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Peds Flashcards

1
Q

in extension SCH frx what denotes more instability

A

medial commiution leading to varus

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2
Q

WB in titanium elastic nails for femur frx

A

allowed

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3
Q

what exacerbates sx of a peds spondy

A

extension

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4
Q

are oblique xr needed to dx a spondy

A

NO - lateral is enough

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5
Q

highest risk group for spondy slip progression

A

just before teen growth spurt, general reduced risk with age

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6
Q

OCD imaging of choice

A

MRI; not arthrogram; never XR

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7
Q

tx of peds discitis with vt osteo

A

IV Abx - no I&D needed

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8
Q

highest incidence of peds spondy in what population

A

Native americans

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9
Q

UBC tx in prox hum

A

generally even with frx first tx is observation - if it remains painful or cortex does NOT thicken after frx healing then C&G&BG

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10
Q

tx of suspected Lyme Septic arthritis

A

aspiration, lyme serology and oral amoxicillin 30 days

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11
Q

UBC by skeletal maturity

A

they typically resolve

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12
Q

what percent of peds spondy develop to needing surgery

A

less than 5%

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13
Q

how to diagnose and tx a neonatal elbow injury

A

get arthrogram - generally Transphyseal and need to visualize the distal humerus

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14
Q

achondroplasia features

A

lumbar stenosis, lordosis; short pedicles, post radial head dislocation, frontal bossing, genu varum

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15
Q

achondroplasia genetics

A

FGFR 3, gly-arg substitute slows prolif zone, Auto dom but 90% sporadic

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16
Q

SED genetics

A

type 2 collagen COL2A1 gene - auto dom

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17
Q

SED features

A

short trunk and limbs, abnormal epiphyses INCLUDING spine; odontoid hypoplasia and resultant atlanto axial instability; coxa vara, DDH, hearing loss, retinal detachment

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18
Q

what is Kniest dysplasia

A

same gene as SED (COL2A1); auto dom. Joint contractures, dumbell femurs, respiratory problems, cleft palate, kyphoscoliosis; retinal detachment and hearing loss.

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19
Q

Cleidocranial dysplasia genetics

A

CBFA1 - transcription factor that activates osteoblast differentiation auto dominant, affects intramembranous ossification

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20
Q

features of cleidocranial dysplasia

A

clavicles absent, delayed skull closure, frontal bossing, coxa vara (osteotomy for > 100deg); delayed ossification of pubis; genu valgum; short middle phalanx of 3-5th finger

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21
Q

Nail patella syndrome genetics

A

lin homeobox gene transcription factor; autosomal DOM. - also in eyes and kidneys

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22
Q

features of nail patella

A

aplasia or hypoplasia of patella/condyles; iliac horns; post dislocation of radial head; 30% get renal fx and glaucoma as adults

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23
Q

diastrophic dysplasia genetics

A

sulfate transporter gene - affects proteoglycan sulfate groups in cartilage - auto REC.

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24
Q

features of diastrophic dysplasia

A

short, rhizomelic, cervical kyphosis and kyphoscoliosis; hitchiker thumb; cauliflower ears; rigid club feet; skew foot; severe OA joint contractures

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25
Q

mucopolysacchridoses genetics

A

all are auto recessive except Hunters (x-link recessive)

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26
Q

Metaphyseal Dysplasia(MD) genetics

A

Schmid type defect in collagen X (COL10A1); Jansen type - PTHreceptor defect which regulates chondrocyte differentiation; McKusick type worse type - affects ribosome nucelic acid component of mitochondria

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27
Q

MD features schmid

A

mild; coxa vara, genu valgum

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28
Q

MD features jansen

A

short, squat stature, hyper Ca; bulbous metaphyseal expansion of long bones; extremity malalignment

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29
Q

MD McKusick type

A

C1-2 instability; hypoplastic cartilage; immunocomp; malignancies, thin hair, intestinal malabsorption/megacolon; ankle deformities due to fibular overgrowth; ligamentous laxity; genu varum and pectus abnormalities

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30
Q

pseudoachondroplasia genetics

A

COMP gene on C19 - extracellular matrix glycoprotein in cartilage - Auto Dom

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31
Q

pseudoachondroplasia features

A

DDH, early OA, scoliosis; norma face, c1-2 instability due to odontoid dyspasia; metaphyseal flaring

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32
Q

multiple epiphyseal dysplasia (MED) genetics

A

COMP, COL 9A2, COL9A3, for collagen 9 ; links collagen 2 to cartilage- auto dom.

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33
Q

MED features

A

short; does not involv spine; genu vulgum; hip osteoNec; double layer patella

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34
Q

Ellis van crevel EVCgenetics

A

mutation in EVC gene; auto recessive

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35
Q

Ellis van crevel features

A

acromesomelic shortening (middle and distal imbs); POST axial polydactyly’ genu valgum; 60% congenital heart disease; medial iliac spikes; fusion of carpals - capitate and hamate

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36
Q

diaphyseal dysplasia also called

A

camurati-engelemen - symmetric thick cortex of tibia, femur, humerus - tx with NSAIDS - watch for LLD

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37
Q

Leri Weil dyschondrosteosis genetics

A

SHOX gene; auto dom. On sex chromosomes

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38
Q

Leri Weil features

A

mild short stature mesomelic shortening; madelung deformity

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39
Q

what does CFBA code for

A

TF for osteocalcin

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40
Q

MED height

A

patients are NORMAL height EARLY on but then develop their short stature later

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41
Q

SED types

A

AD , COL2A; milder version is rarer shows up later 8-10y and is X-recessive; BOTH have C-spine instability

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42
Q

marfan genetics

A

Fibrillin 1-FBN 1 n C15; auto dom.

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43
Q

marfan features

A

60 percent have scoliosis hard to brace; need MRI prior to spinal fusion due to high rate of dural ectasia

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44
Q

Ehlers danlos genetics

A

about half are classic COL5A1 or 2 mutation; auto dom. For collagen 5; type 6 is auto recessive has severe kyphoscoliosis; type 4 is COL3A1 and auto dom - has the GI and artieral ruptures

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45
Q

additional workup is needed for Ehlers Danlos

A

echo for aortic root dilation

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46
Q

types of JRA

A

systemic type is stills disease (least common, worst); olig (4 joints or less)is most common; poly (5+ joints)

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47
Q

features of systemic JRA (stills disease)

A

hepatosplenomegaly, lymphadenopathy, pericarditis, anemia; ages 5-10 equal genders; poor prognosis

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48
Q

features of OLIGO JRA

A

peak age is 2-3; 4 joints or less; most common and more in girls; generally good long term prognosis ; uveitis is possible. Limp that imrpoves; LLD is possible, check optho exam

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49
Q

hypophosphatemic rickets

A

x-linked dominant; impaired renal absoprtion of phosphate

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50
Q

hypophosphatemic rickets lab values

A

LOW Phos; NORMAL Ca, PTH, Vit D. HIGH ALK; tx with high dose phos and vit D

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51
Q

Nutritional rickets values

A

LOW vit D Ca and Phos; HIGH PTH and ALP; tx with vit D

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52
Q

Vit D Dependent Rickets Type 1

A

cant make 1,25. LOW ca, phos, Vit D, normal 25 hydroxy D; HIGH ALP and PTH ; tx with 1,25 vit d replacement

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53
Q

vit D dependent rickets 2

A

bad receptor; LOW ca, phos. VERY HIGH vit D1,25; HIGH ALP; PTH - tx with hi dose vit 1,25 vit D and Ca

