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Summer Disciplines 3 > Peds ortho LE > Flashcards

Peds ortho LE Flashcards

1
Q

How do femur fractures usually present

A

Hx of trauma
pain in groin or buttock
unable to bear weight/walk

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2
Q

How does a proximal femur fracture present

A

Patient holding leg in slight ADduction and ER

Can see shortening of limb

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3
Q

What must you r/o in a patient with a femur fracture

A

child abuse

it is very unlikely a child will Fx the femur, 70% are 2/2 abuse

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4
Q

How do you diagnose a femur fracture

A

XR the entire* length of femur

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5
Q

How do you manage a femur fracture

A

Send to ortho for hip spica cast or surgery

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6
Q

Complications of a hip Fx are

A

shortening of limb
lengthening of limb
angulation

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7
Q

What is a patellar sleeve fracture

A

Peds fracture caused by forced extension with knee in flexion (jumping, kicking)
Seen at superior or inferior pole of patella

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8
Q

How do you manage a patellar sleeve fracture

A

*Knee immobilizer (in complete extension)
NSAIDs
Send to ortho for cast vs surgery

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9
Q

What is a Toddler’s fracture

A

a spiral tibial fracture

Commonly caused by a young kid falling while running, twisting mechanism

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10
Q

How do you diagnose a Toddler’s Fx

A 
Usually clinically (can be an occult Fx on initial films) 
XR AP, lateral, and oblique
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11
Q

How do you manage a toddler’s fracture

A

Immobilize (splint)
non-weight bearing, NSAIDs, Elevate
Ortho for wee walker vs cast

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12
Q

How does an ankle sprain/Fx present

A

ttp**
swelling and ecchymosis
WB status depends on location and severity

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13
Q

How do you diagnose an ankle sprain/Fx

A

XR: AP, mortise, lateral, internal & external oblique

May appear occult in kids

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14
Q

What is a mortise view XR

A

Look at the mortise, the U shape

If it is NOT wide then you likely have a fracture

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15
Q

How do you manage an ankle sprain/Fx

A

Posterior vs stirrup splint

Elevation, NWB, NSAIDs Ortho consult as needed

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16
Q

What are triplane fractures

A

Ankle injury from external rotation

SH 3 on AP view + SH 2 on lateral view= SH 4

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17
Q

How do you diagnose a Triplane fracture

A

XR to diagnose it

Need a CT to assess displacement

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18
Q

How do you treat a Triplane fracture

A

Surgical fixation vs closed reduction

Closes medially before laterally

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19
Q

What is a jones, Pseudo-jones/avulsion Fx

A

Fracture of the base of 5th MT

Occurs 2/2 pull of peroneus brevis at insertion site, and aponeurosis (traction injury)

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20
Q

How can you distinguish between the apophysis and a jones fracture

A

Apophysis typically runs parallel to MT shaft

Fracture typically runs perpendicular to MT shaft

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21
Q

What is torticollis

A

Unilateral contraction of SCM w/ visible shortening

2/2 compartment syndrome SCM from venous outflow obstruction

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22
Q

How does torticollis present

A

head tilt to short muscle side, chin rotation to oppo side

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23
Q

How do you treat torticollis

A

Stretching, PT

Positioning education

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24
Q

What is scoliosis

A

lateral curve os spine >10 degrees
rotational component
W>M
MC in adolescents >10 y/o

