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Peds II Final > Peds Ortho > Flashcards

Peds Ortho Flashcards

1
Q

Kids periosteum vs. adults

A

metabolically more active (promotes callus formation, remodeling ability)
thicker and more durable (less likelihood of displacment, unique fracture presentations: buckle/torus, greenstick, plastic deformation/bowing)

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2
Q

Apophysis

A

bony prominences arising from separate ossification centres; (growth plates that don’t add to length of bone)

fibrocartilage, fusion over time, site of tendon or ligament attachment, prone to overuse w/ inflammation or avulsion injuries

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3
Q

Occult fractures

A

toddler’s fracture
salter-harris I
some non-displaced elbow fractures
stress fractures

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4
Q

Growth plate aka

A

physis

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5
Q

SALTER harris levels

A 
I: seperate (through physis)
II: Above (metaphysis)
III: Lower (epiphysis)
IV: through (both metaphysis and epiphysis)
V: Reduced (crush of growth plate)
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6
Q

Best prognosis saltr

A

I

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7
Q

Worst prognosis saltr

A

V (reduced)

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8
Q

Slipped fracture: type 1

A

seperation through physis
Prognosis: excellent
Rx: non-operative management

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9
Q

Type 2: Above

A

fracture through part of physis that extends through metaphysis
Prognosis: excellent
Rx: likely non-operative

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10
Q

Type 3: Lower

A

fx through part of physis that extends through epiphysis, often involving the joint space
Prognosis: often unstable
Rx: +/- operative

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11
Q

Type 4: through

A

through metaphysis, physis and epiphysis
Prognosis: unstable, can lead to LLD
Rx: +/- operative

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12
Q

Type 5: Reduced (ER)

A

crush injury to physis
Prognosis: unstable, can lead to LLD
Rx: +/- operative

uncommon, high impact

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13
Q

Elbow ossification centers

A

(CRITOE)

  1. Capitellum
  2. Radial head
  3. Internal (medial) epicondyle [easily missed]
  4. Trochlea
  5. Olecranon
  6. External (lateral) epicondyle
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14
Q

Fat Pad Sign

A

bleeding from bone into joint (aka sail sign) [dark shadow around bone]

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15
Q

Most common pediatric elbow fracture

A

supracondylar humeral fractures

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16
Q

Supracondylar humeral fractures

A

90% occur <10 yo

most common pediatric elbow fracture

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17
Q

MOI supracondylar humeral fx

A

fall from moderate height

FOOSH: typically w/ hyperextension

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18
Q

Clinical presentation of supracondylar humeral fx

A

swelling, pain, +/- deformity

NV exam critical: median nerve (anterior interosseous nerve)

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19
Q

Nerve concern for supracondylar humeral fx

A

median nerve: AIN (anterior interosseous nerve)

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20
Q

Dx supracondylar fracture

A

x-ray: AP, LATERAL!!!, & obliques

- anterior humeral line should intersect the capitellum

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21
Q

Types of supracondylar fracture

A

type 1
type 2
type 3: urgent, wake up to do surgery right away, increased risk of NV damage

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22
Q

Management of supracondylar fx

A

Type I/II: splint w/ light overwrap

  • avoid elastic bandages when possible
  • sling, NSAIDs, elevation
  • refer to ortho, +/- reduction for type II (immobilization x 3 weeks)

Type III or NV concern: emergent ortho consult; CRPPF: closed reduction percutaneous pin fixation; open reduction

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23
Q

Lateral humeral condyle fx presentation

A

soft tissue swelling concentrated to lateral aspect of elbow; TTP overal lateral condyle

fx may be subtle: may only appear as SMALL SLIVER on imaging due to large cartilaginous portion

Small threshold for surgery

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24
Q

Dx of lateral humeral condyle fx

A

AP, lateral, and INTERNAL OBLIQUE!