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54
Q

hypophosphostasia

A

cant make ALP; high Ca and phos, low ALP, normal PTH, vit D

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55
Q

patholoy in Gauchers

A

Auto Rec. beta glucosidase doesn_t work; lipids build up; infantile type is lethal. Can be cured with BMTx early on; earlenmeyer flask deformity

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56
Q

what is def of spastic CP

A

rigid and increased tone with rapid stretching - most benefit from ortho surgeries

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57
Q

Hemi vs Diplegic CP

A

Hemi is one half; Di is Lower

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58
Q

normal stance swing ratio

A

62% stance 38% swing

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59
Q

gmfcs 2,3,4

A

2 has some trouble with uneven ground; needs railing for stairs but NO assistive device; 3 needs a device, but can get around; 4 needs wheel mobility most of the time

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60
Q

gmfcs1

A

can do everything including runnig, jumping - BUT balance speed and cooridnation are impaired

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61
Q

AFO types for CP

A

solid ankle improve walking speed and stride length in most CP patients; hinged help prevent equinus; floor reaction help prevent crouch gait due to excess dorsiflexion

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62
Q

what to check before releaseing eqquinus in CP

A

is the contracture from the HIP/KNEE? Leading to crouch gait and eqiunus might be compensatory

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63
Q

scoliosis rates in CP

A

in hemiplegic and dipegic is 20%; quad is 60-80% and bed ridden is 100%

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64
Q

quadriplegic CP scoliosis after skeletal maturity

A

continues to progress

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65
Q

incidence of hip subluxation in CP

A

in quads up to 50% - not the same as DDH

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66
Q

management of CP scoli curves

A

age over10 and > 40-50 degrees interfering with sitting; if 90 deg or more, need to do ant release; QoL, balance and cosmesis improves with sugery

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67
Q

can botox prevent progression of hip migration

A

nope

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68
Q

tx of hips in CP

A

if < 8 and < 60% subluxation- soft tissue procedures; if > 60% or > 8y and 40% the femoral and pelvic bony work

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69
Q

distal recturs femoris transfer used for

A

swvere crouch gait, but can worsen it in GMFCS 3-4

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70
Q

mc cause of crouch gait

A

spastic hamstring

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71
Q

severe crouch gait fixed with

A

either guided growth OR closing wedge anterior osteotomy of distal femur - extension

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72
Q

pes planovalgus in CP

A

best outcoms with calc slide are before age 6; after you need to do mid foot work

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73
Q

fractures in CP

A

higher in NWB patients; consider giving IV pamidronate to those with Z score < 2

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74
Q

myelomingocele pathogenesis

A

failure to close neural tube elements at 3-4 weeks

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75
Q

meningocele vs myelomeningocele

A

meningocelee has little to no impariment bc neural elements stay in side canal ; MM-cele has spinal elements sticking out

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76
Q

prenatal dx of Meningocele/MM-cele

A

AFP in serum 60-90% accurate or via US or via Amniocentesis

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77
Q

RF for spina bifida

A

low folic acide, previous birth with SB; maternal DM; in utero exposure to valproic acid and carbamazepime

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78
Q

mm-cele at L3 vs 4

A

significant difference in ambulation; need quads and hamstrings for ambulation if these are present then 80% are comm amb with K/AFO

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79
Q

issues with MM-cele in the spine

A

tethering leading to scoliosis; syrinx; shunt problems (for treating hydrocephalus)

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80
Q

high vs low sacral mm-cele

A

low has intact GSC; high does NOT have gsc and has a gluteal lurch or pelvic obliquity

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81
Q

mmcele with dislocated hip

A

general do NOT reduce

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82
Q

tx of mmcele foot deformities

A

tenotomy over tendon transfers - better to have a flail braceable foot

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83
Q

sx of duchenne

A

decreased ambulation by 8-9; wheelchair by 12; and progressive solciosis/respiratory disease and death by second decade

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84
Q

CPK level of duchenne

A

usually diagnostic and 100x normal

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85
Q

EMG of duchenne

A

myopathic, decr amplitude, short duration of polyphasic motor

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86
Q

biopsy of DMD

A

fibrofatty replacement of muscle

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87
Q

weakness in duchenee

A

proximal muscles first

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88
Q

Duchenne and anesthesia

A

risk for malignant hyperthermia -pre-tx with dantrolene

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89
Q

when to treat DMD spine

A

after 20 deg

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90
Q

SMA type 1 acute

A

severe, death at age2

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91
Q

SMA type 1 chronic

A

delayed onset at 6-18months; weaker in LOWER extremities; hip dislocations at 60% and joint contractures common

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92
Q

SMA 3 - kugelberg

A

onset after 18 months; wheelchair by late adulthood, normal lifespan; weaker proximal muscles

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93
Q

SMA 4-

A

adult onset; moderate proximal weakness

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94
Q

genetics of SMA

A

ALL SMA types are missing SMA 1 gene (on c5; severity based on how much SMA2 gene is available; progressive loss of alpha motor neurons in anterior horn of cord

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95
Q

when to fuse SMA spine

A

generally after age 10 o greater than 40 deg; can use VEPTER rods

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96
Q

when to fix SMA scoliosis to pelvis

A

if spin is > 40 deg and FVC > 40%

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97
Q

SMA joint contractures

A

common but generally not treaated even if hip and knee ones exceed 30-40

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98
Q

charcot marie tooth type 1

A

type 1 most common; peripheral mylein degen; leads to decre motor NCV in upper limb onset in first-second decade; PMP 22 gene on c17;

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99
Q

charcot marie tooth type 2

A

second decade; auto dom. Myelin is in tact but wallerian degen occurs decreased motor AND sensory; EMG has normal or long action potential

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100
Q

charcot marie tooth type 3

A

severe; peripheral nerve demyelination; Auto recessive; presents in infacncy; enlarged peripheral nerves; ataxia; MPZ gene;

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101
Q

cavus foot in CMT tx

A

typicall p longus is over powering so transfer to p brevis and move EHL over to 1st MT to help tib ant

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102
Q

friedrichs ataxia timeline

A

onset by age 25; death from cardiac complications by 40-50s; affects UE NCV

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103
Q

genetic repeat in friedrichs ataxia

A

GAA on c-9; frataxin gene; used for cell iron homeostasis

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104
Q

tx of Freidrich ataxia foot

A

pes cavovarus and is progressive and rigid - bracing does not work - arthrodesis is the main choice

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105
Q

tx of Freidrich ataxia spine

A

when > 50 deg and DO NOT need to fuse to pelvis; cant use SSEP monitoring

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106
Q

RETT disease

A

xlinked dominant condition of gray matter of brain - kids start out normal 6-18 months then regress; females die; men get klinefelters - they get scoliosis and need to fuse spine

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107
Q

Klippel Feli c-spine shows

A

congenital vertebral abnormalities; may see a sprengels asociated as well due to thoracic spinous process tether

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108
Q

what to screen for in Klippel Feli

A

c-spine films; GU and hearing loss and cardiac

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109
Q

Klippel Feli and sports participation

A

no contact if massive c-spine fusion or C2 involvement; if below C3 there is 1 or 2 levels involved and noraml neck motion then ok to play

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110
Q

normal age of appearance for femoral head

A

4-7 months

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111
Q

osteomyelitis after 7 days xray appearance

A

erosive metaphyseal lesion with loss of cortical integrity is seen generally after 7 days

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112
Q

motion in LCP

A

restricted passive motion; can present with trendelenberg gait too

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113
Q

renal disease and pediatric hip pain is a scenarior for

A

renal osteodystrophy affecting proximal femur with physeal widening due to secondary hyper PTH - can lead to SCFE

