Peds Ortho Knott (Exam 2) Flashcards
Your 5yo male patient has an antalgic gait (hip abducted and externally rotated) from a sore hip, no fever, recently had a URI. What is your dx?
Transient synovitis
Your peds pt has acute onset of fever with joint pain and a limp. Pt has swelling, pain, and limited ROM, joint effusion, and warm/tender joint. The CBC shows a left shift. What is your dx?
Septic arthritis
Your 3yo peds pt imaging shows infection in the metaphysis that lifts the periosteum. BloodCx shows gram positive staph. What is your dx?
osteomyelitis
Your 15yo male pt presents to the clinic with pain in proximal femur that is worse at night. He has point tenderness over the area with swelling, and he has a limp. NSAIDs relieve the pain. On xray you see a “radiolucent nidus.” What is your dx?
Osteoid osteoma
What are the 3 benign bone lesions for peds?
Osteoid osteoma
Osteoblastoma
Osteochondroma
Your male peds pt presents with chronic pain in the c-spine that is not responsive to nsaids. You see a mass on the posterior column of the spine that looks like an “expansive bony lesion.” What is your dx?
Osteoblastoma
Your 15yo male pt presents to the clinic with a cartilage capped bony spur on his distal femur. The xray shows an osseous spur or “cauliflower” appearance. What is your dx?
Osteochondroma
Name the two malignant bone lesions Knott talked about.
Osteosarcoma and Ewing sarcoma
You see a 14yo pt who presents to the clinic with localized pain over the femur that has been there for several months. On PE you note a large, tender, soft tissue mass. Labs are normal except alkphos and LDH are elevated. On xray you see a “sunburst” near the metaphysis of the femur. What is your dx?
Osteosarcoma, most common primary malignant bone lesion in kids
Your 14 yo pt has localized proximal femur pain and swelling that is aggravated by exercise and is worse at night. On plain film you notice a “moth-eaten” or permeative lesion, Codman’s triangle, and an “onion peel” appearance. What is your dx?
Ewing’s sarcoma
Your peds patient has a distal radius buckle fx from a FOOSH. Do you need to reduce?
No, immobilize
Your 3yo peds pt has a bowing of the radius and ulna that is less than 20 degrees. Should you reduce?
Less than 20deg or child <4yo it will self correct, so no reduction
Fx that doesn’t go all the way across the bone?
Greenstick fx
Your peds pt has a fx straight through the physis or growth plate. What type of Salter-Harris fx classification is this?
Type 1: straight across physis Type 2: above physis Type 3: below physis Type 4: Through physis Type 5: Crushed
Type 1 and 2 Salter-Harris fxs usually do well with little complication, but types 3-5 may require what?
Percutaneous pinning or ORIF (open reduction internal fixation)
Your peds pt presents to the ER after a FOOSH with the elbow in extension as he fell backwards. You notice a fat pad sign. Pt reports pain, is guarding, and can’t perform ROM tests. You note swelling on PE. You know you should check N/V status distally because you suspect what dx?
Supracondylar fx
Your peds patient presents for FOOSH and pain in the “snuff box.” You suspect a scaphoid fx bc you’re an awesome APP. What are you worried about?
Avascular necrosis
Your peds pt presents to the ER with hand pain after punching a brick wall because his gf left him for another man. You note his pinky finger is angulated. What do you suspect for a dx?
Boxer’s fx of the 5th metacarpal
When should you think about NAT (non accidental trauma) in your peds pt?
Rib fxs
Long bone fx in non-ambulatory peds
Injury inconsistent with hx
Sternum, scapula, spinous process, vertebral body fxs
Multiple fxs in various stages of healing
Digital fx in peds <3yoa
Complex skull fxs in <18mo peds
When do the posterior and anterior fontanelles close?
2 months
2 years
Premature closure of any of the sutures in isolation or in multiple areas is?
Craniosynostosis
Premature closure of a unilateral coronal suture is called?
Anterior plagiocephaly
Premature closure of a unilateral lambdoid suture is called?
Posterior plagiocephaly
Flattening of the forehead and elevation of the eyebrow on the affected side is indicative of what?
Plagiocephaly
What is caused by a premature fusion of the sagittal suture, which results in decreased width and elongation of the AP axis of the cranium?
Scaphocephaly
What is the difference noted on inspection between deformational plagiocephaly and synostotic plagiocephaly?
Deformational the ears are not in equal alignment (maybe from the way the kid sleeps. Totally normal)
Synostotic plagiocephally the ears are in alignment as you look down on the head, but the forehead is flattened and the eyebrow is elevated on the affected side)
Scaphocephaly, or premature closure of the saggital suture, may be normal in which ped population?
Premature infants <36wks and 3 days
Your peds pt presents with a head tilt toward the affected side of contracture and the chin away from the affected side. What do you suspect?
