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1. Disciplines 2 > Peds Ortho > Flashcards

Peds Ortho Flashcards

1
Q

What are 2 examples that cause genu varus? AKA “bow-legged”

A

Blount’s disease

Rickets (vit D deficiency)

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2
Q

Which type of fractures are not initially evident on plain radiograph?

A

Toddler’s fx
Salter-Harris I
Some non-displaced elbow fx
Stress fx

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3
Q

Describe a Salter-Harris I fx

A

Transverse physeal fx w/ widening

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4
Q

Describe a Salter-Harris II fx

A

Fx through metaphysis & physis

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5
Q

Describe a Salter-Harris III fx

A

Fx through physis & epiphysis

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6
Q

Describe a Salter-Harris IV fx

A

Fx through metaphysis, physis, & epiphysis

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7
Q

Describe a Salter-Harris V fx

A

Physeal compression or crush fx

Rare, can occur in high intensity accident

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8
Q

What does “SALTR” stand for?

A 
I: Separate 
II: Above 
III: Lower 
IV: Through 
V: Reduced
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9
Q

What does “CRITOE” stand for? What ages are associated?

A

Elbow ossification:

Capitellum (1 yo)
Radial head (3 yo)
Internal epicondyle (5 yo)
Trochlea (7 yo)
Olecranon (9 yo)
External epicondyle (11 yo)
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10
Q

What is the MC pediatric elbow fx?

A

Supracondylar fx

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11
Q

What is the presentation of a supracondylar fx? What exam is critical?

A

FOOSH injury
Swelling, pain, +/- deformity

*NV exam is critical!

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12
Q

How do you dx a supracondylar fx?

A

Xray: AP, lateral*, & oblique

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13
Q

How do you manage a supracondylar fx?

A

Type I/II = posterior splint w/ light overwrap

Type III or NV concerns –> emergent ortho consult

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14
Q

What is the presentation of a lateral condylar fx of the distal humerus?

A

Soft tissue swelling concentrated to lateral elbow

TTP over lateral condyle

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15
Q

How do you dx a lateral condylar fx?

A

Xray: AP, lateral, internal oblique focused on lateral condyle

MRI if needed

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16
Q

How do you manage a lateral condylar fx of the distal humerus?

A

Splint, sling, NSAIDs

Emergent referral if displacement > 2mm (requires surgery)

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17
Q

What are complications of a lateral condylar fx of the distal humerus?

A

Nonunion

Fish tail deformity

Cubitus valgus/varus deformity

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18
Q

What are common causes of a medial epicondylar fx of the distal humerus?

A

Muscle attachment avulsion (seen in throwing athletes)

May be a/w elbow dislocation

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19
Q

How do you dx a medial epicondylar fx of the distal humerus?

A

Xray: AP, lateral, external oblique

R/o incarceration

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20
Q

How do you manage a medial epicondylar fx of the distal humerus?

A

Splint including wrist, sling, NSAIDs

If entrapped fragment –> emergent!

Ortho: immobilization vs open fixation

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21
Q

What are complications of a medial epicondylar fx of the distal humerus?

A

Ulnar nerve palsy
Nonunion
Angular deformity
Decreased ROM

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22
Q

What are common causes of a radial neck fx?

A

FOOSH w/ valgus stress

Elbow dislocations

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23
Q

How does a radial neck fx present?

A

TTP over radial head/neck

Pain w/ supination/pronation

Young kids c/o wrist pain

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24
Q

How do you dx a radial neck fx?

A

Xray: AP, lateral, external oblique

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25
Q

How do you manage a radial neck fx?

A

Immobilize including wrist

Sling, NSAIDs

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26
Q

What are complications of a radial neck fx?

A

Premature physeal closure
Loss of ROM
Nonunion

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27
Q

What is a common cause of nursemaid’s elbow?

A

Sudden pull of pronated arm

MC occur in 1-3 yo

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28
Q

How does a nursemaid’s elbow present?

A

Arm fully extended or slightly flexed & pronated

Refusal to use arm

Mild pain over radial head, increases w/ supination

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29
Q

How do you dx a nursemaid’s elbow?

A

Clinically!

Imaging not usually necessary

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30
Q

How do you manage a nursemaid’s elbow?

A

Reduction by:

  1. Hyperpronation w/ pressure over radial head
  2. Supination, flexion w/ pressure over radial head

“Lollipop/popsicle test”

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31
Q

What population most often suffers from capitellar osteochondrosis (Panner Disease) ?

A

Males, 5-10yo

Baseball, gymnasts, handball

Involves dominant (throwing arm)

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32
Q

How does capitellar osteochondrosis (Panner disease) present?

