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Clinical Disciplines II > Peds Ortho > Flashcards

Peds Ortho Flashcards

1
Q

At which ages do you see linear alignment?

A

18months and Young adult

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2
Q

At which age is Genu varum normal alignment?

A

6 months

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3
Q

At which age is Genu valgum normal alignment?

A

4 years

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4
Q

2 examples of Genu Varum

A
  1. Blount’s Disease

2. Rickets (vitamin D deficiency)

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5
Q

Things that make kid’s bones different?

A
  1. Metabolically more active

2. Thicker and more durable

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6
Q

Examples of Occult Fractures

A
  • Salter-Harris
  • Toddler’s Fracture
  • Stress Fractures
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7
Q

Elbow ossification centers

A

CRITOE

Capitellum (1 yr)
Radial Head (3 yrs)
Internal [medial] epicondyle (5yrs)
Trochlea (7 yrs)
Olecranon (9yrs)
External [lateral epicondyle (11 yrs])
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8
Q

What is the most common pediatric elbow fracture?

A

supracondylar

  • FOOSH from height
  • Lateral radiograph**
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9
Q

Medial Epicondylar fx of distal humerus

A

cause:
- throwing athlete–> muscle attachment avulsion

“POP!”

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10
Q

Radial Neck Fracture: MOI

A

FOOSH with valgus stress

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11
Q

Radial Neck fracture: management

A

immobilize including the wrist

-Pain with supination and pronation

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12
Q

Nursemaid’s Elbow

A

subluxation of radial head

cause: pull of pronated arm
- Occur between ages 1-3

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13
Q

Capitellar Osteochondrosis “Panner Disease”

A
  • Fragmentation of the capitellum (irregular articular surface)
  • males, 5-10

Clinical presentation:

  • rapid onset pain
  • deep lateral pain
  • limited extension
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14
Q

Monteggia Fracture

A
  • Ulnar Fx
  • Radial dislocation

DX: Xray and remember to include elbow in films

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15
Q

If a pediatric patient with femur fracture what must you rule out?

A

child abuse

70% of these in kids <1 yr are from abuse

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16
Q

Femur Fracture: clinical presentation

A
  • can’t bear weight

- pain in butt or groin

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17
Q

Femur Fx: treatment

A

Hip spica cast

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18
Q

Patellar Sleeve Fracture

A
  • Avulsion fracture at the distal pole of the patella
  • Unique to kids (MC patelllar fracture under 13 yrs)

Tx: immobilize knee. Don’t bear weight

19
Q

Toddler’s Fracture

A

Distal Tibial shaft fracture

MOA: falling while running, twisting mechanism

20
Q

Salter Harris classifications

A
  1. horizontal through pophysis (widening)
  2. Through pophysis and metaphysis
  3. Through pophysis and epiphosis
  4. Through epophysis, pophysis, and metaphysis
  5. Compression, loss of pophysis
21
Q

Triplane Fracture

A
  • Ankle fracture
  • MOI: external rotation
  • Salter Harris IV
  • **Must get CT to assess displacement

Tx: surgery

22
Q

Jones, Pseudo-Jones/Avulsion Fracture

A

-Fx of the base of 5th metatarsal

MOI: Traction injuries pull of peroneus brevis (avulsion of apophysis)

23
Q

Torticollis affects which muscle

A

-unilateral contraction of the sternocleidomastoid muscle

Tx: stretching with PT

24
Q

Scoliosis

A
  • lateral curve of spine >10 with rotational component

- more common in women

25
Q

Scoliosis age groups

A

congenital: 0-3
Juvenile: 4-9
Adolescent: >10

26
Q

Scoliosis: PE

A

Adam’s forward flexion exam

  • Asymmetry of scapulae
  • Abdominal reflexes
27
Q

Scoliosis: imaging

A

PA/AP standing radiograph

-Cobb Angle - to determine severity of kyphosis

28
Q

Scoliosis: Tx

A

If 25 degrees –>Brace

If 45 degrees –>Surgery

29
Q

Osteochondritis Dissecans (OCD)

A
  • idiopathic osteonecrosis of subchondral bone
  • 10-20 years old

-Knee:
lateral portion of medial femoral condyle
Normal ROM

Elbow: lateral portion, above radial head (decreased ROM)

30
Q

Osteochondritis Dessicans

A

-gradual onset of poorly localized deep pain

Xray: flattening of articular surface (crater)

Tx: stages I-III immobilization

Stage IV with intraarticular loose body needs surgery

31
Q

Septic Hip criteria

A

Kocher Criteria

  1. WBC >12,000
  2. ESR >40
  3. Fever >101.3
  4. Non weight bearing

Score of 2/4 warrants joint aspiration

32
Q

Septic Hip vs Transient Synovitis presentation

A
  • Flexed at knee
  • Abduction
  • Slight external rotation
33
Q

Septic Hip vs Transient Synovitis: management

A

NSAIDS can be therapeutic and diagnostic
(will be able to treat synovitis, outpatient)

Septic hip needs drainage and IV antibiotics

34
Q

Legg-Calve-Perthes Disease

A
  • Idiopathic avascular necrosis of the femoral head
  • MC in boys 4-8

Presentation: limp at end of the day, occasional pain (knee or hip)
-limited internal rotation and abduction of hip

Prognosis: younger the better chance of healing

35
Q

Slipped Capital Femoral Epiphysis (SCFE)

A

“Ice cream slipping off the cone”

M>F
10-16 years
Obesity is significant risk factor**

36
Q

Slipped capital femoral epiphysis: clinical presentation

A
  • Limp or not weight bearing
  • Hip or knee pain (dull, achy)
  • Restricted ROM
37
Q

Slipped capital femoral epiphysis: dx

A

Xray: AP pelvis and Frog lat

38
Q

Slipped capital femoral epiphysis: tx

A

if not weight bearing –> admit to hospital

39
Q

Developmental dysplasia of the hip

A

F>M
Most common orthopaedic condition in newborns

Greatest risk factors:

  • 1st born
  • breech position
  • family history
40
Q

Developmental dysplasia of the hip

A

Barlow:

  • provocative maneuver
  • Flexion, adduction*, posterior pressure

Ortlani:

  • Reductive maneuver
  • Flexion, abduction* (out)

Galeazzi:
-limb length discrepancy while supine and knees flexed at 90 degrees

41
Q

Developmental dysplasia of hip: Tx

A

Pavlik harness (very effective if started by 6 weeks)

42
Q

Osgood-Schlatter’s Disease:

A

traction at tibial tubercle apophysis (inflammation or patellar tendon insertion)

Management:

  • Quad exercises
  • hamstring stretches
  • Chopat strap
43
Q

Calcaneal apophysitis

A

“Sever’s Disease”

  • overuse of the achilles tendon
  • MC in children 6-12
  • Soccer or gymnastics

Tx: stretch, Ice, NSAIDs

44
Q

Club foot (congenital Talipes Equinovarus)

A

Risks: family history, maternal smoking

CAVE:
midfoot cavus
forefoot adductus
hindfoot varus
hindfoot equinus

Tx: Ponseti Method

Clinical Disciplines II (15 decks)

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