MRI if needed

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25
Q

Management of lateral humeral condyle fx

A

emergent referral if displaced >2mm on internal oblique view
Sling, sling, NSAIDs

ortho: casting vs surgery
- immobilize 6 weeks
- open reduction w/ screw fixation

HIGH RISK OF COMPLICATIONS

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26
Q

Medial humeral epicondyle fx MOI

A

muscle attachment avulsion (throwing athletes and gymnasts; “POP”)
FOOSH w/ arm fully extended
secondary to posterior elbow disolcation

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27
Q

Presentation of medial humeral epicondyle fx

A

localized pain
pain w/ resisted wrist flexion
ulnar nerve dysfunction

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28
Q

Dx of medial humeral epicondyle fx

A

ap, later and EXTERNAL oblique
comparison views if needed
R/o incarceration of fragment in joint (advanced imaging may be needed)

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29
Q

Management of medial epicondyle fx

A

emergent if entrapped fragment
splint (INCLUDING WRIST), sling
NSAIDs
ortho: short term immbolization vs open fixation

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30
Q

Complications of medial epicondyle fx

A

ulnar nerve palsy
nonunion
angular deformity
decreased ROM

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31
Q

radial neck fx presentation

A

TTP overal radial head/neck
pain w/ supination/pronation&raquo_space; flexion/extension
Young children may complain of “wrist pain”

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32
Q

Pain w/ flexion

A

medial humeral epicondyl

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33
Q

Pain w/ pronation/supination

A

radial neck fx

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34
Q

Internal oblique view

A

lateral epicondyle fx

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35
Q

external oblique view

A

medial epicondyl fx

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36
Q

Dx for radial neck fx

A

ap, lateral, external oblique (flatten head of radius)

Clinical if radial head not ossified (3-5 yo)

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37
Q

Management of radial neck fx

A

immobilize including wrist
sling
NSAIDs
ortho: cast vs. surgery

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38
Q

Complications of radial neck fractures

A

premature physeal closure
loss of ROM
nonunion

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39
Q

Nursemaid’s elbow

A

subluxation of radial head

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40
Q

MOI of nursemaid’s elbow

A

> 80% b/w 1-3 YO

MOI: sudden pull of pronated arm

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41
Q

Presentation of nursemaid’s elbow

A

arm either fully extended or slightly flexed and pronated
overall refusal to use arm but may use fingers
mild pain over radial head
pain increase w/ attempt to supinate*
evaluate entire extremity

imaging usually not required

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42
Q

pain increases w/ supination

A

nursemaid’s elbow

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43
Q

Management of nursemaid’s elbow

A

reduction by either:

  1. Hyperpronation w/ pressure over radial head *
  2. Supination, flexion w/ pressure over radial head
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44
Q

How to test if reduction worked in nursemaid’s elbow

A

“lollipop/popsicle test”

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45
Q

Wrist fx causes

A

FOOSH

direct trauma

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46
Q

Most common wrist fx

A

distal radius typically involved at metaphysis

+/- unlar involvement

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47
Q

Presentation of wrist fx

A

point tenderness
swelling
ecchymosis

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48
Q

Dx of wrist fx

A

AP, Lat, +/- obliq

SH I often clinical dx w/o initial radiographic finding

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49
Q

Management of wrist fx

A

emergent w/ significant deformity or NV compromise

Splint & NSAIDs
Ortho: cast, +/- reduction vs. surgery

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50
Q

Presentation of femur fx

A

hx of trauma
pain in groin or buttock
unable to bear weight/walk
proximal femus fx pt will hold leg in slight adduction and external rotation (may see shortening of limb)

  • R/O child abuse - 70% of these in kids <1 YO is from abuse
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51
Q

Dx of femur fx

A

xray entire length of femur

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52
Q

Management of femur fx

A

hip spica cast vs. surgery

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53
Q

Complications of femur fx

A

shortening
lengthening
angulation

54
Q

Patellar sleeve fx

A

unique to children; most common patellar fx in kids <13 yo;

seen at either superior or interior pole of patella

55
Q

Cause of patellar sleeve fx

A

forced extension w/ knee in flexion (jumping/kicking)

56
Q

Management of patellar sleeve fx

A

knee immobilizer (full extension), NWB, elevate
NSAIDs
Ortho: cast vs. surgery

57
Q

Toddler fx MOI

A

falling white running/twisting;

SLIDES (spiral fx)

58
Q

Presentation of toddler fx

A

limp or refusal to weight bear (often mistaken as foot injury); pain with palpitation along tibia typically mid to distal diaphysis

59
Q

Dx of toddler fx

A

xray: AP, lateral, obliques; may be occult on initial films

60
Q

Management of toddler fx

A

immobilize (splint/wee walker)
NWB, NSAIDs, elevate if possible
ortho: wee walking vs. cast