Torticollis
Scoliosis is seen more in girls, mostly in the thoracic region. What is the epidemiology?
80% idiopathic
30% family hx (genetic)
Scoliosis is much more common in what peds population?
adolescent peds >10yoa
At what degree of contortion should you consider using a brace? Surgery?
25-40 degrees for brace
>40 degrees for surgery
What is a fracture of the posterior arch in the lower lumbar spine due to overuse (stress, fatigue)?
Spondylolysis
What is a defect/fx in the posterior arch with anterior displacement of the vertebral body?
Spondylolisthesis
What are 4 risk factors for DDH (developmental dysplasia of the hip)?
1st born
Breech birth (legs first)
Female gender
Family hx
Besides a positive Barlow and Ortolani, what are some findings on PE that might indicate DDH?
- Galeazzi test or Allis sign: It is performed by flexing an infant’s knees when they are lying down so that the feet touch the surface and the ankles touch the buttocks. If the knees are not level then the test is positive
- inguinal folds extending beyond the anal aperture
What are the age ranges for US vs X-ray for peds with DDH?
<4-6wks US
|»_space;4-6wks X-ray
DDH tx for peds pt 0-6months? 6-12 months?
- Pavlik Harness for 0-6 months
- Closed reduction w/ hip spica cast for 3-4 months
What are 4 complications of DDH if undiagnosed?
Avascular necrosis
Deformed femoral head
Leg length discrepancy
Early onset arthritis
On imaging for your peds pt you notice “ice cream falling off the cone.” Your pt is also overweight, african american, and a male between 11-16yoa. What is your dx?
SCFE (slipped capital femoral epiphysis)
Parents may notice a limp
Pain with any weight bearing activity
What are the treatments and complications of SCFE (slipped capital femoral epiphysis)?
Non-wt bearing for >8wks
Percutaneous pinning in situ
Avascular necrosis
What is the name of the disease when a peds pt has osteonecrosis of the femoral head?
Legg-Calve-Perthes disease
When considering treatment for osteonecrosis of the femoral head (Legg-Calve-Perthes disease), what should you be most concerned about?
Avoiding severe degenerative arthritis
How do you treat osteonecrosis of the femoral head (LCP disease)?
Crutches, PT, bracing, traction
Surgery for severe cases
When do you refer to ortho for valgus?
> 8cm between medial malleoli
- progressive knock-knees after age 4-5
- asymmetry
- short stature
- hx of concern such as metabolic disease, fx, tumor, infection
Indications for referral for genu varus in peds?
> 6cm between medial femoral condyles
- progressive bowing
- persistent bowing after age 3
- asymmetric
- short stature
- hx of concern
What is the most common congenital foot deformity?
Metatarsus adductus (medial deviation of the forefoot)
How do you treat clubfoot in an infant?
- Stretch medial/posterior elements
- serial casting/splinting to hold correction
- percutaneous heel-cord lengthening
- after correction will need nighttime brace
- surgical (10%)
Your male adolescent patient with bilateral complains of pain and points directly to his tibial tuberosity where the patellar ligament inserts. What dz are you suspicious of?
Osgood Schlatter’s dz
How do you treat the bony growth on the anterior tuberosity of the tibia seen in Osgood-Schlatter’s dz?
Resolves when growth plates close at 14-16 yoa
RICE
Nsaids
PT
Your adolescent patient presents with heel pain right where the achilles inserts into the calcaneus. The pain is relieved with RICE and nsaids. What do you suspect for a dx?
Sever’s Apophysitis
Your adolescent (>10yoa) patient presents with knee pain. You dx it as Osgood-Schlatter’s dz. What other dz accompany’s Osgood-Schlatter’s that also affects the knee?
OCD (osteochondrosis dessicans): ostenecrosis of subchondral bone
Your pediatric patient, who plays baseball, presents with elbow pain at the medial epicondyle apophysis. What is at the top of your ddx?
Little Leaguer’s elbow akak “lateral epicondylitis”
Besides inflammation at the medial epicondyle apophysis, what fractures might you see in a peds pt with lateral epicondylitis?
Avulsion fx of lateral epicondyle
Lateral compression of radial head and capitellum
Your peds pt presents with her mother who says she was swinging her daughter by her arms when her daughter started crying. After stopping the slinging motion, the daughter holds her arm against her body in pain. You suspect nursemaid’s elbow where the radial head slips under the annular ligament in a subluxation. How do you treat this pt?
Lots of morphine (jk)
Place thumb of one of your hands on the radial head that is subluxed. With your other hand, extend the arm in a supination movement, then flex the arm. You should feel the radial head slip back into place with your thumb as you provide pressure. Place the arm across the child’s chest and place in sling.