A

Rapid onset of deep, lateral pain

Limited extension

Possible precursor to OCD lesion

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33
Q

What does Panner disease look like on PE?

A

+/- swelling

Pain/guarding w/ passive extension

Lateral pain w/ valgus stress

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34
Q

How do you manage Panner disease?

A

ice, NSAIDs, rest

Immobilization controversial

+/- PT

Avoid elbow stress for wks- months

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35
Q

What is a monteggia fx?

A

Ulnar shaft fx w/ dislocation of radial head

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36
Q

How do you dx a monteggia fx?

A

Xray (include elbow)

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37
Q

What are common causes of wrist fractures?

A

Direct fall (FOOSH)

Direct trauma

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38
Q

What is the MC type of wrist fx?

A 
Distal radius (at metaphysis)
\+/- ulnar involvement
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39
Q

How do wrist fractures present?

A

Point tenderness

Swelling, ecchymosis

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40
Q

How do you dx wrist fractures?

A

Xray: AP/lat +/- obliq

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41
Q

How do you manage wrist fractures?

A

Splint & NSAIDs

If significant deformity or NV compromise –> emergent

42
Q

How do femur fractures present?

A

Hx of trauma
Pain in groin or buttock
Unable to bear weight/walk

May hold leg in adduction & external rotation

43
Q

What must you r/o in pediatric femur fractures?

A

Child abuse (70%)

44
Q

How do you dx a femur fx?

A

Must xray entire length of femur

45
Q

How do you manage a femur fx?

A

Hip spica vs surgery

46
Q

What are complications of a femur fx?

A

Shortening
Lengthening
Angulation

47
Q

What causes patellar sleeve fractures?

A

Forced extension w/ knee in flexion

Unique to children

48
Q

How do you manage a patellar sleeve fx?

A

Knee immobilization
NWB, elevate, NSAIDs
Cast vs surgery

49
Q

What is a common cause of a toddler’s fx?

A

Falling while running, twisting mechanism

50
Q

How do you dx a toddler’s fx?

A

Usually clinically!

Xray: AP, lateral, oblique

51
Q

How do you manage a toddler’s fx?

A

Immobilize
NWB, NSAIDs, elevate
Wee walker vs cast

52
Q

What is the presentation of an ankle sprain or fx?

A

TTP
Swelling, ecchymosis
WB status varies
Location matters!!!

53
Q

How do you dx an ankle fx?

A

Xray: AP, mortise, lateral, internal, external oblique

54
Q

How do you manage an ankle fx?

A

Posterior vs stirrup splint
Elevate, NWB, NSAIDs
Ortho consult prn

55
Q

What do you need to r/o in an ankle sprain or fx?

A

Physeal widening (SHI fx)

56
Q

What is a triplane fx? & what is the MOI?

A

Special fx of the ankle

External rotation

57
Q

What kind of SH fx is a triplane fx?

A

SHIII on AP view +

SHII on lateral view = SHIV

58
Q

How do you dx a triplane fx?

A

Must get CT to assess displacement

59
Q

How do you treat a triplane fx?

A

Surgical fixation vs closed reduction

60
Q

What is a Jones, Pseudo-jones/avulsion fx? What is the MOI?

A

Fx to the base of the 5th MT

Traction injury

61
Q

What causes torticollis?

A

Compartment syndrome secondary to venous outflow obstruction

62
Q

Describe: scoliosis

A

Lateral curve > 10˚
Rotational component
Idiopathic
W>M

63
Q

What is the clinical presentation of adolescent idiopathic scoliosis (AIS)?

A

Asx
+/- pain
Obstructive lung sx if severe

64
Q

What does AIS look like on PE?

A

Shoulder or pelvic obliquity
Asymmetry of scapulae
Adam’s forward flexion exam
Abd reflexes

65
Q

What imaging is used to dx scoliosis?

A

Cobb angle

AP/PA standing xray

66
Q

How do you treat scoliosis?

A

TLSO brase: 25˚

Surgery: 45˚, internal rod fixation

67
Q

What are characteristics of osteochondritis dissecans (OCD)?

A

Idiopathic osteonecrosis of subchondral bone

10-20yo

68
Q

What causes osteochondritis dissecans?

A

Repetitive trauma
Vascular disruption
Ischemia following trauma
+/- genetic predisposition

69
Q

Describe: juvenile osteochondritis dissecans

A

Repetitive small stresses to subchondral bone –> disruption of blood supply

70
Q

How does osteochondritis dissecans occur at the elbow?

