factors for Avascular Necrosis after Femoral Neck Fractures in children
  
  • Fracture type, displacement, age and treatment were all statistically independent predictors of AVN
  • With logistic regression analysis fracture type and age only predictors
  • Older kids 1.14x more likely to get AVN per year of age
• Bone Joint J 2019;101-B:1160–1167.
  • We found that age (p = 0.006) and initial displacement (p = 0.001) were significant independent risk factors.

Question 24

24. Pediatric patient with midshaft femoral fracture. You plan to do retrograde femur elastic nailing. What % of the canal at the isthmus should you fill with your elastic nails?
25. 60%
26. 70%
27. 80%
28. 90%

Answer 24

ANSWER: C (80%)

• 2012
• JAAOS - IM Nailing of pediatric femoral shaft fractures
• Use 2 nails with combined diameter equal to 80% of narrowest diameter
• Greater stiffness at fracture, BUT increases malreduction and rotational(posterior gapping and malalignment)
• Each nail 40%
• Sizes 1.5-4.0mm

Question 25

25. A 5yo with a femur fracture is treated with a spica cast. What is an unacceptable deformity? 1. 25 degrees malrotation 2. 2.5cm shortening 3. 20 degrees coronal plane angulation 4. 20 degrees sagittal plane angulation

Answer 25

ANSWER: B (2.5 cm shortening not acceptable) * 2014 * 2009 AAOS Practice Guidelines: Treatment of Pediatric Diaphyseal Femur Fractures * We suggest early spica casting or traction with delayed spica casting for children age six months to five years with a diaphyseal femur fracture with less than 2 cm of shortening. Level of Evidence: II Grade of Recommendation: B * We are unable to recommend for or against using any specific degree of angulation or rotation as a criterion for altering the treatment plan when using the spica cast in children six months to five years of age. Level of Evidence: V Grade of Recommendation: Inconclusive * Management of Pediatric Femoral Shaft Fractures. JAAOS. 2004. * Generally, for children aged 2 to 10 years, acceptable fracture alignment at union is ≤15° of varus or valgus angulation, ≤20° of anterior or posterior angulation, and ≤30° of malrotation. Overgrowth may vary with the age of the child, the fracture pattern and location, the amount of shortening, and possibly the treatment method. In children aged 2 to 10 years, overgrowth averages 0.9 cm (range, 0.4 to 2.5 cm). Shortening at union should be no more than 1.5 cm to 2.0 cm. No more than 1.0 cm of shortening is recommended for older children.

Question 26

26. 54kg kid with a diaphyseal femur fracture. What is the most appropriate treatment? 1. Ex-fix 2. Rigid IM nail 3. Flexible IM nail 4. Submuscular plate

Answer 26

ANSWER: D * B or D depending on age of patient \> 10 – rigid nail, \< 10 submuscular plate * 2015 * JAAOS 2011 - IM nailing of pediatric femoral shaft fracture * JAAOS 2012 - Submuscular plating of pediatric femur fractures * Flexible nails have a worse outcome with age \> 11 years or weight \> 50kg, consider bracing or augmenting with brace * If Skeletally mature, then would do rigid IM nail, otherwise sub-muscular plating

Question 27

27. What artery is commonly implicated in compartment syndrome in tibial tubercle fractures: 1. Anterior tibial recurrent 2. Peroneal artery 3. Inferior patellar 4. Posterior tibial recurrent

Answer 27

ANSWER: A (Anterior tibial recurrent artery) * 2015 * JAAOS - Pediatric Knee Dislocations and Physeal Fractures About the Knee * "disruption of the anterior tibial recurrent artery can result in bleeding into the anterior compartment of the leg, leading to compression of the anterior tibial artery and deep peroneal nerve"

Question 28

28. In a pediatric tibial spine/eminence fracture, all of the following are true, except: 1. ACL laxity and instability is a common complication and can cause functional impairment 2. Meniscal and chondral injuries are not associated 3. Associated with a larger femoral intercondylar notch