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25
How does adolescent idiopathic scoliosis present
ASx! | +/- pain and obstructive lung Sx if severe
26
On AIS PE, what will you see
Shoulder or pelvic obliquity Asymmetry of scapulae Adam's forward flexion shows paraspinal prominences Abdominal reflexes
27
What imaging should you get for AIS
XR AP/PA standing on a LONG casette- if you are unsure of what imaging to get, refer so they don't get unnecessary radiation Looking for Cobb angle!
28
How do you treat AIS
TSLO brace if up to 25 degrees (stops progression but does not fix the curve) Surgery if 45+ degrees, need internal rod fixation
29
What is osteochondritis dissecans
Idiopathic osteonecrosis of subchondral bone MC in knee but also in elbow (capitellar osteochondrosis) and in adults ankles MC etiologies are repetitive trauma, vascular disruption, ischemia s/p trauma, +/- genetic predisposition
30
What is juvenile OCD
Repetitive small stresses to subchondral bone lead to disruption of bone supply
31
What are the grades of OCD
``` I is SF II is deeper abrasions III looks like a punch IV has cartilage coming off V has a loose body ```
32
What causes elbow OCD
chronic valgus stress or microtrauma with compression in overhead activities Affects capitellum MC in teens and young adults that are throwers or in gymnastics
33
What causes knee OCD
Repetitive axial loading (valgus/varus stress), usually over the lateral portion of medial femoral condyle MC in preteens
34
How does OCD usually present
Gradual onset of poorly localized deep pain (ex. if elbow, just deep lateral pain) Decreased ROM if in elbow (not common in knee) Limited WB in LE *popping, locking, or catching if advanced +/- swelling
35
What are common knee and elbow OCD findings
Elbow: pain and guarding with passive motion. Lateral pain with valgus stress Knee: pain with flexion over medial condyle. gait disturbance
36
What imaging should you get for OCD
XR (will show flattening of articular surface (like a crater) MRI if XR is inconclusive
37
How do you treat OCD
Stage I-III: conservative Tx. avoid running and jumping. +/- immobilization and PT Surgery if intraarticular loose body (stage 4) or if skeletally mature
38
What kind of surgery is done for OCD
Drilling to stimulate vascular growth and new bone formation Fixation if unstable or to remove a loose fragment
39
What is septic hip vs transient synovitis
Septic hip is an infectious process. Often febrile and ill appearing Transient synovitis is an inflammatory mechanism. Usually s/p viral illness
40
How do septic hips and transient synovitis present
Hold leg in flexion, abduction, and slight ER | Refuse to bear weight, walk with limp
41
What is Kocher criteria
``` A diagnosis that helps you determine if you need a joint aspiration. 2/4 means aspirate! 1. WBC >12K 2. ESR >40 3. Fever >101.3 NWB on affected side ```
42
How do you manage transient synovitis
Outpatient obs Activity restriction NSAIDs (high dose can be diagnostic and therapeutic)
43
How do you manage septic hip
Admit with emergent ortho referral Joint aspiration or surgical ID is diagnostic Need IV antibiotics after drainage!
44
What is legg-calve-perthe disease
Idiopathic avascular necrosis of femoral head | MC in boys 4-8, thin and very active
45
How does Legg-calve-perthe disease present
Limp by EOD Occasional pain in knee or hip region Limited IR and abduction of the hip
46
How do you diagnose Legg-Calve-perthe disease
Initially clinical, get radiographs to confirm
47
How do you treat Legg-calve-perthe disease
Observation PT to improve ROM Activity modifications Surgery for realignment
48
What is the course of legg-calve-perthe disease
Initial: femoral head necrosis Fragmentation: reabsorption of bone, femoral head collapse Re-ossification: new bone formation Healed (remodeling): femoral head reshapes into normal spherical shape (flattening, fragments, re-ossifying, new head)
49
What is a slipped capital femoral epiphysis
When the femoral physis slips off __ MC in men, 10-16 y/o can be stable vs unstable based on WB status RF: Obesity**
50
How does SCFE present
Limp or NWB w/ complaint of hip/knee pain (sull or achy) | Restricted abduction and IR
51
How do you diagnose SCFE
XR (AP pelvis, Frog lat)* bilateral | MRI if XR is negative but you still highly suspect
52
How do you treat SCFE
Urgent surgical consult for screw fixation | NWB, admit to hospital
53
What is DDH
MC ortho condition in newborns F>M Screen for laxity, subluxation, and dislocation in hospital and at every well child visit
54
What is the pathophys of DDH
maternal/fetal laxity genetic laxity IU malpositioning *RF: first born, breech, or FHx
55
What tests can you do for DDH
Barlow (back): provocative maneuver. Flex, ADduct, and provide posterior pressure to joint Ortolani: reductive maneuver. Flex, ABduct, and posterior pressure to lift the greater trochanter Galeazzi: while supine, flex knees to 90 to assess limb length. DDH side will be lower
56
What should you do if you get a positive ortolani or barlow
Refer to ortho! If inconclusive, repeat B&O in 2 weeks If not positive, eval for FHx (refer if positive)
57
How do you manage DDH
Ortho referral Pavlik harness (initiate by 6 weeks, keep for 6 weeks. doesn't hurt baby at all!) Avoid swaddling and tight fitting clothes Compliance is key! (do NOT usually need cast)
58
What is Osgood Schlatter disease
inflammation or irritation of patellar tendon insertion at tibial tubercle AKA traction at tibial tubercle apophysis
59
How does osgood schlatter present
focal tenderness to tibial tubercle | Enlargement or protrusion at tibial tubercle
60
How do you diagnose osgood schlatter
Lateral XR, need to r/o avulsion
61
How do you manage osgood schlatter
rest, ice, NSAIDs quad exercises and hamstring stretches Chopat strap
62
When is pain most prevalent in osgood schlatter
During times of rapid growth; Girls 10-11 Boys 13-14
63
What is Sever's disease
irritation or inflammation of calcaneal apophysis causing pain over cancaneal apophysis (essentially osgood schlatter but in heel of foot) 2/2 overuse* and rarely achilles tendon pull MC in soccer and gymnastics 6-12 y/o
64
How do you treat Sever's disease
stretch ice NSAIDs
65
What is club foot (congenital talipes equinovarus)
Fixed deformity that can be bilateral or unilateral (affected limb has smaller foot and calf w/ shorter tibia) RF: FHx, maternal smoking
66
Clbfoot presents with
midfoot Cavus forefoot Adductus hindfoot Varus hindfoot Equinus
67
How can you diagnose Clubfoot
on fetal US!
68
How do you treat clubfoot
Ponseti method of correction, takes 4-6 weeks of casting

Summer Disciplines 3 (9 decks)

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