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114
Q

rate of AVN afer open mod Dunn for SCFE

A

26-30%

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115
Q

when should you see femoral ossificaiton center after reduction of hip

A

if not seen by 12 months post reduction it_s a sign of prox femoral growth disturbance and AVN

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116
Q

what deformity is seen with SCFE

A

varus, flexion; ext rot. Causes a Lost of hip flexion and internal rotation

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117
Q

nerve injuries with SCH frx

A

AIN with extension is most common; second most common is radial; Flexion type most common Is ulnar nn

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118
Q

order of ossification at elbow

A

capitellum (1), radial head(4), medial epi (6), trochlea (8), olecranon(10), lateral epi (12)

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119
Q

gene involed in club foot

A

PITX1-TBX4 it is a SNP

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120
Q

what amonunt of coalition is allowed before resection in foot

A

generally less than 50% - requires a CT

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121
Q

suspected peds fem neck stress frx - what is first step

A

MRI - not just activity modification

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122
Q

what is a/w fibular hemimelia

A

absent ACL and absent rays of the foot

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123
Q

what conditions have MYH3 gene mutation

A

codes for myosin heavy chain 3; seen in distal arthrogyropsis; sheldon hall and freeman sheldon

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124
Q

sx of Beckwith Weidman

A

C-11; neonatal hypoglycemia, macroglossia, large organs, hemi hypertrophy and embryonal tumors like Wilms Tumor

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125
Q

tx of mid shaft clavcile in peds with 100 % displacement

A

sling

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126
Q

dystrophic scoliosis features seen with

A

NF-1- look for penciled ribs, scalloped vertebrate, severe rotation and short sharp kyphoscoliosis

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127
Q

clubfoot associated with what vascualr anamoly

A

absent anterior tibial artery

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128
Q

first step in treating a RECURRENT clubfoot

A

recasting

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129
Q

kingella knee infection rule out

A

generally need a PCR for RTX protein - common scenario for day care patient

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130
Q

toddler or baby with band on digit

A

called hair tourniquet syndrome

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131
Q

inheritance of tarsla coalition

A

auto dom.

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132
Q

which group of genetic conditions has more tarsal coalitions

A

FGFR related conditions Apert,

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133
Q

sprengels caused by

A

vascular interruption at subclavian artery

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134
Q

what perecnt of CBC is elevated in osteo and septic OA

A

25% for osteo; 30-60% for septic joint

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135
Q

CRP and ESR in peds septic joint timeline

A

generally rises to abnormal by 6 hours; >2 is predictive; ESR takes 3-5 days for peak.

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136
Q

XR Timeline of osteo

A

4-7 days new periosteal bone; 10-14d, osteolysis; 1-2 weeks metaphyseal rarefaction and intraosseous abscess

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137
Q

kocher criteria

A

ESR>40; temp over 38.5; inability to bear weight, CRP > 2; and WBC > 12

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138
Q

how to choose MRI for septic joint vs going to OR

A

if > 3 of these 5 criteria; ag >4; sx > 3d; CRP > 13.8; platelets < 314k, and ANC > 8600

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139
Q

PMN and Leukocyte difference in Transient synovitis vs Septic Hip

A

TS - 25% PMN; 5-10K cellcount; vs 75% PMN and 50K cell count

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140
Q

peds osteo can mimic

A

LEUKEMIA! - CBC will show leukopenia or anemia!! But all other labs may look like infection (ESR, CRp)

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141
Q

elevated urine or serum homovanillic acid HVA or vanillylmandelic VMA

A

metastatic neuroblastoma

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142
Q

diagnosis of CRMO

A

whole body bone scan or MRI - lab markers can be normal

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143
Q

demographics of CRMO

A

girls more than boys generally age of onset is around 10

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144
Q

tx of CRMO

A

scheduled NSAIDS works for upto 80%

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145
Q

Kingella features

A

Gr-; needs PCR; kids < 4y; 50% of Septic joint under age 2; might present as subacute infection; can use oropharynx swab

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146
Q

most common spot for TB in kids

A

spine; typically ant 2/3 of vt body; usually in TL jxn, joint invovlement tends to be hip or knee

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147
Q

diagnosis of septic TB in kids

A

acid fast bacilli on stain

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148
Q

lab values in lyme OA

A

typically ESR and CRP are elevated but WBC can be normal

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149
Q

tx of lyme

A

oral abx including doxy, amox, and cefuroxime

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150
Q

medium for growing gonorrhea culture

A

chocolate blood agar

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151
Q

how soon does septic oA damage cartilage

A

8 hours

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152
Q

cause of septic joint in peds 2w to 4wks

A

Group B Strep

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153
Q

shoe puncture infections

A

stilll more common to get s aureus but pseudomonas is a concern; only 1% become deep infection

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154
Q

tx of shoe puncture deep infection

A

if deep then most likely pseudomonas

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155
Q

Discitis diagnosis and tx

A

xray is normal for 2-3 weeks but MAY show loss of sagittal contour; MRI confirms; abx is mainstay - do NOT need biopsy ; typically kids under 5

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156
Q

vertebral osteo

A

older children more painful on exam than diskitis; MRI again for diagnosi; tx with anti-staph abx

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157
Q

in sickle cell how to rule out infection vs crisi

A

labs and MRI are simillar and not helpful - need aspirate or Gram stain

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158
Q

risk factors for DDH

A

12-33% have affected family member; 6% risk if sibling; 12% parents; 36% if sibling AND parent; female, breech, first born, and ANY intrauterine packing condition

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159
Q

packing conditions a/w DDH

A

metatarsus adductus, muscular torticolis

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160
Q

how do toddlers with dislocated hips present

A

LORDOSIS

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161
Q

DDH and dislocation rates

A

1% and .1% for dislocation

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162
Q

when can you use xray for DDH

A

after 6 months

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163
Q

normal ultrasound angles

A

alpha should be GREATER than 60; Beta shouild be < 55 - alpha goes DOWN

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164
Q

how much coverage should you see on normal hip ultrasound

A

at least 50% acetab coverage

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165
Q

normal actab index

A

less than 25deg by age 12; less than 20 by 2 years

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166
Q

normal latearl center edge angle (seen on AP) for PEDS

A

at least 20 deg

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167
Q

who gets US at birth for DDH

A

ONLY if risk factors; otherwise wait to 4-6 weeks

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168
Q

tx od DDH

A

< 6month - pavlik, 6-18 month open vs closed reduction and spica; >18months

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169
Q

pavlik for DDH

A

tx for 6-8 weeks with weekly US, if still dislocated by 3-4 weeks discontinue - generally 90% success

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170
Q

risks of pavlik

A

excess abduction > 60 leads to osteonecrosis or pavlik disease which is deformation of posterosup acetab rim; excess flexion beyond 100 can cause fem nn palsy

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171
Q

how to confirm hip reduction in 6-18 month old

A

arthrogram with < 5mm of medial dye pooling

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172
Q

max age for surgery for dislocation hip

A

unliteral 10years; bilatearl 6-8 years

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173
Q

after age 2 dislocated hip what must be done

A

shorteing femoral osteotomy

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174
Q

is IV abx with clinical infection but neg. MRI

A

yes, start IV abx in setting of suspected infection and cover for MRSA

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175
Q

peds abx for osteo

A

always cover for MRSA

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176
Q

what does Harris view show for Talocalc coalition

A

can show an oblique medial facet, suggestive of fibrous or cartilaginous connection

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177
Q

popliteal cysts are between what two structures

A

gastroc and semi-M bursa

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178
Q

early infant with hip instability what is next step

A

apply brace and repeat exam in 2 weeks with ultrasound

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179
Q

TL kyphosis in achondroplasia follows what course

A

resolves with independent walking

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180
Q

which children get overgrowth after femur frx

A

ages 2-10

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181
Q

gymnasts wrist

A

distal radius epiphysiolysese - look for wide distal radius physis - tx with SAC for 6 weeks

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182
Q

flexion SCH requires what extra step

A

are inhertyl unstable and may require open reduction if medial gapping -due to ulnar nerve entrapment.

