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Summer Disciplines 3 > Peds ortho > Flashcards

Peds ortho Flashcards

1
Q

How do you assess rotational profile in peds

A 
foot progression angle 
medial rotation 
lateral rotation 
thigh foot angle 
forefoot adductus
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2
Q

What is intoeing

A

femoral anteversion, internal tibial torsion, and forefoot adductus cause pigeon toeing

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3
Q

What is the common LE allignment

A

Infant: varus
Toddler: valgum

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4
Q

What commonly happens when you start walking sooner

A

Bow legged (Varus) 2/2 increased pressure on immature bones

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5
Q

What pathologies can cause genu varum (bow legged)

A

Blount’s disease

Rickets (vitamin D deficiency)

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6
Q

What is the periosteum

A

Thick, durable layer of vascular connective tissue around bones
Metabolically more active= promote callus formation and remodeling ability

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7
Q

Thickness and durability of periosteum means

A

Less likely to displace

Unique fractures: buckle/torus, greenstick, and plastic deformation/bowing

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8
Q

What are apophysis

A

Bony prominences from separate ossification centers
It is fibrocartilage that will fuse over time
Site of tendon or ligament attachment
Prone to overuse with inflammation or avulsion injuries

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9
Q

Explain displacement vs angulation

A

Displacement is a shift, it can be 100% displaced without a bend
Angulation is a bend. Can be 100% bent and no displacement

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10
Q

What are occult fractures

A

Fractures not initially evident on plain radiographs;

Toddler’s, Salter Harris 1, some non-displaced elbow Fx, and stress fractures

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11
Q

What are the regions of a bone

A

Epiphysis (most superior)
Growth plate
Metaphysis
Disphysis (shaft)

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12
Q

What are the SalterHarris Fx classifications

A

I: Separate. transverse fx w/ widening in growth plate area
II: Above. Fx through metaphysis
III: Lower. Fx through epiphysis
IV: Two/Through. Fx thru epi/meta/and physis
V: Erasure/cRush. Compression Fx

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13
Q

What are Fx types in kids

A 
Bowing 
Torus/bukle 
Greenstick 
Transverse 
Oblique 
Spiral 
Longitudinal
Avulsion
Butterfly 
Segmental
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14
Q

What will you see anatomically on elbow on XR

A 
CRITOE: 
Capitellum (1 y/o)
Radial head (3 y/o) 
Internal epicondyle (5 y/o) 
Trochlea (7 y/o)
Olecranon (9 y/o) 
External epicondyle (11 y/o)
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15
Q

What is fat pad sign

A

Darkening that indicated bleeding around a joint

Usually a sign of occult fracture

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16
Q

What is th eMC peds elbow fracture

A

Supracondylar fracture!

Type I is non-displaced, Type II is usually displaced, Type III is usually neuro involvement

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17
Q

How do supracondylar Fx present

A

FOOSH from height; Monkey bars! cause hyperextension
Swelling, pain, +/- deformity
*must do neuro exam

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18
Q

How do you diagnose supracondylar Fx

A

Lateral XR** Need to be 90 degrees at shoulder, and 90 at elbow!
Can also do AP and oblique XR

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19
Q

What nerves do different injures affect

A

Humerus: radial nerve
Medial Fx: ulnar nerve
FOOSH: median nerve

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20
Q

Normal elbow anatomy on an XR is (specific finding)

A

Anterior humeral line should intersect the capitellum

If it does not, then it is displaced

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21
Q

How do you manage type I/II supracondylar fracture

A

*Posterior splint w/ light overwrap, no elastic bandages
Sling, Ibuprofen, Elevation
+/- orhto for reduction if needed

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22
Q

How do you manage Type III supracodylar Fx

A

Emergency ortho consult as there is neurovascular concern

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23
Q

How does a lateral condylar Fx of distal humerus present

A

Swelling to lateral elbow

TTP over lateral condyle

24
Q

How do you diagnose lateral condylar Fx of distal humerus

A

XR: AP, lateral, and internal oblique

MRI if needed

25
Q

How do you manage lateral condylar Fx of distal humerus

A

Emergent referral if displaced >2mm
Splint, sling, NSAIDs
Ortho referral to decide cast vs surgery

