Peds

Question 1

4-year-old girl who is being evaluated for genu varum. She has a family history of bowed legs and short stature. She has a mutation in the PHEX gene. Identify the laboratory studies most consistent with this diagnosis.

Answer 1

Decreased phosphorus, increased serum alkaline phosphatase, normal calcium and vitamin D 25-OH

Question 2

Thoracolumbar kyphosis is a characteristic feature of achondroplasia and thought to be a result of

Answer 2

Thoracolumbar kyphosis is a characteristic feature of achondroplasia and thought to be a result of developmental motor delay and hypotonia and disproportionate head size relative to a small chest size.

Question 3

most common complication after unstable scfe

Answer 3

avn…not contralateral disease

Question 4

most common type of pediatric brachial plexus lesion

Answer 4

upper trunk- ERB’s C5-C6

Question 5

GMFCS level-what is more active 1 or 5

Answer 5

Level one is more active, “one can run”

five is wheelchair bound and totally dependent on caretakers

Question 6

angle formed by Hilgenreiner’s line and a line from a point on the lateral triradiate cartilage to a point on lateral margin of acetabulum

Answer 6

acetabular index, should be less than 25 degrees

Question 7

DDH-angle created by lines along the bony acetabulum and the ilium

Answer 7

alpha angle should be > 60

Question 8

normal alpha angle

Answer 8

> 60 deg

Question 9

DDH-angle created by lines along the labrum and the ilium

Answer 9

normal is < 55

Question 10

normal beta angle

Answer 10

< 55 deg

Question 11

DDH tx birth-6 months

Answer 11

pavlik

• contraindicated if SpinaBifida, spasticity, teratologic hip
• must have normal muscle function to pavlik

Question 12

DDH tx 6-18 months

Answer 12

Closed reduction and spica

*or for failure of pavlik

Question 13

DDH tx >18 months

Answer 13

open reduction spica casting

*of failure of closed reduction

Question 14

avn in DDH treated with pavlik is due to what?

Answer 14

due to impingement of the posterosuperior retinacular branch of the medial femoral circumflex artery
seen with extreme abduction (> 60°)

Question 15

DDH- single transverse cut above the acetabulum through the ilium to sciatic notch

Answer 15

Salter- acetabulum hinges thru the pubic symphisis

20-25 deg anterior coverage, lengthen leg up to 1 cm

Question 16

DDH- Salter osteotomy plus additional cuts through superior and inferior pubic rami

Answer 16

Steele- Triple
acetabular re-orientation procedure
*open tri0radiate, pubic symphisis doesnt rotatate too well, little bit older child than dega or salter

Question 17

ddh-• involves multiple osteotomies in the pubis, ilium, and ischium near the acetabulum
•allows for improved 3D correction of the acetabulum configuration

Answer 17

PAO- GANZ, Burnese

*Older child, closed Tri-radiate

Question 18

DDH-osteotomy starts approximately 10-15mm above the AIIS and proceeds posteriorly to end at the level of the ilioischial limb of the triradiate cartilage (halfway between the sciatic notch and the posterior acetabular rim)

Answer 18

Pemberton-reduces acetabular volume
)
• acetabulum hinges through the triradiate cartilage
• does not enter the sciatic notch and is therefore stable and does not need internal fixation
• improves anterior, central, or posterior coverage
• reduces the acetabular volume

Question 19

DDH salvage osteotomy-
add bone to the lateral weight-bearing aspect of the acetabulum by placing an extra-articular buttress of bone over the subluxed femoral head

Answer 19

Shelf

• depends on fibrocartilage metaplasia for successful results

Question 20

DDH salvage-
• osteotomy starts above the acetabulum to the sciatic notch and ileum is shifted lateral beyond the edge of the acetabulum
• depends on fibrocartilge metaplasia for successful results
• medializes the acetabulum via iliac osteotomy

Answer 20

chiari

Question 21

when do you start to use XR to monitor DDH

Answer 21

4-6 months, before this the femoral head isnt ossified enough, so use USG

Question 22

how long until 94% of elbow ROM returns after CRPP of SCH fx

Answer 22

6 months