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183
Q

what scoliosis curve is ATYPICAL

A

LEFT THORACIC

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184
Q

Uveitis in JIA symptoms

A

chronic and asymptomatic can cause permanent vision loss in 20-30%

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185
Q

growing rod vs PSF for scoliosis

A

usually the cutt off for growing rods is < 10

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186
Q

tx for infantile idiopathic scoliosis

A

ages 0-3 and if RVAD (rib vertebral angle difference ) is < 20 then observe; afte 20deg then begin serial casting

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187
Q

What type of fusion for SMA patients scoliosis

A

generally PSF is enough unless curve is > 100 deg.

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188
Q

congen vert talus tx

A

reverse ponsetii casting followed by achiles tenotomy and bracing

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189
Q

DVT with osteo in peds population is seen with

A

genrally more common with MRSA and those expressing the panton-valentine leukocidin

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190
Q

sprengle is most common in which condition

A

Klippel Feli

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191
Q

tx of infantile blounts

A

tib fib osteotomy before age 4

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192
Q

risk of MRSA infection includes risk of

A

DVT or PE ; needs chemical DVT prophylaxis

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193
Q

torticolis after virus tx

A

often requires CT or radiographs to asses if rotatory subluxation of c1-2 - tx would involve traction and then halo vest; if unable to reduce then C1-2 fusion

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194
Q

indicator of NF scoliosis progression

A

rib pencilling;

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195
Q

dystrophic vs non dystrophic scoliosis

A

dystrophic is more severe, has higher rates of dural ectasia, faster curve progression; nerve injury etc and cannot be treated like idiopathic scoliosis

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196
Q

features of dystrophic scoliosis

A

faster curve progression, more kyphosis, more neuro injury, dural extasia, dumbell foramina from NF, scallping, rib pencilling, spindling of the TP, severe apical rotation, severe vertebral wedging,

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197
Q

what determines modulatio of non-dystrophic scolosis to dystrophic scoloisis

A

age, generally if presenting before age 7 up to 80% can modulate.

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198
Q

best xray for peds medial epicondyle displacement

A

AXIAL view; 45 deg abducted arm with elbow at 90. xray tube is 25 deg from axis of of hum shaft

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199
Q

what injury is associated with peds tib tubercle frx

A

ogden 3 is a/w Meniscus tear

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200
Q

persistent drainage after I&D of septic hip -what next

A

check MRI for prox femur osteo

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201
Q

most common complication of transphyseal distal hum frx

A

cubital varus due to either AVN of medial epicondyle, malunion, or growth arrest - higher than with SCH

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202
Q

what SH type is seen with distal humerus frx

A

if < 3 SH 1; if > 3 SH 2

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203
Q

when to switch from pavlik to rigid abduction brace

A

if hip is unstable at 3-4 weeks

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204
Q

camptodactylly

A

contractures of the fingers

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205
Q

where is GNAS mutation in fibrous dysplasia

A

c-20

206
Q

what femur frx pattern is a/w non accidental trauma

A

transverse; NOT spiral

207
Q

tx of osteoid osteoma in sacrum

A

excision

208
Q

advantage of screw fixation for medial epicondyle frx

A

shortern immobilization and earlier motion

209
Q

tx of toddlers frx

A

WBAT in cast or boot

210
Q

whats optimal cast index

A

less than .8

211
Q

what are recommendation to avoud Little league shouilder

A

avoid overhead throwing at least 2-3 months with a break from COMPETITIVE pitching for 4 months

212
Q

Erb vs Klumpke palsy

A

erb is more common and is UPPER; Klumpke is LOWER and worse

213
Q

disciod meniscus types

A

1 and 2 are stable but either complete or incomplete; 3 looks like a normal meniscus but posterior horn is BIG and unattached -requires stabilization (Wrisberg variant)

214
Q

physiologic genu varum timeline and severity

A

general improves by 16-18monts but rarely EXCEEDS 20deg

215
Q

capsule management in a slipped SCFE

A

open decompression to reduce risk of AVN

216
Q

early switch to oral abx for peds osteo vs prolonged IV

A

early switch to orals has shown SIMILAR tx failure rates and less rehospitalizations or ED visits due to lower cathetar related concerns

217
Q

predictors of MRSA in osteo

A

temp > 38; WBC > 12k; hematocrit < 34%; CRP >13; if all 4 then 92% chance MRSA; if 3 then 46%, then drops to 10% and 1%

218
Q

bilateral congenital knee dislocation is what condition

A

Larsen - need to check C-spine before anything else

219
Q

how to cofirm newborn CVT vs calcaneovalgus

A

plantarflexion lateral; talus does NOT line up with 1st MT in CVT

220
Q

defects in collagen 3 cause

A

Ehlers Danlos

221
Q

lipomeningocele associated with

A

TETHERING ; form of lumbosacral lipoma

222
Q

risk of spina bifida

A

low folic acid need to get .4-.8mg per day before conception; 4mg DAILY if prior history

223
Q

L3/L4 MM-cele has what function

A

has quads and POOR hamstrings

224
Q

what does L5 mmcele NOT have

A

glut medius - therefore waddle gait

225
Q

whats associted with mmcele

A

arnold chiari (descent of cerebellar tonsils); feeding/crying/breathing issues from lower CN involvment,

226
Q

what is diastematomyelia

A

bone or fibrous, or cartilage bar diving the spinal cord longitudinally

227
Q

how do you pick up tethered cord syndrome

A

change in neuro sx or urologic sx after a rapid growth or rapid change in scoliosis.; ususally a decreased muscle stretngh or sensation

228
Q

latex allergy with mm-cele

A

acute IGE mediated; and delayed T-cell mediated allergy

229
Q

beckers is more prone to

A

cardiomyopathy due to prolonged course

230
Q

when do complications of Duchene scoliosis fusion increase

A

when FVC <35%

231
Q

clubfoot associated with what condition

A

arthrogyropsis

232
Q

Distal Arthrogryposis

A

type 1 TMP2 gene; fast twitch muscle fibgers

233
Q

what is predictive of long term function of CP kids

A

GMFCS level ; also relates to rate of hip dislocation

234
Q

prognosis to walk with CP assoc with

A

sit indepently by age 2

235
Q

goal of selective dorsal rhizotomy

A

to reduce stretch reflex

236
Q

best candidate for dorsal rhizotomy

A

ambulatroy GMFCS 1/2 spastic diplegic, ambulatory

237
Q

best orthotic for crouch gait

A

ground reaction AFO

238
Q

when to extend spinal fusion to pelvis

A

if 90 deg and non-ambulator

239
Q

salvage pelvic osteotomies

A

Chiari and Shelf

240
Q

potential causes of perthes

A

second hand smoke, carbon monoxide, collagen 2 problems, transient synovitis

241
Q

associated factors of perthes

A

ADHD up to 30% and skeletally immature with delayed bone age up to 90%

242
Q

histo of LCP

A

histo is ABNORMAL in cartilage, epiphysis and metaphysis

243
Q

LLD in LCP

A

mild; may seem bigger due to hip contracture or fem head collapse

244
Q

Risk factors for worse LCP

A

gage sign; lateral calcifications from epiphysis, horizontal epiphyseal scar, lateral subluxation of fem head

