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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
How do you manage lateral condylar Fx of distal humerus
Emergent referral if displaced >2mm Splint, sling, NSAIDs Ortho referral to decide cast vs surgery
26
Complications of lateral condylar Fx of distal humerus are
Non-union Fish tail deformity Cubitus valgus/varus deformity
27
What causes medial epicondylar Fx of distal humerus
Muscle attachment avulsion in throwing athletes | +/- elbow dislocation association
28
How do you diagnose medial epicondyle Fx of distal humerus
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
How do you manage medial epicondylar Fx of distal humerus
If trapped fragment, emergency Splint elbow and wrist, sling, NSAIDs Refer to ortho for short term immobilization vs open fixation
30
Complications of medial epicondylar Fx of distal humerus is
Ulnar nerve palsy* | nonunion, angular deformity, decreased ROM
31
What causes radial neck fractures
``` FOOSH with valgus stress Elbow dislocation (either during dislocation or relocation) ```
32
How do radial neck Fx present
TTP over radial head/neck pain w/ supination and pronation (not so much flex/extend) Wrist pain in young kids
33
What must you remember to do with any ortho complaint
Check the joint above and below!!
34
How do you diagnose radial neck Fx
XR: AP, lateral, and external oblique (will show flat radial head)
35
How do you manage radial neck Fx
Immobilize elbow and wrist, sling, NSAIDS | Ortho to determine cast vs surgery
36
Complications of a radial neck Fx are
premature physeal closure loss of ROM nonunion
37
What is nursemaid's elbow
Subluxation of the radial head, MC at 1-3 y/o | Common cause is sudden pull of pronated arm
38
How does nursemaid's elbow present
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
How do you diagnose nursemaid's elbow
Don't usually need imaging, can judge off presentation (pronated, won't use arm but will use fingers, MOI)
40
How do you manage nursemaid's elbow
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
What is capitellar osteochondrosis (panner disease)
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
How does capitellar osteochondrosis present
rapid onset of deep, lateral pain Limited extension* No locking sensation
43
On PE for capitellar osteochondrosis you may see
Swelling Difficult to elicit ttp pain and guarding with passive extension lateral pain with valgus stress
44
On XR, capitellar osteochondrosis may show
Fragmentation (irregular articular surface, looks fuzzy) | Humerus will look flat over capitellum instead of healthy curve
45
How do you manage capitellar osteochondrosis
Conservative, Sx (ice, NSAIDs, rest) Immobilize, not sur for how long +/- PT with gradual return to play Avoid elbow stress for wk-months
46
You should avoid elbow stress in capitellar osteochondrosis until
Sx free Unremarkable PE Radiographs show healing
47
Capitellar osteochondrosis is a possible precursor to
``` OCD lesion (when they are older) osteochondritis dessicans, basically necrosis of the bone ```
48
What must you always include in a forearm XR
the elbow!
49
What is a monteggia fracture
ulnar shaft fracture w/ dislocation of radial head | dislocation of radial head MUST be present for this diagnosis
50
How do you diagnose monteggia Fx
X-Ray of forearm AND elbow
51
Common causes of a wrist fracture are
FOOSH (direct fall) | Direct trauma
52
MC wrist fracture is
Distal radius at metaphysis, +/- ulnar involvement
53
How does a wrist Fx present
Point tenderness swelling ecchymosis "dinner fork" deformity
54
How do you diagnose a wrist Fx
AP/Lateral X-ray* can also do oblique salter harris I is a common clinical diagnosis w/o radiographs
55
How do you manage a wrist Fx
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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