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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
Q

How does adolescent idiopathic scoliosis present

A

ASx!

+/- pain and obstructive lung Sx if severe

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26
Q

On AIS PE, what will you see

A

Shoulder or pelvic obliquity
Asymmetry of scapulae
Adam’s forward flexion shows paraspinal prominences
Abdominal reflexes

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27
Q

What imaging should you get for AIS

A

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!

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28
Q

How do you treat AIS

A

TSLO brace if up to 25 degrees (stops progression but does not fix the curve)
Surgery if 45+ degrees, need internal rod fixation

29
Q

What is osteochondritis dissecans

A

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
Q

What is juvenile OCD

A

Repetitive small stresses to subchondral bone lead to disruption of bone supply

31
Q

What are the grades of OCD

A 
I is SF
II is deeper abrasions 
III looks like a punch
IV has cartilage coming off 
V has a loose body
32
Q

What causes elbow OCD

A

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
Q

What causes knee OCD

A

Repetitive axial loading (valgus/varus stress), usually over the lateral portion of medial femoral condyle
MC in preteens

34
Q

How does OCD usually present

A

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
Q

What are common knee and elbow OCD findings

A

Elbow: pain and guarding with passive motion. Lateral pain with valgus stress
Knee: pain with flexion over medial condyle. gait disturbance

36
Q

What imaging should you get for OCD

A

XR (will show flattening of articular surface (like a crater)
MRI if XR is inconclusive

37
Q

How do you treat OCD

A

Stage I-III: conservative Tx. avoid running and jumping. +/- immobilization and PT
Surgery if intraarticular loose body (stage 4) or if skeletally mature

38
Q

What kind of surgery is done for OCD

A

Drilling to stimulate vascular growth and new bone formation
Fixation if unstable or to remove a loose fragment

39
Q

What is septic hip vs transient synovitis

A

Septic hip is an infectious process. Often febrile and ill appearing
Transient synovitis is an inflammatory mechanism. Usually s/p viral illness

40
Q

How do septic hips and transient synovitis present

A

Hold leg in flexion, abduction, and slight ER

Refuse to bear weight, walk with limp

41
Q

What is Kocher criteria

A 
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
Q

How do you manage transient synovitis

A

Outpatient obs
Activity restriction
NSAIDs (high dose can be diagnostic and therapeutic)

43
Q

How do you manage septic hip

A

Admit with emergent ortho referral
Joint aspiration or surgical ID is diagnostic
Need IV antibiotics after drainage!

44
Q

What is legg-calve-perthe disease

A

Idiopathic avascular necrosis of femoral head

MC in boys 4-8, thin and very active

45
Q

How does Legg-calve-perthe disease present

A

Limp by EOD
Occasional pain in knee or hip region
Limited IR and abduction of the hip

46
Q

How do you diagnose Legg-Calve-perthe disease

A

Initially clinical, get radiographs to confirm

47
Q

How do you treat Legg-calve-perthe disease

A

Observation
PT to improve ROM
Activity modifications
Surgery for realignment

48
Q

What is the course of legg-calve-perthe disease

A

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
Q

What is a slipped capital femoral epiphysis

A

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
Q

How does SCFE present

A

Limp or NWB w/ complaint of hip/knee pain (sull or achy)

Restricted abduction and IR

51
Q

How do you diagnose SCFE

A

XR (AP pelvis, Frog lat)* bilateral

MRI if XR is negative but you still highly suspect

52
Q

How do you treat SCFE

A

Urgent surgical consult for screw fixation

NWB, admit to hospital

53
Q

What is DDH

A

MC ortho condition in newborns
F>M
Screen for laxity, subluxation, and dislocation in hospital and at every well child visit

54
Q

What is the pathophys of DDH

A

maternal/fetal laxity
genetic laxity
IU malpositioning
*RF: first born, breech, or FHx

55
Q

What tests can you do for DDH

A

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
Q

What should you do if you get a positive ortolani or barlow

A

Refer to ortho!
If inconclusive, repeat B&O in 2 weeks
If not positive, eval for FHx (refer if positive)

57
Q

How do you manage DDH

A

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
Q

What is Osgood Schlatter disease

A

inflammation or irritation of patellar tendon insertion at tibial tubercle
AKA traction at tibial tubercle apophysis

59
Q

How does osgood schlatter present

A

focal tenderness to tibial tubercle

Enlargement or protrusion at tibial tubercle

60
Q

How do you diagnose osgood schlatter

A

Lateral XR, need to r/o avulsion

61
Q

How do you manage osgood schlatter

A

rest, ice, NSAIDs
quad exercises and hamstring stretches
Chopat strap

62
Q

When is pain most prevalent in osgood schlatter

A

During times of rapid growth;
Girls 10-11
Boys 13-14

63
Q

What is Sever’s disease

A

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
Q

How do you treat Sever’s disease

A

stretch
ice
NSAIDs

65
Q

What is club foot (congenital talipes equinovarus)

A

Fixed deformity that can be bilateral or unilateral (affected limb has smaller foot and calf w/ shorter tibia)
RF: FHx, maternal smoking

66
Q

Clbfoot presents with

A

midfoot Cavus
forefoot Adductus
hindfoot Varus
hindfoot Equinus

67
Q

How can you diagnose Clubfoot

A

on fetal US!

68
Q

How do you treat clubfoot

A

Ponseti method of correction, takes 4-6 weeks of casting

Summer Disciplines 3 (9 decks)

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