245
Q

prognosis based on pillar classification and age for LCP

A

if younger than 6 good outcome generally no matter which tx; if >8 then generally surgery in Pillar B; if Pillar C - bad outcome either way

246
Q

what osteotomy is used for Perthes salvage

A

VALGUS And FLEXION producing

247
Q

mecahnical factors that increase risk of SCFE

A

increased physeal obliquity, obesity, retroversion of femur; decreased neck shaft angle

248
Q

optimal fixation for SCFE

A

6.5mm screw cannulated, fully threaded, one screw is usually enough, two sometimes for unstable SCFE

249
Q

what position does SCFE fall

A

neck moves anterior and flexed. Screw needs to start on anterolateral femoral neck

250
Q

what two things can cause osteonecrosis from SCFE

A

unstable is biggest risk factor, BUT screw placement in post/sup neck can do it too

251
Q

risk of fracture with SCFE fixation

A

higher if screw entry is lateral and starting beloe the lesser troch

252
Q

scfe slip progression risk

A

1-2% with insitu single screw fixation

253
Q

cox vara demographics

A

equal gender , no laterality, bilateral 30-50%

254
Q

what else is seen with bilateral coxa vara

A

increased lumbar lordosis

255
Q

what Is Hilgenreiner-epiphyseal angle

A

assess severity of coxa vara by angle of epiphysis. 25 is normal, up to 45 observe, 45-60 intermediate risk of progression, 60 deg or more high risk of progression

256
Q

surgery to correct coxa vara should_.

A

overcorrect to avoid the 50% recurrence. Up to 89% can have premature closure of proximal fem physis about 1-2 years post-op

257
Q

which club feet are hardest to treat

A

those a/w arthrogyposis; amniotic band; diastrophic dyspasia; mm-cele - more prone to relapse with these conditions

258
Q

how long to wear dennis brown orthosis after club foot casting

A

3 months of 23 hrs/day then nights and naps for 2-3 years

259
Q

CVT vs oblique talus

A

on plantarflex view in CVT The navicular will NOT reduce down

260
Q

what are you trying to strech in reverse ponseti

A

dorso LATERAL soft tissue for CVT

261
Q

calcaneovalgus is associated with

A

posteromedial bowing

262
Q

cavus foot assoc with

A

neurologic condition; usually CMT - due to excess calcaneaus dorsiflexion

263
Q

peds patient with lots of ankle sprains - look for

A

cavus due to CMT or other neuro condition

264
Q

unilateral cavus requires what other work up

A

MRI spine

265
Q

what is mearys angle

A

lateral foot view, angle made by long axis of 1st MT an talus - should be co linear or > 5. increased in cavus, decreased in pes planovalgus

266
Q

normal heel -forefoot alignment

A

heel bisects 2nd web space

267
Q

natural course of metatarsus adductus

A

resolves by age 4 most of the time

268
Q

what is skewfoot

A

adducted forefoot; valgus hindfoot and plantarflexed talsu

269
Q

when to investigate toe walking

A

after 2y

270
Q

CN vs TC coalition

A

CN is 8-12y and more common; TC is 12-15y and second most common

271
Q

which conditions have multiple tarsal coalitions

A

apert and fibular deficiency

272
Q

if severe valgus at time of coalition resection

A

the need to do calc osteotomy to improve outcome and prevent recurrence of the coalition

273
Q

best view to see accessory navicular

A

external oblique view of foot

274
Q

when does Kohlers resolve

A

generally symptoms resolve in 6-15 months; and reconstitutes in 6months to 48 months without disability

275
Q

overlapping 5th toe caused by

A

contracted EDL, famial and bilateral generally

276
Q

curly toe caused by

A

contracted FDL or FDB perform tenotomy at 3-4 years

277
Q

multiplier method is most accurate for

A

congenital discrepencies iN LLD that are constantly proportional

278
Q

teloradiograph adv and d-adv

A

single exposure and good for angular deformity; BUT magnificaiton error

279
Q

orthoradiograph adv and d-adv

A

three exposures hip, knee, ankle on single cassette, eliminates mag error, BUT cant assess angular deformity and movement error

280
Q

scanogram adv and d-adv

A

same as orthogram, but smaller cassette, no mag error, but same d-adv as ortho

281
Q

CT scanogram adv and d-adv

A

accurate even with joint contractures BUT cant assess angular deformity

282
Q

when do to limb lengtehnign

A

If LLD is going to be greater than 5cm

283
Q

what is best predcitor of self resolution or progressoin in blounts

A

if metaphyseal diaphaseal angle is < 10 deg then 95% resolve if > 16 deg then 95% progression

284
Q

when to brace blounts

A

ages 2-3 with stage 1-2 disease

285
Q

what is adv to doing prox tib osteotomy for blounts before age 4

A

less risk of recurrence

286
Q

normal deg and progression of physiologic genu valgum

A

at 3-4y its around 20 deg and then by age 7 should be restored to 12 deg with a intramalleolar distance < 8cm

287
Q

femoral anteversion from birth to adulthood

A

starts at 30 and reduces to 15 by skeletal maturity

288
Q

amount of rotation to correct excess anteversion

A

(prone internal - prone external) divided by2

289
Q

what is normal transmalleolar axis

A

20 deg ext rotated

290
Q

normal tibial internal torsion

A

presents by age 1-2 and resolved by age 6; surgery only after age 8 and if severe

291
Q

how to prevent tibial pseudoarthrosis in AL bowing

A

clamshell total contact cast

292
Q

PFFD sugery timing

A

best when 2.5-3 years and projected LLD is 20cm or LESS; need a stable hip, functional foot

293
Q

what bowing is associated with fibular hemimelia

A

anteroMEDIAL

294
Q

LLD with paralysis how do you correct

A

undercorrect slightly to allow for foot clearance

295
Q

surgery for congenital knee dislocation best done

A

before 6 months

296
Q

address deformity in what order

A

angulation, translation, length, rotation

297
Q

where should HTO be

A

if deformityis < 10 deg then above tib tubercle; if > 10 then go BELOW the tib tubercle

298
Q

what is the MOST common posttraumatic deformity

A

Rotational

299
Q

tx of persistent hip dyspasia

A

by age 5 ideally perform your receonstructive osteotomy - do not jus observe

300
Q

timeline of sx in little league shoulder

A

2.6months to sx resolution, 4 months to RTP

301
Q

r/f for recurrence of Little league shoulder

A

GIRD

302
Q

when is Little league elbow get the most forces

A

during late cocking , early acceleration

303
Q

what radiopgraphic signs are seen with LL elbow

A

apophysitis, hypertrophy or radial head or Med. Epicondyle

304
Q

when to fix medial epicondyle

A

when greater than 5mm dispacement

305
Q

consequence of aggressive debridement of osteophye in valgus extension overload

A

elbow instability

306
Q

conseqeunce of untreated gymnasts wrist

A

positive ulnar variance and resultant TFCC pathology

307
Q

tx of gymansts wrist

A

at least some form of immobilization, splint to cast depending on severity.

