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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
How do you manage a radial neck fx?
Immobilize including wrist Sling, NSAIDs
26
What are complications of a radial neck fx?
Premature physeal closure Loss of ROM Nonunion
27
What is a common cause of nursemaid's elbow?
Sudden pull of pronated arm MC occur in 1-3 yo
28
How does a nursemaid's elbow present?
Arm fully extended or slightly flexed & pronated Refusal to use arm Mild pain over radial head, increases w/ supination
29
How do you dx a nursemaid's elbow?
Clinically! Imaging not usually necessary
30
How do you manage a nursemaid's elbow?
Reduction by: 1. Hyperpronation w/ pressure over radial head 2. Supination, flexion w/ pressure over radial head "Lollipop/popsicle test"
31
What population most often suffers from capitellar osteochondrosis (Panner Disease) ?
Males, 5-10yo Baseball, gymnasts, handball Involves dominant (throwing arm)
32
How does capitellar osteochondrosis (Panner disease) present?
Rapid onset of deep, lateral pain Limited extension Possible precursor to OCD lesion
33
What does Panner disease look like on PE?
+/- swelling Pain/guarding w/ passive extension Lateral pain w/ valgus stress
34
How do you manage Panner disease?
ice, NSAIDs, rest Immobilization controversial +/- PT Avoid elbow stress for wks- months
35
What is a monteggia fx?
Ulnar shaft fx w/ dislocation of radial head
36
How do you dx a monteggia fx?
Xray (include elbow)
37
What are common causes of wrist fractures?
Direct fall (FOOSH) Direct trauma
38
What is the MC type of wrist fx?
``` Distal radius (at metaphysis) +/- ulnar involvement ```
39
How do wrist fractures present?
Point tenderness | Swelling, ecchymosis
40
How do you dx wrist fractures?
Xray: AP/lat +/- obliq
41
How do you manage wrist fractures?
Splint & NSAIDs If significant deformity or NV compromise --> emergent
42
How do femur fractures present?
Hx of trauma Pain in groin or buttock Unable to bear weight/walk May hold leg in adduction & external rotation
43
What must you r/o in pediatric femur fractures?
Child abuse (70%)
44
How do you dx a femur fx?
Must xray entire length of femur
45
How do you manage a femur fx?
Hip spica vs surgery
46
What are complications of a femur fx?
Shortening Lengthening Angulation
47
What causes patellar sleeve fractures?
Forced extension w/ knee in flexion Unique to children
48
How do you manage a patellar sleeve fx?
Knee immobilization NWB, elevate, NSAIDs Cast vs surgery
49
What is a common cause of a toddler's fx?
Falling while running, twisting mechanism
50
How do you dx a toddler's fx?
Usually clinically! Xray: AP, lateral, oblique
51
How do you manage a toddler's fx?
Immobilize NWB, NSAIDs, elevate Wee walker vs cast
52
What is the presentation of an ankle sprain or fx?
TTP Swelling, ecchymosis WB status varies Location matters!!!
53
How do you dx an ankle fx?
Xray: AP, mortise, lateral, internal, external oblique
54
How do you manage an ankle fx?
Posterior vs stirrup splint Elevate, NWB, NSAIDs Ortho consult prn
55
What do you need to r/o in an ankle sprain or fx?
Physeal widening (SHI fx)
56
What is a triplane fx? & what is the MOI?
Special fx of the ankle External rotation
57
What kind of SH fx is a triplane fx?
SHIII on AP view + | SHII on lateral view = SHIV
58
How do you dx a triplane fx?
Must get CT to assess displacement
59
How do you treat a triplane fx?
Surgical fixation vs closed reduction
60
What is a Jones, Pseudo-jones/avulsion fx? What is the MOI?
Fx to the base of the 5th MT Traction injury
61
What causes torticollis?
Compartment syndrome secondary to venous outflow obstruction
62
Describe: scoliosis
Lateral curve > 10˚ Rotational component Idiopathic W>M
63
What is the clinical presentation of adolescent idiopathic scoliosis (AIS)?
Asx +/- pain Obstructive lung sx if severe
64
What does AIS look like on PE?
Shoulder or pelvic obliquity Asymmetry of scapulae Adam's forward flexion exam Abd reflexes
65
What imaging is used to dx scoliosis?
Cobb angle | AP/PA standing xray
66
How do you treat scoliosis?
TLSO brase: 25˚ Surgery: 45˚, internal rod fixation
67
What are characteristics of osteochondritis dissecans (OCD)?
