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radiology > Pediatric MSK > Flashcards

Pediatric MSK Flashcards

1
Q

what is the most common salter Harris fracture?

A

type 2 (75%)

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2
Q

Which SH fractures are ass w/ complications. What are they and mx?

A
  • Type 3-Growth arrest. Require surgery
  • Type 4: growth arrest, focal fusion. Require anatomic reduction (often sx)
  • type 5-poor prognosis.
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3
Q

“bony bridge across physics”

A

type 5 SH

A physeal bar or partial premature physeal arrest is a result of injury or infection to an unfused physis. It consists of a bony bridge crossing the growth plate that results in growth disturbance and/or deformity.

These bars form when the cartilage barrier is breached as a result of infection or trauma, this abnormal connection of metaphysis and epiphysis can be fibrous or osseous.

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4
Q

physeal bar

A

early bony bridge crossing growth plate

-inf or trauma

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5
Q

how long for periosteal rxn to appear on xray?

A

7-10 d

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6
Q

toddler fx

A

oblique fracture; 9 mo-3 yr

-if spiral, question child abuse

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7
Q

Wimberger sign

A

destruction of medial portion proximal metaphysis of tibia ass w/ syphilis. Pathogmonic.

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8
Q

torch infections w/ osseous change

A

-rubella (50%, appears ~wks) & syphilis (95%, appears ~6-8 wks)

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9
Q

syphilis osseous change

A

95%

  • app 6-8 wks
  • metaphyseal lucent bands, periosteal rxn
  • “wimberger sgx”-destruction of medial portion proximal tibial metaphysis

*Treponema pallidum

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10
Q

rubella osseous change

A

50%

  • ~wks
  • “celery stall”-generalized lucency of metaphysics
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11
Q

Caffey dx

A

aka infantile cortical hyperostosis

  • ST swelling, periosteal rx, irritability ~6 mo’s life
  • HOT MANDIBLE –> clavicle –> ulna
  • self-limiting
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12
Q

Effects of PgE 1 & 2

A

periosteal rxn

-look for sternotomy wires

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13
Q

neonatal periosteal rxn

A
  • cong rubella, syphilis
  • caffey
  • PgE 1 & 2
  • NB mets
  • physiologic (NOT newborns, ~3 mo)
  • abuse
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14
Q

physiologic periostitis of newborn-rules

A

NOT newborns (~3mo’s)

  • first involves femur THEN tibia
  • always involves DIAPHYSIS
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15
Q

3 classic appearances LCH

A
  • beveled edge (uneven destruction inner and out tables)
  • ribs-mult lucent lesions, expanded appearance
  • spine-pancake/vertebra plant
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16
Q

“septic tank”

A

crossing vess close and infection cannot escape

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17
Q

when does OM bony change appear?

A

day 10

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18
Q

Define:

-brachy-, poly-, syn-, camp-, clino-, arachnodactyly

A
  • short
  • too many
  • fused
  • contracture
  • radially angulated (usually 5th)
  • spider like
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19
Q

a-, mero-, acro-, meso-, rhizo-, micromelia

A
  • limb absent
  • mostly absent
  • hands/feet (distal limbs) are short
  • forearm/lower leg (middle limb) short
  • femur/humerus (prox lims) short
  • short all over
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20
Q

Dwarfism-subtypes to know

A
  • achondroplasia=mc
  • thanatophoric=mc lethal
  • asphyxiating thoracic dystrophy (Jeune)-usually fatal
  • ellis-van crevald
  • pseudoachondroplasia
  • pyknodysostosis
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21
Q

achondroplasia-moa, RF, classic findings

A
  • mc skel dysplasia
  • fibroblast GF rec problem. FGFR3–> abN cartilate formation. Affects bones formed by endochondra oss, not mesenchymal
  • RF-advanced paternal age
  • Symmetric shortening of all bones, rhizomelia=most prom.
  • tomb stone iliac crest, narrowing interpedicular distance, trident hands (3rd/4th long fingers), rhizomelia, flat acetabula w/ short femoral necks
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22
Q

thanatophoric dysplasia

A
  • mc lethal dwarfism
  • rhizomelia-“telephone receiver”
  • very short ribs w/ long thorax
  • small/squared iliac bones
  • cloverleaf skull
  • flat vertebral bones (platyspondyly)
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23
Q

asphyxiating thoracic dystrophy (jeune)