308
Q

panners vs OCD of capitellum

A

panners is 1st decade, benign course and self resolves. OCD is after age 10 and can cause permanent disability

309
Q

drilling vs fixation of OCD

A

drilling has good success for type 1 and stable 2, fixation has variable success especially if size is big

310
Q

best elbow portal to visualize the capitellum for OCD

A

posterior portals and anconeus portal

311
Q

most common site of OCD in kids

A

knee; specifically lateral aspect of medial femoral condyle

312
Q

non op tx of OCD in knee

A

first rest and activty mod - but then immobilization for 6 weeks before considering surgery

313
Q

Rehab after knee OCD

A

after fixation, immediate active assis tmotion and pass motion; and quad work right away with TTWB

314
Q

risk of growth disturbance after peds acl recon

A

determined by age of patient; younger has higher risk

315
Q

rehab of peds ACL

A

no start-stop or cutting until 8 to 12 months

316
Q

alignment risk factors for patellar instability

A

femoral anteversion; tibial EXTERNAl torsion; high q angle; dysplasia or patella alta

317
Q

for patellar instability need to assess

A

all alignment variables - may require hemiepiphysiodesis or osteotomies in addition to MPFL

318
Q

surgical pearls for patella instability

A

tension at 30 deg; should be isometric 0-60; do not overtension; in teens above physis in younger kids below physis for femoral fixation

319
Q

most important predictor of recurrent patellar dislocation

A

severe trochlear dysplasia

320
Q

mri of meniscus in pt < 10 shows what

A

high false positive rate of meniscus tear due to vascularity

321
Q

what is gold standard for meniscus repair

A

inside out vertical mattress

322
Q

m/c cause of death in kids over 1

A

trauma

323
Q

most predictive of in house mortality after trauma

A

initial hypotension and Low GCS; GCS < 8 carries high risk of mortality

324
Q

GCS motor at 72 hours is related to what

A

permanent disability severity

325
Q

what to look for with abdominal bruising after MVC

A

visceral injuries and spine frx

326
Q

trauma response in kids vs adult

A

damp systemic response; better local response; organs fail simultaneously instead of sequential; lower risk of acute lung injury

327
Q

GCS scoring

A

6motor;5movement;4vision;

328
Q

when does head trauma spasticity begin

A

within days to weeks of injury

329
Q

what is effect of TBI on fractures

A

heal faster

330
Q

what lab value can portend HO after TBI

A

increase in ALP

331
Q

what reduces risk of multi organ failure after polytrauma

A

fixation within 48 hours

332
Q

predictor of long term morbidity

A

GCS at 6 weeks

333
Q

timing of I&D for peds open frx

A

within 24 hours; no differnece between < 24 vs < 6 hrs

334
Q

failure to report child abuse has what risk

A

30-50% of repeat offense and 5-10% of death

335
Q

which prox humerus fractures need reduction

A

grade 3 and 5; basically anythin with >33% displacement of humerus width

336
Q

what can block reduction of prox hum frx

A

LH biceps or periosteum

337
Q

which prox humerus need Surgery

A

TEENS with grade 3 or 4

338
Q

last physis in body to closer

A

medial clavicle

339
Q

which SCH type 2 can be treated in cast

A

no medial comminution, and ant humeral cortex bisects the capitellum

340
Q

risk of iatrogenic ulnar nn injury in SCH frx

A

3-8%

341
Q

best view for lateral condyle fractures

A

internal oblique

342
Q

when to begin motion after medial epicondyle frx

A

after 3-5 days

343
Q

how to fix med epicondyle

A

ideally screw fixation to allow early motion- very young kids can use K-wires

344
Q

most common ages for distal humerus physeal frx

A

usually < 3years but up to 6 can have it

345
Q

sch frx displacement direction and nn injury

A

extension - AIN; PosteroLATERAL -median; PosteroMEDIAL -radial; flexion - ulnar

346
Q

when should closed reduction of transphyseal humerus frx NOT be done

A

after 5-7days to avoid physeal injury - switch to OPEN

347
Q

indications for surgery of radial head frx

A

30 deg residual angulation or 3-4mm of translation after closed reduction; OR less than 45 deg of pronation supination

348
Q

position of casting for greenstick

A

if apex volar- then pronate; if apex dorsal then supinate

349
Q

rate of PIN injury with monteggia

A

10% but generally self resolves

350
Q

peds metacarpal frx toleraances

A

10-20 deg SAGITTAL angulation for index; 20-30 for long; 30-40 for ring; 40-50 for pinky

351
Q

can buckle frx be tx with removeable wrist splint

A

YES

352
Q

subacute physeal distal radius frx - how to tx

A

immobilize and treat without surgery or reduction

353
Q

asymptomatic scoliosis in Duchene - tx?

A

FUSE

354
Q

rectus inserts on what part of pelvis

A

AIIS

355
Q

sartorius inserts on what part of pelvis

A

ASIS

356
Q

pectus is assoc with

A

syndactyly

357
Q

blounts <10 vs > 10

A

after 10 and up do epiphysiodesis NOT osteotomy; osteotomy reserved for skeletally mature

358
Q

adolescent blounts

A

more likely UNILATERAL less common, more severe; obesity is r/f; NO CLASSIFICATION; often includes femoral deformity; never treated with bracing

359
Q

lateral elbow spurring

A

a complication seen with fixation of lateral condyle frx due to periosteum - reduce periosteum to avoid this complication - happens about 50% - related to initial displacement

360
Q

tx of radial head dislocation

A

radial head resection at skeletal maturity if significant disability

361
Q

base of dens fuses at

A

3-6 years

362
Q

what coverage does salter provide

A

anterior coverage at the expense of posterior coverage

363
Q

pediatric burst fracture what else to look for

A

another vertebral level inovled, 30-50% have another invovled level

364
Q

coverage loss in CP hips

A

posterior and superior

365
Q

indications for fixation of peds pelvic frx

A

unstable vertical or rotational; more than 2cm displacement in ring for teens to prevent LLD; or poly trauma

366
Q

vertically unstable pelvic frx can lead to

A

LLD

367
Q

surgery for peds hip frx

A

generally closed reduction is preferred

368
Q

fixation of peds hip frx

A

Delbet 1 - K wire or cannulated screws; 2 and 3 - cannulated screws; 4 gets DHS or locking plate

369
Q

delbet classification

A

peds hip frx 1 - physeal (SCFE); 2 middle neck;3 - base of neck; 4 - Intertroch

370
Q

risk of osteonecrosis based on delbet

A

1 -90-100%; 2 - 50%; 3 - 25%; 4; 10%

371
Q

common complication of non-op peds hip frx

A

coxa vara and nonunion - esp Delbet 3-4

372
Q

which femur frx need work up for NAT

A

femoral shaft under 3 years; and any femur frx under 1

373
Q

contraindication to spica in peds fem frx

A

shortening greater than 2.5-3 cm

374
Q

common complication after submuscular plating for femur frx

A

distal femoral valgus; plate should end 2cm proximal to physis

375
Q

how effective is RF ablation for osteoid osteoma

A

95% after one treatment

376
Q

what is delayed in duchenne

A

duchenne kids hit NORMAL milestones by 2 - except language can be delayed. Also a/w delayed learning disability in 30-50%; risk of autism, ADHD and OCD in boys

377
Q

pediatric rigid femoral nail starting point

A

ideally LATERAL entry; trochanteric entry has a lower risk of osteoNec but still 1.4%

378
Q

what additional workup does beckwith wiedemann need

A

must get abd/pelvic US and AFP levels 3-4 x a year until age 8 to rule out Wilms tumor

379
Q

what to do with hypoplastic thumb stage 3

A

check CMC joint stability - if UNSTABLE -then amputation with index pollicization or toe transfer; if CMC stable then ok to reconstruct

380
Q

peds both bone frx with minimal to no trauma

A

consider Neurofibromatosis - look for absent intramedullary canals in distal third forearm; pseudoarthrosis of forearm is in up to 50% of NF cases

381
Q

peds jones frx get

A

Perc screw fixation; not ORIF

382
Q

radial dysplasia is caused by

A

defect in Apical ectodermal ridge

383
Q

PHEX codes for

A

x-linked hypophosphatemia

384
Q

proximal humerus frx in kids vs teens - which get surgery

A

< 13 does NOT generally get surgery; over 13 follow parameters of displacement and angulation > 30 deg

385
Q

tx of peds hip dislocation

A

ALWAYS general, closed ideally; never in ED with conscious sedation

386
Q

first line tx for spondylolysis

A

bracing and PT for 3 months

387
Q

order of closure of neurochondral synostosis

A

cervical, lumbar, thoracic

388
Q

both bone angulation parameters by age

A

under age 8 can allow up to 20 deg angulation and 100% displacement and 45 deg rotation, after age 10, 10 deg, 100% tanslation and 30 deg rotation.