61
Q

Triplane fx MOI

A

external rotation

62
Q

Triplane ankle fx

A

SH III on AP view + SH II on lateral = SH IV

63
Q

Management of triplane ankle fx

A

get CT to assess displacement

ortho: surgical fixation vs. closed reduction

64
Q

Fracture or ankle sprain tx

A

initial tx the same: posterior vs stirrup splint
elevation, NWB, NSAIDs
ortho consult for NWB, bony pain, concerns on imaging - most ped ankle injuries are referred

recondition following sprain/fx to prevent recurrent (PT and home exercise program)

65
Q

Torticollis

A

unilateral contraction of SCM muscle with visible shortening

66
Q

Etiology of torticollis

A

compartment syndrome SCM secondary to venous outflow obstruction

67
Q

Presentation of torticollis

A

head tilt to shorted muscle and chin rotation to contralateral side

68
Q

SE of torticollis

A

plagiocephaly: flattening of skull on one side

69
Q

Tx for torticollis

A

stretching/PT

positioning education

70
Q

Scoliosis

A

lateral curve of the spine >10 degrees

71
Q

Epidemiology of scoliosis

A

idiopathic
W>M

congenital/infantile: 0-3
Juvenile: 4-9
Adolescent**: >10
Neuromuscular

~the younger, the more concerning~

72
Q

Presentation of scoliosis

A

asymptomatic
+/- pain
obstructive lung sx if severe

73
Q

PE for scoliosis

A

shoulder or pelvic obliquity
asymmetry of scapulae
adam’s forward flexion exam: paraspinal prominences
abdominal reflexes

74
Q

Imaging for scoliosis

A 
Cobb angle (>10)
AP/PA standing plain radiographs on long cassette
75
Q

Tx for scoliosis

A

TLSO Brace: boston, Milwaukee, Charleston, Bending (25 degress)
Surgery: 45 degrees, internal rod fixation

76
Q

Septic hip ages

A

first few months
3-6 YO

M>F

77
Q

Pathophys of septic hip

A

direct inoculation from trauma/surgery
hematogenous seeding
spreading of osteomyelitis from adjacent bone

(bacterial)

78
Q

Presentation of septic hip

A

febrile and toxic appearing
monoarticular pain: severely exacerbated w/ passive ROM
limited or refusal to weight bear

FABER appearance

79
Q

Ddx for septic hip

A

Psoas abscess

Transient synovitis

80
Q

Pediatric emergency

A

septic hip

81
Q

Most common cause of pediatric hip pain

A

transient synovitis of the hip

82
Q

presentation of transient synovitis

A

appears well, typically afebrile
pain worse in am and improves during day
recent URI ** (viral inflammatory response)

83
Q

Ages for transient synovitis

A

3-8 YO M>F

84
Q

Management of transient synovitis

A

NSAIDS

  • improves in 24-48 hours w/ resolution w/i 1 week
  • must rule of septic arthritis, hospitalize if suspicious
85
Q

Probability of septic hip vs. transient synovitis

A

Kocher Criteria:

  1. WBC > !2,000
  2. ESR > 40
  3. Fever >101.3
  4. Non-weight bearing on affected side

2/4 criteria warrants joinT aspiration
CRP independent risk factor: CRP >2.0

86
Q

imaging for septic hip

A

radiograph: AP and frog-leg lateral pelvic (normal in early stage, potential joint space widening)

U/S: effusion & aspiration

MRI

87
Q

Management of septic hip

A

EMERGENT!!!!
operative: I & D (aspiration and identification is diagnostic)

Abx: cephalosporin IV (monitor CRP and ESR: duration 3-4 weeks)

Non-operative management: N. gonorrhoae (older pt w/ STI) – high dose PCN

88
Q

Main causers of septic hip

A

S. aureus, S. pneumo, GAS, H. influenza

89
Q

Non-operative septic hip

A

gonorrhea: give high dose PCN

90
Q

Legg-Calve-Perthes

A

juvenile idiopathic osteonecrosis of femoral head

91
Q

Age of Perthes

A

4-8 YO

92
Q

Risk factors of perthes

A

family hx
caucasion
maternal smoking or african american

93
Q

Legg-Calve perthes is associated w/

A

ADHD

94
Q

Presentation of Perthes

A

painless limp or insidious onset of pain: hip, groin, thigh, or knee

limp/pain related to activity and worse by end of day; relieved w/ rest

95
Q

Worse in morning

A

transient synovitis of hip

96
Q

Worse at end of day

A

Perthes

97
Q

PE for Perthes

A

gait disturbance
limited internal rotation or abduction of hip
LLD later in course (+) Galeazzi