A
  • usually fatal
  • “bell shaped thorax” w/ short ribs that are bulbous anterior
  • high-riding handlebar clavicle
  • trident acetabulum
  • vs thenatophoric dysplasia: Jeune has normal vb’s
  • chronic nephritis if survive
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24
Q

Gorlin syndrome

A

bifid ribs
falx calcifications
basal cell cancers
odontogenic keratocysts

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25
Q

cleidocranial dysostosis

A
  • complete or partial absence of clavicles
  • delayed ossification of the skull, worming bones
  • widened pubic symph (seen later)
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26
Q

pyknodysostosis

A

osteoporosis + worming bones + acro-osteolysis
-“wide or obtuse angled mandible”

Acro-osteolysis (plural: acro-osteolyses) refers to resorption of the distal phalanx. The terminal tuft is most commonly affected. It is associated with a heterogeneous group of pathological entities and, some of which can be remembered by using the mnemonic PINCH FO.

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27
Q

“wide or obtuse angled mandible”

A

pyknodysostosis

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28
Q

klippel feil

A

congenital fusion of cervical spine, tall & skinny

  • +sprengel deformity (high riding scap)
  • omovertebral bone-big VB (fibrous, cartilaginous or by), superomedial angle of scap to SP, lam or TP (may be primary cause of limited ROM); present in 1/3
  • short webbed neck & low ahirline
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29
Q

hunters/hurlers/morquio

A
  • mucopolysaccharidoses
  • oval shaped VBs w/ ant beak (Mid in Morquio, Inf in Hurlers)
  • canoe-paddle clavicles, ribs (thick and narrowed more medially)
  • tall, flared iliac wings
  • classic: wide metacarpal bones w/ proximal tapering
  • findings progress 1st yr of life
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30
Q

mc lysosomal storage dx

A

gauchers

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31
Q

gaucher img findings

A

SMG, HMG

  • avn femoral heads
  • h shaped vert
  • bone infarct
  • erlenmeyer flask shaped flasks
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32
Q

skull markings

A
  • convolutional-pst gyral markings
  • copper beaten-gyral markings associated with raised intracranial pressure in children.
  • luckenschadel/lacunar (resolves in 6 mo)- dysplasia of the membranous skull vault and is associated with Chiari II malformations (seen in up to 80% of such cases). The inner table is more affected than the outer, with regions of apparent thinning (corresponding to unossified fibrous bone) of the skull vault. abnormal collagen development and ossification
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33
Q

wimburger’s sign

A
  • scurvy
  • small epiphysis sharply marginated by sclerotic rim with central portion more radiolucent
  • decreased cartilage proliferation and unimpaired mineralization
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34
Q

NF 1

A
  • -kypho/scoliosis, scalloped vertebra, hypoplastic pedicles/pst elements-dysplasia of vert bodies, meningocele formation or enlarging neurofibroma.
  • enlarging NF can cause spindling and deform of TPs and adj rib if intercostal nerve is affected
  • osseous mesodermal dysplasia
  • anterior tibial bowing, pseudoarthrosis
  • ribbon ribs
  • sphenoid wing dysplasia
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35
Q

idiopathic scoliosis configuration

A

S shaped

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36
Q

CoArc rib change

A
  • BL
  • T4-T8
  • inf aspect ribs
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37
Q

rib change s/p post thoracotomy s/p PDA ligation

A

IP side of AA

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38
Q

congenital lobar overinflation/hyperinflation/emphysema-moa

A

one way valve

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39
Q

MOA rickets bony change

A
  • provisional zone of calcification not formed –> cartilage proliferation not inhibited –> physis quite wide.
  • never present at birth (mom’s vitD still doing its thing)
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40
Q

moa leukemia bone change

A

bone pain –> decreased weight bearing–> demineralization prox metaph just beyond zone of Ca, provisional zone persists but may be thinned