389
Q

does clubfoot delay ambulation

A

generally NO - neither does hip dysplasia; if delayed walking by 18months - needs work up for neurologic disorder

390
Q

peds jones RE fracture

A

IM screw; no more casting

391
Q

air bag reccs

A

turn off if < 80lb

392
Q

m/c complication of distal femur frx

A

malunion is MOST common complication of NON-PHYSEAL frx; in PHYSEAL - gorwth arrest is m/c complication

393
Q

complicatio of anterior displaced epiphysis in distal femur frx

A

popliteal artery and compartment syndrome

394
Q

distal fem frx with vascular compormise - what is first step

A

REDUCE the fracture - can be tenting the vessel

395
Q

age for patella sleeve frx

A

8-12 years-look for a normal xray with patella alta!

396
Q

can you non-op patella frx

A

yes if non displaced with INTACT extensor mechanism

397
Q

non op tx of tibial spine frx

A

must be type 1 or reduced within mm - cast at 0-20 of flexion; may need to arthrocentesis for hematoma before casting

398
Q

what is often trapped in peds tibial spine fr

A

anterior horn of medial meniscus

399
Q

what must be evaluated with tubercle type 3 frx

A

evaluate articular surface for congruity and meniscus tears

400
Q

tx of prox tib physeal frx

A

typically k wires for I and II; but III and IV might need cannulated screws

401
Q

avg age for tib shaft frx

A

typically 8 years; healing for toddlers frx takes 3-4 WEEKS

402
Q

surgical parameters for tib shaft frx

A

if 10 deg angulated or 1cm short

403
Q

what deformity is seen with tibia frx if closed reduc fails

A

if ISOLATED tib - VARUS; if COMBO Tib Fib - then valgus

404
Q

order closure of distal tibia physis

A

central, posterior, medial, lateral

405
Q

can you closed reduce and non -op (Tillaux) salter 3 distal tibia

A

YES but need post-reduction CT to show < 2-3mm articular displacement; non displaced triplane can also be non-op IF CT is good

406
Q

which distal tib frx have highest risk of growth arrest

A

medial sided salter 4

407
Q

peds lis franc tx

A

k-wires for young kids; cannulated screws for teens

408
Q

normal t-spine kyphosis and l-spine lordosis

A

20-45 for t-spine; 30-60 lumbar

409
Q

most commmon curve pattern in INFANTILE idiopathic scoli

A

LEFT THORACIC

410
Q

risk of curve progression in infantile scoli

A

overall 10% but higher risk of Neuro abnormality if RVAD is > 20 or phase 2 - overlap of rib head at apical vertebrate - up to 80% need neurosx

411
Q

juvenile idiopathic scoli demographics

A

female > male; RIGHT THORACIC is more common;

412
Q

juveniile scoli curve over 20 deg must get

A

MRI - 25 % chance of abnormality

413
Q

fastest area of spine growth

A

T1-L5 before age 5 is fastest RATE

414
Q

AIS demographics

A

if curve is small then 1-1 ratio; 10-1 ratio for females if curve > 30

415
Q

which AIS curves likely to get surgery

A

cuves greater than 30 deg at peak heigh velocity in females - typicall JUST before menses

416
Q

RVAD angle

A

is CONCAVE angle - convex angle at apical vertebrate

417
Q

what is curve progression AFTER skeletal maturity

A

T-spine > 50 or L spine > 40 continues about 1 deg per year

418
Q

curve progression in AIS and lung fxn

A

after 60 deg lung function is affected BUT not clinically relevant until 90 deg

419
Q

which AIS needs MRI

A

left thoracic, curves growing > 1deg/month; 20 deg curves or higher in AGE < 10

420
Q

which conditions see dural ectasisa

A

NF, Marfan, and Ehlers Danlos

421
Q

ages for idiopathic scoli classificaiton

A

infantile <3y; juveile 3-10; AIS starts at 10y

422
Q

which scoli is cured by casting sometimes

A

18-24 month kids with curves < 40-50

423
Q

what t-spine curve is a relative contraindication to bracing

A

t-spine HYPOkyphosis

424
Q

when is TLSO most effective for scoli

A

when apex of curve is BELOW T7

425
Q

surgery for infantile or juvenile scoli

A

at least 50-70 deg

426
Q

short term complications of AIS PSF

A

ileus; atelectasis, SMA syndrome; ADH secretion; stomach pain

427
Q

early PSF infection

A

before 6 months; do NOT remove implants

428
Q

when to do wake up test for spinal fusion

A

if after removal/revers of steps and IV steroids signals do not return to baseline

429
Q

3 types of hemi vertebrate

A

segmented, semi segment, and un segment -has to do with if disc space is present

430
Q

worst prognosis of congenital scoli

A

unilateral bar with contralateral hemi vert - 5-10 deg/year

431
Q

jarco-levin syndrome

A

fusion of t-spine either to each vertebrate or to ribs - leading to pulm dysfunction

432
Q

how to manage hemivertebrate WITHOUT trunk inbalance

A

if segmented, <5years, and a flexible curve < 40 then can do hemiepiphysiodesis on contralateral side with fusion if progression occurs.

433
Q

how to manage hemivertebrate WITH trunk inbalance

A

excision of hemi vertebrate if under 6, flexible curve < 40, progressive curve

434
Q

Neuromuscular scoli curves tend to be

A

long sweeping C-shaped curves with apex at TL junction

435
Q

what FVC is risk of prolonged vent for scoliosis

A

FVC < 35%

436
Q

sheurman kyphosos and gender

A

males more common 2:1 to 7:1

437
Q

definition of scheurmans kyphosis

A

3 consecutive thoracic vertebrate with more than 5 deg of ant wedging; severe defined as thoracic kyphosis > 75 deg; pulm compromise at 100 deg

438
Q

what is seen with scheurmans

A

lumbar sponlylolisthesis

439
Q

when can you brace scheurmans

A

1 year of growth remaining with 50-70eg curve

440
Q

how much to correct t-spine kyphosis

A

no more than 50% to avoid neuro injury;if < 55deg then just fuse posterior spine for some correction; if > 55 deg then vertebral resection might be needed to avoid neuro injury

441
Q

artery of adamkiewicz arises and supplies what

A

arises from t8 to l2 but supplies T4-T9

442
Q

where is spondylolysis

A

typically L5; but L4 < 10%;

443
Q

progression of spondylolisthesis a/w

A

teen growth spurt; higher grade; Lumbosacral kyphosis > 40 deg; dome shaped sacrum

444
Q

pain in spondy listhesis is worse with

A

back extension

445
Q

tx of slipped spondy

A

if grade 1-2 then lumbosacral brace for 4-6 months + core strengthening

446
Q

what slip angle is increased risk of spondy slip

A

50deg

447
Q

downs syndrome cspine issues

A

61% have occiput c1 instability; 22% have C1-2 instability

448
Q

when does dens fuse to its part

A

dens to tip by 12years; dense to base by 7 years

449
Q

mcrae and mcgregor lines in cspine

A

mcrae is line connecting A/P of foramen magnum; mc gregor is posterior tip of hard palate to posterior foramen magnum