Idiopathic osteonecrosis of subchondral bone 10-20yo
68
What causes osteochondritis dissecans?
Repetitive trauma Vascular disruption Ischemia following trauma +/- genetic predisposition
69
Describe: juvenile osteochondritis dissecans
Repetitive small stresses to subchondral bone --> disruption of blood supply
70
How does osteochondritis dissecans occur at the elbow?
Chronic valgus stress or micro trauma w/ compression attributed to overhead activities
71
How does osteochondritis dissecans occur at the knee?
Repetitive axial loading (valgus/varus stress)
72
What is the clinical presentation of OCD?
Gradual onset of localized deep pain Decreased ROM in elbow Limited WB in LE +/- swelling, locking, popping, catching
73
What does OCD look like on PE?
+/- swelling Elbow: pain/guarding Knee: pain w/ flexion over medial condyle
74
What imaging do you use to dx OCD?
Xray: flattening of articular surfcae MRI if xray inconclusive
75
How do you treat OCD?
Stages I-III: avoid running & jumping, immobilization, PT Stage IV: 1. drilling & fixation
76
What is the clinical presentation of septic hip vs transient synovitis?
Holds leg in flexion, abduction & external rotation Refuses to WB or walk Septic arthritis often febrile Transient synovitis follows viral illness
77
How do you dx septic hip & transient synovitis?
``` Kocher criteria: WBC > 12,000 ESR > 40 Fever > 101.3 Non WB on affected side ``` 2/4 --> joint aspiration
78
How do you treat septic hip & transient synovitis?
High dose NSAIDs Admit to hospital if concern for septic arthritis w/ emergent ortho referral --> joint aspiration, IV abx
79
What is legg-calve-perthes disease?
Idiopathic AVN of femoral head Boys 4-8, thin & active
80
What is the clinical presentation of legg-calve-perthes disease?
Limp at end of day Occasional pain (knee or hip) Limited internal rotation +/- abduction of hip**
81
How do you dx legg-calve-perthes disease?
Clinically, but xray confirms
82
How do you treat legg-calve-perthes disease?
obs, PT to improve ROM Surgery for re-alignment (if needed)
83
Describe the course of legg-calve-perthes disease?
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
What is the best prognostic factor for legg-calve-perthes disease?
Age of onset! | Younger age = better px
85
What are characteristics of slipped capital femoral epiphysis (SCFE)?
"Ice cream slipping off cone" M>F 10-16yo Obesity is RF
86
What is the clinical presentation of SCFE?
Limp or NWB w/ hip or knee pain | Restricted ROM: abduction & internal rotation
87
How do you dx SCFE?
Xray | MRI if xray inconclusive
88
How do you treat SCFE?
Urgent surgical consult for single screw fixation NWB! Admit!
89
What is the MC orthopedic condition in newborns?
Developmental dysplasia of the hip (DDH)
90
What are the genetic RFs for DDH?
1st born Breech Fam hx
91
What tests do you perform for DDH?
Barlow: flexion, adduction Ortolani: reduction, flexion, abduction Galeazzi: supine & knees 90˚
92
How do you treat DDH?
Pavlik harness | Avoid swaddling, tight clothes
93
What is Osgood-Schlatter disease?
Inflammation & irritation of pateller tendon insertion on tibial tubercle
94
What is the presenation of Osgood-Schlatter disease?
Tenderness & enlargment of tibial tubercle
95
How do you dx Osgood-Schlatter disease?
Lateral xray to r/o avulsion
96
How do you treat Osgood-Schlatter disease?
NSAIDs, ice Quad & hamstring exercises Chopat strap *Pain flares around time of rapid growth
97
What is calcaneal apophysitis (Sever's disease)? MOI?
Irritation/inflammation of calcaneal apophysis Overuse, pull of achilles tendon 6-12yo
98
How do you treat calcaneal apophysitis?
NSAIDs, ice, streching
99
Describe: Clubfoot | Congenital Talipes Equinovarus
Fixed deformity Can be dx on fetal U/S Affected limb has smaller foot & calf w/ shortened tibia
100
What are RFs for clubfoot?
Fam hx | maternal smoking
101
What does "CAVE" stand for in clubfoot?
midfoot Cavus forefoot Adductus hindfoot Varus hindfoot Equinus
102
How do you treat clubfoot?
Ponseti method

1. Disciplines 2 (11 decks)

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