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41
Q

spinning top urethra

A

urethra dilated to size > bladder neck (should be about the same)

  • detrusor sphincter dysinergy
  • bladder instability-detrusor contrast and pt vol close ext sphincter
  • vesicourinary reflux (bc of relative BOO)
  • mx: biofeedback mechs
  • vaginal reflux = mimic
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42
Q

MCC anterior wall “mass”

A

bifid rib-usually 1 (4th), if multiple think Gorlin

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43
Q

Gorlin syndrome

A
  • bifid ribs (1+)
  • Falx Ca
  • BCC
  • odontogenic keratocysts
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44
Q

OI relationship btw tib/fib

A

fib longer

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45
Q

OI mc subtype

A

infantile

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46
Q

Osteopetrosis MOA

A
  • diminished OC act
  • bone in bone of VB or carpals
  • picture frame
  • diffuse sclerosis, loss of CM diff
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47
Q

pyknodysostosis

A

osteopetrosis + worming bones + acro-osteolysis

-wide/obtuse angled mandible

48
Q

klippel feil

A
  • fused cervical spine, VBs tall and skinny
  • sprengel defomoty
  • omovertebral bone
49
Q

MCC death mucopolysaccharidosis

A

C2 myelopathy

50
Q

scoliosis causes

A
  • idiopathic (girls), S shaped
  • vertebral anomolies
  • NF
51
Q

radial dysplasia causes

A
  • VACTERL
  • Hold-oram
  • Franconi Anemia
  • Thrombocytopenia Absent Radius (TAR)-have a thumb
52
Q

Hand foot syndrome-who/where/img

A
  • SCD
  • foot/hand ischemia –> dacylitis (swelling, pain)
  • self resolving
  • rgx: periostitis 2 wks after pain goes away
53
Q

blounts-aka, patho, who, types, management, angle on plain film

A
  • tibia vara
  • prox tibia medial metaphysis downward slope –> disease progress depressed –> osseous outgrowth with epiph/metaph fusion
  • BL and Bimodal (<2yo, >12 yo)
  • infantile vs adolescent-infantile no syx. Adolescent UL & medial
  • can brace but by adol yrs it doesn’t work
  • metadiaphyseal angle of drennan: beasure btw medial and lat peaks (>11 degrees = blount)
54
Q

foot vocab: talipes

A

congenital

55
Q

foot vocab: pes

A

foot, acquired

56
Q

foot vocab: equines vs calcaneus

A
  • tibiocalcaneal angle. *calcaneus normally dorsiflexed
  • equines- plantar flexed ankle: heel cord often tight, heel doesn’t touch floor. CT angle >90
  • calcaneus- exaggerated DF; calcaneus angle up
57
Q

foot vocab: varus vs valgus

A

forefoot in vs out

58
Q

foot vocab: cavus vs planus

A
  • cavus- high arch

- planus- flat foot

59
Q

foot vocab: supination vs pronation

A

sole in vs sole out

60
Q

hindfoot valgus vs varus

A
  • AP talocalcaneal angle. Midtalar line passes through base of 1st MT and midcalcaneal line through base of 4th MT on AP view
  • varus: talus outward, lat to 1st MT and angled down
  • valgus: talus inward, medial to 1st MT and angled up/parallel to C
61
Q

flat foot/pes planus subtypes

A
  • defined by hindfoot valgus
    1) adult
    2) congenital-flexible or rigid
    a) flexible (improves w/ stress on plantar flexion view)
    b) rigid- i) tarsal coalitions & ii) vertical talus
62
Q

tarsal coalitions

A
  • talocalcaneus

- calcaneonavicular

63
Q

talocalcaneus findings

A

-C shaped
-absent middle facet
talar beak (spur on ant talus, 25%)

