Physical abuse, Ortho

Question 1

What type of fractures are pathognomonic of abuse?

Answer 1

• classic metaphyseal lesion (CML)

* corner fracture, chip fracture, bucket handle fracture

Question 2

Most rib fractures from abuse are located where?

Answer 2

-posterior near the vertebrae or lateral

Question 3

What is a serious consequence of shaken baby syndrome?

Answer 3

• subdural hematoma

Question 4

Retinal hemorrhages are commonly seen in this condition.

Answer 4

• shaken baby syndrome

Question 5

What % of kids grade 6-12 report to have been bullied at school?

Answer 5

10%

Question 6

Which of the Salter-Harris fracture types is a clinical diagnosis?

Answer 6

• Type 1

* not able to be seen on XR films

Question 7

Dysplasia of the hip is much more common in which gender?

Answer 7

• Girls 6x greater

Question 8

What are the 2 newborn exams for DDH? What are you trying to elicit with each test?

Answer 8

• Barlow’s = dislocation

- Ortolani’s = relocation

Question 9

If you pick up any abnormality in the DDH exam for how long should you continue observation before treating?

Answer 9

• for 1 month

Question 10

What is the first treatment option for DDH?

Answer 10

• Pavlik harness

* check alignment by XR in 1-2 weeks

Question 11

What is the treatment option for DDH if it is picked up after 6 months of age?

Answer 11

• closed reduction surgery

Question 12

What is the treatment option for DDH if it is picked up after 2 years?

Answer 12

• open reduction + femoral or pelvic osteotomy

Question 13

What is the most common cause of an acquired painful hip?

Answer 13

transient synovitis of the hip

Question 14

What is the hallmark sign of transient (toxic) synovitis of the hip?

Answer 14

• spasm with hip internal rotation

Question 15

What drug therapy can result in dramatic improvement for transient synovitis of the hip?

Answer 15

• NSAIDs

Question 16

What is the proposed cause of Legg-Calve-Perthes Disease (LCPD)?

Answer 16

• joint effusion disrupting blood flow to femoral head during critical development stage leading to necrosis of proximal femoral head

Question 17

What is a common biologic risk factor for slipped capital femoral epiphysis (SCFE)?

Answer 17

• obesity

Question 18

What % of SCFE incidents are bilateral?

Answer 18

• 25-35%

Question 19

If a patient presents with a mildly painful limb that was not acute onset what are you concerned for?

Answer 19

Legg-Calve-Perthes Disease (LCPD)

Question 20

slipped capital femoral epiphysis (SCFE) is more common in which 2 populations?

Answer 20

• Male

- African Americans

Question 21

What degree of varum is common until 18 months?

Answer 21

Up to 20 degrees is normal

Question 22

Rickets is a risk factor for what?

Answer 22

• pathologic genu varum

Question 23

Night bracing for genu valgum is necessary if exceeds how much degrees?

Answer 23

> 20 degrees

Question 24

Surgery for genu valgum is indicated in what instance?

Answer 24

> 15 degrees at 10 yo

Question 25

What is a common sign of osgood-schlatter disease?

Answer 25

• prominence of tibial tubercle

Question 26

What is the cause of Osgood-schlatter disease?

Answer 26

• skeletally immature athlete with open tibial growth plate

* associated with rapid growth spurt