Answer 28

ANSWER: A/B *  JAAOS 2015 Complications of Tibial Eminence and Diaphyseal fractures in children * JAAOS 2010 Tibial Eminence Fractures * ACL Laxity (Willis RB JPO 1993) * 74% have laxity on KT-1000, rarely subjectively a problem * Laxity more prevalent in non-op patients * Therefore A is TRUE * Kocher (AJSM 2003) * 65% of type III have meniscal entrapment (26% type II) BUT only 3% had meniscal tears – “therefore do not appear to be commonly associated with anterior meniscal or inter-meniscal ligament entrapment” * Feucht MJ (KSSTA 2016) * Meniscal injuries in 37% * 30% of injuries were posterior horn longitudinal tear * Associated with higher age, advanced Tanner stage, pubescence * Kocher (JPO 2004) ACL injury vs tibial spine fracture in the skeletally immature knee * ACL injury had narrower notch indices than tibial spine fracture group * Therefore C is TRUE

Question 29

29. A 4 year old has a proximal tibia fracture. What deformity may occur? 1. Varus 2. Valgus 3. Procurvatum 4. Recurvatum

Answer 29

ANSWER: B (valgus) * 2009 * Cozen's fracture

Question 30

30. What is true regarding pediatric tibia fractures? 1. The average 11yr old will have 10mm of overgrowth 2. 10° of coronal displacement in an 8yr old will remodel adequately 3. 10° of rotation is unacceptable in any age 4. the proximal tibial physis growth will be affected even with distal fractures

Answer 30

ANSWER: B * 2008 * Lovell and Winter: * Average overgrowth 5-7mm, almost no overgrowth in girls \>8/boys \>10 * Kids \<6 15o acceptable angulation, Kids \> 6 10o acceptable * No guidelines for rotation, but won't remodel much

Question 31

31. With regards to triplane fractures in children? 1. Results from lateral rotation 2. Occurs because posteromedial physis closes first 3. High risk of growth arrest 4. Cannot happen with growth plates are fully open

Answer 31

ANSWER: A (lateral rotation aka ER) * 2012 * Rang’s = SER mechanism * Clement DA (JBJS 1987) Triplane fracture of the distal tibia. A variant in cases with an open growth plate * "We have reviewed 15 cases of triplane fracture of the distal tibia. The mechanism of injury is lateral rotation and the anatomical pattern of the fracture depends on the state of the growth plate at the time of injury. In seven of our cases the anteromedial part of the growth plate was fused, but in eight children the plate was completely open." * "In six of these eight children there was a hump or projection of the medial growth plate. It is suggested that this hump (kump’s hump) stabilises the anteromedial part of the epiphysis in a manner similar to the partial anteromedial fusion seen in older children, and that this accounts for the occurrence of triplane fracture in the presence of an open growth plate." * JAAOS triplane fractures * This closure proceeds from central to anteromedial to posteromedial and, finally, to the lateral portion of the epiphysis, leaving the unfused portions vulnerable to injury. The anterolateral physis is the last to close. * These fractures also have been termed transitional fractures. This injury usually does not occur in patients younger than age 10 years or older than age 16.7 years, but there are case reports of both.

Question 32

32. Which portion of the distal tibial physis is the last to fuse? 1. Anterolateral 2. Central 3. Anteromedial 4. Posteromedial

Answer 32

ANSWER: A * 2012 * JAAOS triplane fractures  * This closure proceeds from central to anteromedial to posteromedial and, finally, to the lateral portion of the epiphysis, leaving the unfused portions vulnerable to injury. The anterolateral physis is the last to close.

Question 33

33. List 3 radiographic features of C2-3 pseudosubluxation (2009, 2012, 2014)

Answer 33

* JAAOS 2011 - Pediatric Cervical Spine Trauma * Spinalaminar line within 1.5mm * AAOS Core Review: * Reduces with extension * \<4mm subluxation is normal * No soft-tissue swelling

Question 34

34. List 4 ways in which radiographs of the cervical spine in children differ from those of skeletally mature patients? (2015)

Answer 34

* AAOS Core Review 2/OKU Peds 3 * Increased ADI (\>5mm abnormal) * Pseudosubluxation of C2-C3 * Loss of cervical lordosis * Widened retropharyngeal space (\>6mm C2, \>22mm at C6) * Wedging of cervical vertebral bodies * Neurocentral synchondroses (closure by age 7) * JAAOS Pediatric Cervical Spine Trauma: * Relative Horizontal Facets * Flat Unicate processes (