Upper Extremity Peds Squirm Flashcards
Growth Plate Zones
Germinal zone.
Proliferative
Hypertrophi
Endochondral
Name of fragment in a type II salter harris
Thursday holland is metaphyseal fragment
Skipped Ogden
ok
Ossification of humeral head, greater and lesser tuberosity?
6 months
1-3 years
4 years
Classification of proximal humeral plate fracture
Neer Harowitz Grade 1 is less than 5 mm displaced Grade II is less than 1/3 width Grade III is displaced 1-2 thirds Grade IV is greater than 2/3 width
Acceptable alignment for Proximal humerus fracture in kids. Complication?
1-4 years old: any angulation
5-12 years old: up to 45 degrees angulation and one half displaced (near III)
12 is 20 degrees of angulation and displacement of less than 30% (neer horowitz II)
Can do osteotomy if its a problem, Axillary nerve needs exploration if out after 4 months (1% incidence and usually neuropraxia)
whats the disease with no clavicle?
cleidocranial dyostosis
Classification of AC disruption
Dameron and Rockwood (two favs) 1-3 is noon
1 is sprain
2 is partial tear with widening
3 is periosteal split with 25-100% displaced
4 posterior displacement buttonholed through trap
5 more than 100% displaced
6 is infracoracoid and into the conjoined tendon
Ossification of scapula shit?
Coracoid 1 year for base, upper fourth are 10 years
Acromion fuses late, 20 year
stopped writing it
Stryker notch view is for what?
Coracoid fracture or hill sachs
Ideberg:
1a antioer, 1b posterior glenoid, 2 inferior exit 3 superior exit, 4 across the body, 5 is combo, six is comminuted
Acromion fracture
1 non displaced. 1 a is avulsion, 1b direct trauma
II is displaced without narrowing
III is subacromial narrowing
Shoulder suspensory complex
Clavicle AC, acromion, neck glneoid, coracoid and CC
What do you consider if luxatio?
Ehler’s dances syndrome
Reduction of elbow first move?
How do you splint anterior dislocation?
HYPERSUPINATION
Some extension
Bauman angle?
Humeral ulnar angle?
Metaphyseal diaphysial angle
11-20 degrees
5-15
40 degrees
Most common displacement and how it happens in supracondy? What type puts risk to brachial after and median nerve?
Posteromedial is more common! and happens when pronated (makes sense, its how you catch yourself)
IT IS LUCKY because posteriolateral puts brachial after and nerve at risk
Classification of supracondy’s
Gartland
Milch lateral condyle?
What are stages? Tx?
Note: crepitus suggests unstable
Through trochleaocapitellar groove. Two is through trochlea
Jakob!
Stage 1 is intact articular surface, less than 2 mm displace
Stage 2 is 2-4 mm displaced and articular surface disrupted
Stage 3 is displaced fragment, rotated
Stage 1 usually treat in slab with forearm NEUTRAL!!!!
Warning sign of medial condyle?
watch out for fat pad sign, because epicondyle is actually not in the capsule
Medial condyle staging?
Kilfoyle?
Transphyseal imaging finding?
Classification
Posteriomedial displacement but radial and ulnar relationship maintained
DeLee: Based on ossification Lateral condyle
1 is prior to it being there (salter 1, before 1 year old)
2 is age 1-3. Can be 1 or II SH
3 is age 3-7, WATCH For smooth outline of distal metaphysics
T condylar fracture classification?
1 nondisplaced
2 Displaced but no metaphysical comminution
3 Displaced
Basically always need OR
Radial head/neck classification?
Obrien is based on angulation
Type 1 is less than 30 degrees
2 is 30-60
6 is more
Wilkins is based on fracture
A SH1 or 2
B is SH3 or 4
C is metaphseal completely
Treatment radial head?
Type 1 obrien (less than 30 degree is nonop)
Type 2 is isrealli or patterson method of reduction. Esmarch also
type 3 is OR or do OR for anything unstable
Problem with ORIF radial head?
Osteonecrosis, PIN, shit like that
Olecrenon fx tx?
In cast with 5-10 degrees flexion unless significantly displaced. THINK ABOUT OI
Unless shear, then hyper flex but worry about swelling
Montagia equivalent classification?
1 is isolated radial head dislocation
2 is ulna and proximal radius fracture
3 isolated radial neck
4 is elbow dislocation
Acceptable angulation in montagna?
10 degrees as long as radial head pops in
Galleazi classification and positions for treating?
Type 1 is apex volar. IT IS A SUPINATION injury. So pronate it (remember thumb follows apex)
Type 2 is opposite. Apex dorsal so supinate it
Distal radius physical injury acceptable range?
1 and 2 needs 50% apposition without rotational deformity.
SH III must be anatomic
IV and V need surgery if at all displaced (1 mm)
Also OR if carpal tunnel
Acceptable deformity for radius fracture?
15 degrees if less than 9 for girls 11 for boys
10 degrees for 9-13 for girls
10 degrees for 11-13 for boys
none after that
Scaphoid classification. Who gets surgery?
Type A is distal pol
a1 extraarticular. A2 intraartic
B is middle third (waist)
C is proximal pole
Displacement 1 mm or angulate more than 10 degrees
Capitate and scaphoid fx without dislocation is what?
Naviculocapigtate syndrome
Metacarpal classification
Type A epiphyseal/physeal
Type B metacarpal neck: 4th and 5th is peds version of peer fracture Acceptable angulation is 15 for 2nd and 3rd, 45 for 4th and 5th
C shaft and ten degrees for 2nd and 3rd and 20 for 4th and 5th
D is base. Unstable, usually operative
Thumb metacarpal classification
NOTE physis is proximal
A is distal to physis and 30 degrees acceptable
B is Salter harris two metaphseal medial. APL pulls laterally and proximally, adductor medial. THUMB SPICA
C is SH II and metaphysical laterally. Tends to buttonhole and need ORIF
D intraarticular III or IV and bennet equivalent
Gamekeeper classification
A sprain
B rupture of ligament
C avulsion (Salter harris 3)
D psuedogamekeeper: from SH 1 or II feracure
Phalanx classifciation
A physeal
B is shaft and tend to be APEX VOLAR in P1 due to lateral band and central slip
C Neck USUALLY operative b/c shit gets stuck in it like volar plate
D condylar intraairticular and needs wires to hold it
Phalanx fx operative when?
Unstable type C and D (neck and condyle)
Interposition of shit and won’t reduce
Type B (shaft) and alignment angulated 30 degrees or 2- degrees if ten