98
Q

Imaging for perthes

A

radiographs (AP and frog laterals)

  • often initially normal
  • bone scan/MRI if needed

fragmentation and remodeling present on radiographs w/ disease progression

99
Q

Stages of perthes

A

initial phase (necrosis)
fragmentation
re-ossification
healed (remodeling)

100
Q

Tx for perthes

A

younger age of onset = better outcome
Goal: symptomatic control and preserve hip function

Surgery; nonsurgical: observation, activity restrictions, PT

101
Q

Slipped capital femoral epiphysis (SCFE)

A

slippage of femoral physis “ice cream slipping off the cone”

102
Q

Epidemiology of SCFE

A

M>F
10-16 YO
obesity = risk factor!!

103
Q

risk factor for SCFE

A

obesity

104
Q

Presentation of SCFE

A

limp or NWB w/o hip or knee pain (dull, achy)
Restricted ROM: abduction and internal rotatation
stability: stable vs unstable based on WB status

105
Q

Restricted abduction and internal rotation

A

Perthes

SCFE

106
Q

Dx for SCFE

A

x-ray (AP pelvis and frog lat)

MRI if high suspicion and negative XR

107
Q

Tx for SCFE

A

urgent surgical consultation for in situ single screw fixation
NWB! – ADMIT TO HOSPITAL

108
Q

Developmental dysplasia of the hip (DDH)

A

eval in hospital and well child checks: laxity, subluxation, dislocation

109
Q

Greatest risk factors for DDH

A

1st born
female
Breech position
FHX

110
Q

Dx of DDH

A

positive Barlow- displaced
and/or Ortolani- reductive
Clunking sensation
Galeazzi- affected hip shorted in comparison

111
Q

Management of DDH

A

Pavlik Harness***

avoid swaddling and tight fitting clothes
monitor w/ U/S monthly until normal
Radiographs to monitor after 6-7 months

casting/surgery rarly needed

112
Q

Osgood-Schlatter’s Disease

A

inflammation and irriation of patellar tendon insertion on tibial tubercle (osteocondritis)

113
Q

Presentation of osgood-schlatter’s disease

A

focal tenderness to tibial tubercle

enlargement or bony protrusion of tibial tubercle

114
Q

Dx for Osgood-Schlatter’s Disease

A

lateral x-ray used to r/o avulsion

115
Q

Management of osgood-schlatter’s

A

good and bad days

  • rest, NSAID, ice
  • quad exercise, hamstring stretches
  • Chopat strap
116
Q

Pain flares in osgood-schlatter’s

A

at time of rapid growth
girls: 10-11
Boys: 13-14

117
Q

Calcaneal apophysitis aka

A

Sever’s disease

118
Q

What is sever’s disease

A

irritation, inflammation of calcaneal apophysis

  • overuse syndrome
  • pull of achilles tendone
119
Q

Sever’s is most common in

A

age 6-12
soccer players
gymnasts

120
Q

Sx of Sever’s

A

pain at calcaneal apophysis

121
Q

Tx for sever’s

A

stretch
ice
NSAIDs

122
Q

Clubfoot (congenital talipes equinovarus)

A

fixed deformity of the foot; bilateral or unilateral; affected limb has smaller foot and calf w/ shortened tibia

123
Q

Risk for clubfoot

A

FHx

maternal smoking

124
Q

Maternal smoking increases risk of

A

Clubfoot

Perthes

125
Q

types of clubfoot

A 
"CAVE"
midfoot cavus
forefoot adductus
hindfoot varus
hindfoot equinus
126
Q

Tx for clubfoot

A

ponseti method (percutaneous release of tendon)

127
Q

Causes Intoeing

A

femoral anteversion
internal tibial torsion
forefoot adductus

128
Q

Genu Valgum

A

“knock knee”

129
Q

Genu varus

A

“bow legs”

130
Q

Causes of genu varum

A

Blount’s Disease

Rickets- vitamin D deficiency

Peds II Final (3 decks)

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