A

Chronic valgus stress or micro trauma w/ compression attributed to overhead activities

71
Q

How does osteochondritis dissecans occur at the knee?

A

Repetitive axial loading (valgus/varus stress)

72
Q

What is the clinical presentation of OCD?

A

Gradual onset of localized deep pain

Decreased ROM in elbow

Limited WB in LE

+/- swelling, locking, popping, catching

73
Q

What does OCD look like on PE?

A

+/- swelling

Elbow: pain/guarding

Knee: pain w/ flexion over medial condyle

74
Q

What imaging do you use to dx OCD?

A

Xray: flattening of articular surfcae

MRI if xray inconclusive

75
Q

How do you treat OCD?

A

Stages I-III: avoid running & jumping, immobilization, PT

Stage IV: 1. drilling & fixation

76
Q

What is the clinical presentation of septic hip vs transient synovitis?

A

Holds leg in flexion, abduction & external rotation

Refuses to WB or walk

Septic arthritis often febrile

Transient synovitis follows viral illness

77
Q

How do you dx septic hip & transient synovitis?

A 
Kocher criteria: 
WBC > 12,000
ESR > 40
Fever > 101.3
Non WB on affected side

2/4 –> joint aspiration

78
Q

How do you treat septic hip & transient synovitis?

A

High dose NSAIDs

Admit to hospital if concern for septic arthritis w/ emergent ortho referral –> joint aspiration, IV abx

79
Q

What is legg-calve-perthes disease?

A

Idiopathic AVN of femoral head

Boys 4-8, thin & active

80
Q

What is the clinical presentation of legg-calve-perthes disease?

A

Limp at end of day
Occasional pain (knee or hip)
Limited internal rotation
+/- abduction of hip**

81
Q

How do you dx legg-calve-perthes disease?

A

Clinically, but xray confirms

82
Q

How do you treat legg-calve-perthes disease?

A

obs, PT to improve ROM

Surgery for re-alignment (if needed)

83
Q

Describe the course of legg-calve-perthes disease?

A

Initial: necrosis of femoral head
Fragmentation: re-absorption of bone w/ femoral head collapse
Re-ossification: new bone forms
Healed: femoral head reshapes itself

84
Q

What is the best prognostic factor for legg-calve-perthes disease?

A

Age of onset!

Younger age = better px

85
Q

What are characteristics of slipped capital femoral epiphysis (SCFE)?

A

“Ice cream slipping off cone”
M>F
10-16yo
Obesity is RF

86
Q

What is the clinical presentation of SCFE?

A

Limp or NWB w/ hip or knee pain

Restricted ROM: abduction & internal rotation

87
Q

How do you dx SCFE?

A

Xray

MRI if xray inconclusive

88
Q

How do you treat SCFE?

A

Urgent surgical consult for single screw fixation

NWB! Admit!

89
Q

What is the MC orthopedic condition in newborns?

A

Developmental dysplasia of the hip (DDH)

90
Q

What are the genetic RFs for DDH?

A

1st born
Breech
Fam hx

91
Q

What tests do you perform for DDH?

A

Barlow: flexion, adduction

Ortolani: reduction, flexion, abduction

Galeazzi: supine & knees 90˚

92
Q

How do you treat DDH?

A

Pavlik harness

Avoid swaddling, tight clothes

93
Q

What is Osgood-Schlatter disease?

A

Inflammation & irritation of pateller tendon insertion on tibial tubercle

94
Q

What is the presenation of Osgood-Schlatter disease?

A

Tenderness & enlargment of tibial tubercle

95
Q

How do you dx Osgood-Schlatter disease?

A

Lateral xray to r/o avulsion

96
Q

How do you treat Osgood-Schlatter disease?

A

NSAIDs, ice
Quad & hamstring exercises
Chopat strap

*Pain flares around time of rapid growth

97
Q

What is calcaneal apophysitis (Sever’s disease)? MOI?

A

Irritation/inflammation of calcaneal apophysis

Overuse, pull of achilles tendon

6-12yo

98
Q

How do you treat calcaneal apophysitis?

A

NSAIDs, ice, streching

99
Q

Describe: Clubfoot

Congenital Talipes Equinovarus

A

Fixed deformity

Can be dx on fetal U/S

Affected limb has smaller foot & calf w/ shortened tibia

100
Q

What are RFs for clubfoot?

A

Fam hx

maternal smoking

101
Q

What does “CAVE” stand for in clubfoot?

A

midfoot Cavus
forefoot Adductus
hindfoot Varus
hindfoot Equinus

102
Q

How do you treat clubfoot?

A

Ponseti method

1. Disciplines 2 (11 decks)

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