- Ulnar Fx - Radial dislocation DX: Xray and remember to include elbow in films

Peds Ortho Flashcards by Salvatore Liotta

At which ages do you see linear alignment?

18months and Young adult

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At which age is Genu varum normal alignment?

6 months

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At which age is Genu valgum normal alignment?

4 years

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2 examples of Genu Varum

Blount’s Disease

2. Rickets (vitamin D deficiency)

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Things that make kid’s bones different?

Metabolically more active

2. Thicker and more durable

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Examples of Occult Fractures

Salter-Harris
Toddler’s Fracture
Stress Fractures

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Elbow ossification centers

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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What is the most common pediatric elbow fracture?

supracondylar

FOOSH from height
Lateral radiograph**

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Medial Epicondylar fx of distal humerus

cause:
- throwing athlete–> muscle attachment avulsion

“POP!”

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Radial Neck Fracture: MOI

FOOSH with valgus stress

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Radial Neck fracture: management

immobilize including the wrist

-Pain with supination and pronation

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Nursemaid’s Elbow

subluxation of radial head

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

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Capitellar Osteochondrosis “Panner Disease”

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

Clinical presentation:

rapid onset pain
deep lateral pain
limited extension

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Monteggia Fracture

Ulnar Fx
Radial dislocation

DX: Xray and remember to include elbow in films

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

child abuse

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

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Femur Fracture: clinical presentation

can’t bear weight

- pain in butt or groin

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Femur Fx: treatment

Hip spica cast

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Patellar Sleeve Fracture

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

Toddler’s Fracture

Distal Tibial shaft fracture

MOA: falling while running, twisting mechanism

Salter Harris classifications

horizontal through pophysis (widening)
Through pophysis and metaphysis
Through pophysis and epiphosis
Through epophysis, pophysis, and metaphysis
Compression, loss of pophysis

Triplane Fracture

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

Tx: surgery

Jones, Pseudo-Jones/Avulsion Fracture

-Fx of the base of 5th metatarsal

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

Torticollis affects which muscle

-unilateral contraction of the sternocleidomastoid muscle

Tx: stretching with PT

Scoliosis

lateral curve of spine >10 with rotational component

- more common in women

Scoliosis age groups

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

Scoliosis: PE

Adam's forward flexion exam - Asymmetry of scapulae - Abdominal reflexes

Scoliosis: imaging

PA/AP standing radiograph -Cobb Angle - to determine severity of kyphosis

Scoliosis: Tx

If 25 degrees -->Brace If 45 degrees -->Surgery

Osteochondritis Dissecans (OCD)

- 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)

Osteochondritis Dessicans

-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

Septic Hip criteria

Kocher Criteria 1. WBC >12,000 2. ESR >40 3. Fever >101.3 4. Non weight bearing Score of 2/4 warrants joint aspiration

Septic Hip vs Transient Synovitis presentation

- Flexed at knee - Abduction - Slight external rotation

Septic Hip vs Transient Synovitis: management

NSAIDS can be therapeutic and diagnostic (will be able to treat synovitis, outpatient) Septic hip needs drainage and IV antibiotics

Legg-Calve-Perthes Disease

- 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

Slipped Capital Femoral Epiphysis (SCFE)

"Ice cream slipping off the cone" M>F 10-16 years Obesity is significant risk factor**

Slipped capital femoral epiphysis: clinical presentation

- Limp or not weight bearing - Hip or knee pain (dull, achy) - Restricted ROM

Slipped capital femoral epiphysis: dx

Xray: AP pelvis and Frog lat

Slipped capital femoral epiphysis: tx

if not weight bearing --> admit to hospital

Developmental dysplasia of the hip

F>M **Most common orthopaedic condition in newborns** Greatest risk factors: - 1st born - breech position - family history

Developmental dysplasia of the hip

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

Developmental dysplasia of hip: Tx

Pavlik harness (very effective if started by 6 weeks)

Osgood-Schlatter's Disease:

traction at tibial tubercle apophysis (inflammation or patellar tendon insertion) Management: - Quad exercises - hamstring stretches - Chopat strap

Calcaneal apophysitis

"Sever's Disease" - overuse of the achilles tendon - MC in children 6-12 - Soccer or gymnastics Tx: stretch, Ice, NSAIDs

Club foot (congenital Talipes Equinovarus)

Risks: family history, maternal smoking ``` CAVE: midfoot cavus forefoot adductus hindfoot varus hindfoot equinus ``` Tx: Ponseti Method