450
Q

atlanto axial instabilty defined by

A

ADI > 5 (normal is 2-3 in adults; up to 5 in kids under 8 years)

451
Q

what conditions show basilar invagination

A

Klippel feli; hypoplasia of atlas arch; occitocervical synostosis; morquio; SED; achondroplasia and osteogenesis imperfecta

452
Q

tx of congen musc torticolis

A

passive stretching is intial tx; if > 30 deg or lasts > 1 year then surgery

453
Q

atlantoaxial rotatory instability tx

A

NSAIDS, soft collar

454
Q

when to operate on atlanto axial instability in downs

A

if ADI > 5 with neuro sx or > 10 without neuro sx

455
Q

tx of AARD

A

if 1 week and reducible then head halter traction; if > 1 month halo or rigit brace; if still present then surgery with fusion of c1-2

456
Q

downs mortality after c1-2 fusion

A

high up to 25%

457
Q

c-spine trauma in kids

A

age < 8 has higher risk of neuro injury due to head size; horizontal facets; usually above c3

458
Q

instability of SUBAXIAL C-SPINE defined as

A

intervertebral angulation of 11deg OR 3.5mm translation

459
Q

retropharyngeal space limits

A

less than 6mm at C2; < 22 mm at C6

460
Q

BAI should be

A

< 12mm in kids’

461
Q

what is hangmans frx

A

frx of pars of c2 due to hyperextension

462
Q

what injuries in TL spine are a/w neuro injury

A

distraction/shear - unstable pattern

463
Q

Spinal cord injury wo radiographic abnormality

A

get MRI - this is cause of paralysis in 20-30% of kids with SC injury ; 20-50% have delayed onset

464
Q

which chance frx get non-op

A

< 20 deg segmental kyphosis

465
Q

halo parameters

A

if < 8 years, 8-12 pins at 2-4lb

466
Q

chance frx in peds - trx

A

if only ligamentous; PSF; if bony - then posterior compression and distraction before fusion - these traumatic kyphosis do NOT remodel

467
Q

how does diskitis develop

A

seed the vertebral end plate first then spread to disc space

468
Q

tx of diskitis

A

IV abx 7-10 days then orals

469
Q

lab markers of hypophosphatasia

A

LOW ALP ; HIGH Phos and Calcium

470
Q

lab markers for renal osteodystrophy

A

low Ca - HIGH Phos, ALP, PTH

471
Q

lab markers for type 1 Vit D rickets

A

low phos, Ca; HIGH ALP; high PTH; low vit 1,25 D

472
Q

c-spine clearance protocols have led to

A

DECREASED use of CT withOUT increase in MRI to clearn c-spine - NO increase in missed injuries has been observed

473
Q

what percent of gartland 3 jave vascular compromise

A

20% of these

474
Q

tx order for AL bowing IN NF patients

A

full contact AFO; long leg cast - if pseudoarthrosis develops then surgery

475
Q

typical features of achondronplasia spine

A

foramen magnum stenosis;; tl-spine gibbus formation and focal kyphosis; premature vertebral ossification leading to short pedicles; smaller foramina, short vertebrate, and narrow interpedicle distance

476
Q

which factors are a/w femoral overgrowth after frx

A

length unstable; canal fit < .8

477
Q

what deformity is most likely to occur with transphyseal ACL

A

bc femur outgrows tibia the femoral phsysis will have more effect - so valgus

478
Q

sports reccomendation for downs with ADI 4.5-10mm

A

can participate but avoid some high risk like diving and football

479
Q

peds MRSA assoc with

A

DVT more surgery, tougher course

480
Q

which joints have capsules extending to metaphysis

A

shoulder, hip, elbow, ankle

481
Q

tx of redman syndrome in kids

A

stop infusion; if mild reaction give diphenhydramine and ranitidine and then restart at 1/2 rate

482
Q

main features of marfan

A

tall long bones and arachnodactyly - but also protrusio acetabuli; flatfeet; dural ectasia

483
Q

Marfans scoliosis have

A

higher complication due to Csf leak, fixation failure; distal degen and proximal add on; can have dysplastic pedicels and lamina

484
Q

when to fuse DMD scoli to pelvis

A

if NON ambulatory or if pelvic obliquity is > 15 deg

485
Q

what is the deformity in CVT

A

hindfoot valgus and equinus with dorsally displaced navicular - rocker bottom

486
Q

Vanc vs Clinda for MRSA

A

if STABLE can use clinda for first line; but if unstable or septic then go for vanc

487
Q

which hip spica for fem shaft frx

A

single leg hip spica is enough and better for parents, car seat etc

488
Q

MRI for infantile scoli

A

if RVAD > 20 or if progressing; should NOT do one before 12 months because hard to detect tethered cord; wait 3 months to see if curve < 20 is progressing before getting MRI

489
Q

what percentage of TL kyphosis persists or progress in achondroplasia

A

after walking age 30% of TL kyphosis persists - OF THIS another 30% progress to severe deformity

490
Q

risk factors for persistance of TL kyphosis in achondroplasia

A

not walking by 30months or not sitting by 14 months

491
Q

long term outcome of cubital varus after SCH frx

A

PL rotatory instability; ulnar neuropathy, snapping triceps, lateral condyle frx;

492
Q

gene in Larsens syndrome

A

auto dom FLNB

493
Q

Ehlers Danlos genetics

A

COL3

494
Q

natural hx of osteoid osteoma

A

self resolves in 2-3 years

495
Q

what muscle is active during stance phase

A

eccentric contracture of GSC to allow tibia to fall over talus

496
Q

what is basis of fibrous dysplasia

A

poor mineralization AND immature bone that does not respond to mechanical stress appropriately to turn into mature lamellar bone

497
Q

types of fibrous dysplasi

A

monosototic is more common but does not progress after skeletal maturiy (but does grow proportional to skeletal growth); polyostotic DOES progress, less common more severe

498
Q

risk factors for medial tibia stress syndrome

A

female, bmi; increased navicular drop; prior orthotics; previous running injury or reduced runnig experience, and greater hip EXTERNAL rotation; in ADULTS - reduced plantar flexor muscle endurance is a risk factor

499
Q

AIS typical curve

A

Right Thoracic with HYPOkyphosis - any curve with HYPER kyphosis gets an MRI

500
Q

tx of chronic monteggia

A

ulnar osteotomy

501
Q

what does PHEX mutation cause

A

in osteocytes- leads to increased FGF23 and reduction in renal phosphate resorption or 1,25 OH vit D production - leads to decreased mineralization

502
Q

Kingella gram stain

A

gram negative

503
Q

congenital scoliosis inheritance

A

NONE - usually sporadic insult during gestation 4-8 weeks

504
Q

peds ACL have a significant risk of

A

rerupture in same and other knee

505
Q

how long can popliteal cysts persist

A

2 years

506
Q

which peds pelvic frx needs surg

A

2cm wide symphisis

507
Q

B. plexus injury leads to what shoulder deformity

A

internal rotation; glenoid retroversion; flat head; GH incongruity; posterior sublux of head

508
Q

cleft hand/foot seen with

A

genetically isolated commuities; Auto Dom inheritance

509
Q

medial condyle vs EPIcondyle frx

A

condyle needs arthrogram; epiC is a/w dislocation and CAN be non-oped

510
Q

medial approach for surgical hip dislocation

A

normally b/w pectineus and adductors; but can be modified to pectinues and NV bundle; higher risk of dislocation and cannot address capsule

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