26
Q

Complications of lateral condylar Fx of distal humerus are

A

Non-union
Fish tail deformity
Cubitus valgus/varus deformity

27
Q

What causes medial epicondylar Fx of distal humerus

A

Muscle attachment avulsion in throwing athletes

+/- elbow dislocation association

28
Q

How do you diagnose medial epicondyle Fx of distal humerus

A

External Oblique XR*
can also do AP and lateral XR
-need to rule out incarceration of fragment in joint, so may need advanced imaging to do this

29
Q

How do you manage medial epicondylar Fx of distal humerus

A

If trapped fragment, emergency
Splint elbow and wrist, sling, NSAIDs
Refer to ortho for short term immobilization vs open fixation

30
Q

Complications of medial epicondylar Fx of distal humerus is

A

Ulnar nerve palsy*

nonunion, angular deformity, decreased ROM

31
Q

What causes radial neck fractures

A 
FOOSH with valgus stress 
Elbow dislocation (either during dislocation or relocation)
32
Q

How do radial neck Fx present

A

TTP over radial head/neck
pain w/ supination and pronation (not so much flex/extend)
Wrist pain in young kids

33
Q

What must you remember to do with any ortho complaint

A

Check the joint above and below!!

34
Q

How do you diagnose radial neck Fx

A

XR: AP, lateral, and external oblique (will show flat radial head)

35
Q

How do you manage radial neck Fx

A

Immobilize elbow and wrist, sling, NSAIDS

Ortho to determine cast vs surgery

36
Q

Complications of a radial neck Fx are

A

premature physeal closure
loss of ROM
nonunion

37
Q

What is nursemaid’s elbow

A

Subluxation of the radial head, MC at 1-3 y/o

Common cause is sudden pull of pronated arm

38
Q

How does nursemaid’s elbow present

A

Arm fully extended or slightly flexed, but pronated*
Refuse to use arm, but will use fingers
Mild pain over radial head
Pain increases with attempt to supinate

39
Q

How do you diagnose nursemaid’s elbow

A

Don’t usually need imaging, can judge off presentation (pronated, won’t use arm but will use fingers, MOI)

40
Q

How do you manage nursemaid’s elbow

A

Reduce by:
-hyperpronation w/ pressure over radial head
*Supinate and flex with pressure over radial head
THEN: do the lollipop test, make them reach for the lollipop with the bad arm. If they do w/o pain, then you did your job. If not, may need to reduce again or refer

41
Q

What is capitellar osteochondrosis (panner disease)

A

For unknown reason, vascularity is abn and capitellum does not develop as it should
MC in men, 5-10 in dominant throwing arm
Also common in baseball, gymnastics, and handball

42
Q

How does capitellar osteochondrosis present

A

rapid onset of deep, lateral pain
Limited extension*
No locking sensation

43
Q

On PE for capitellar osteochondrosis you may see

A

Swelling
Difficult to elicit ttp
pain and guarding with passive extension
lateral pain with valgus stress

44
Q

On XR, capitellar osteochondrosis may show

A

Fragmentation (irregular articular surface, looks fuzzy)

Humerus will look flat over capitellum instead of healthy curve

45
Q

How do you manage capitellar osteochondrosis

A

Conservative, Sx (ice, NSAIDs, rest)
Immobilize, not sur for how long
+/- PT with gradual return to play
Avoid elbow stress for wk-months

46
Q

You should avoid elbow stress in capitellar osteochondrosis until

A

Sx free
Unremarkable PE
Radiographs show healing

47
Q

Capitellar osteochondrosis is a possible precursor to

A 
OCD lesion (when they are older)
osteochondritis dessicans, basically necrosis of the bone
48
Q

What must you always include in a forearm XR

A

the elbow!

49
Q

What is a monteggia fracture

A

ulnar shaft fracture w/ dislocation of radial head

dislocation of radial head MUST be present for this diagnosis

50
Q

How do you diagnose monteggia Fx

A

X-Ray of forearm AND elbow

51
Q

Common causes of a wrist fracture are

A

FOOSH (direct fall)

Direct trauma

52
Q

MC wrist fracture is

A

Distal radius at metaphysis, +/- ulnar involvement

53
Q

How does a wrist Fx present

A

Point tenderness
swelling
ecchymosis
“dinner fork” deformity

54
Q

How do you diagnose a wrist Fx

A

AP/Lateral X-ray*
can also do oblique
salter harris I is a common clinical diagnosis w/o radiographs

55
Q

How do you manage a wrist Fx

A

If significant deformity or neuro compromise: emergency!
Splint, NSAIDs
Send to ortho for cast +/- reduction or surgery

Summer Disciplines 3 (9 decks)

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