64
Q

calcaneonavicular

A

anteater (blood thirst. nose of ant eater)= elongated ant process of calcaneus

65
Q

vertical talus (equines hindfoot valgus) (rocker bottom)-app, ass

A
  • talus in extreme plantar flexion w/ dorsal dislocation of navicular –> talus locked in plantar flexion
  • ass w/ myelomeningocele
66
Q

clubfoot (talipes equino varus/congenital plantar flexed ankle forefoot)

A
  • Boys, BL (50%)
  • toes down (equines)
  • hindfoot varus-talocalcaneal angle decr/acute
  • elevated plantar arch
  • dysplasia of ankle: tibial & fibula shortening, talus equinus (ext rotated, can be palp), navicular medially subluxed over talus, cuboid med subluxed over calc, forefoot adducted and supinated.
  • leg m atrophy, esp peroneals-never grew to bg with
  • contracted PTT, FDL, FHL
67
Q

MC complication club foot surgical correction

A

-overcorrection –> rocker bottom foot

68
Q

-DDH-who, BL, BWs

A
  • female, breech, oligohydramnios
  • BL 1/3
  • “asymm skin/gluteal folds”, “leg length discrepancy”, “palpable clunk”, “delayed ambulation”
69
Q

DDH alpha and b angles, acetabular angle

A

alpha <60
beta >60
<50% acetabular coverage
-acetabular angle: >30˚

70
Q

Hilgenreiner’s, Perkin’s, Shenton’s, and Klein’s Line. Acetabular angle

A
  • H=line drawn horizontally through the inferior aspect of both triradiate cartilages.
  • P= line drawn perpendicular to Hilgenreiner line, intersecting the lateral most aspect of the acetabular roof.
  • S=imaginary curved line drawn along the inferior border of the superior pubic ramus (superior border of the obturator foramen) and along the inferomedial border of the neck of femur.
  • broken in ddh
  • K= lateral edge femoral neck –> lateral superior femoral epiphysis
  • acetabular angle: The angle is formed by Hilgenreiner line and Perkins. Should be 30–> 22˚ by 1 yo. Decrease with age as things solidify
71
Q

Normal femoral head location in relation to Hilgenreiner’s and Perkin’s lines

A

inf to H and med to P

72
Q

significance of acetabular angle >30˚

A
  • DDH

- NM disorder

73
Q

proximal focal femoral deficiency

A

absent/hypoplastic proximal femur + varus deformity

  • DDH mimic but DDH has normal prox femur!
  • tends to involve the intertrochanteric femur
  • may be bilateral
74
Q

slipped capital femoral epiphysis-fx type, what makes it unique, who, bilaterally, next step?

A
  • Type I SH that must be fixed
  • fat AA adolescent
  • BL 1/3
  • frog leg
75
Q

Legg-calve-perthes-what, who, bilaterally, next step, findings

A
  • 5-8 yr old Caucasian, B>G
  • BL 10% (20-25?%)
  • frog leg, MRI more sens
  • Klein line messed up, subchondral lucency, flat collapsed FH
76
Q

how will hip joint effusion present?

A

lateral displacement of FH

77
Q

what radiographic test excludes int effusion?

A

Air arthrogram sign

78
Q

transient synovitis cause, peak age, mx

A
  • viral (URI, GI)
  • peak age 5
  • self resolving
79
Q

Kocher Criteria

A

fever, inability or walk, ESR/CRP +, WBC >12

  • 3/4+ = SA
  • CRP most imp
80
Q

septic hip test progression

A
  • xray-medial hip widening, lat displacement FH
  • US-effusion
  • Kocher criteria+ –> aspiration
  • MRI only if hip aspiration can’t/hasn’t been performed
81
Q

rickets bony change

A
  • metaphyseal fraying/cupping

- rachitic rosa-expansion ANT rib at costochondral junction

82
Q

hypophosphatasia

A

rickets in new born-frayed metaph/bowed long bones

  • hypo ALP
  • adult form more mild
83
Q

scurvy

A
  • wimberger’s sign
  • spurs
  • hemarthrosis
  • scorbutic rosary- costochondral expansion (like rickets)
  • never before 6 mo
84
Q

Lucent metaphyseal bands=LINE

A

leukemia
Infection (torch)
NB met
Endocrine-rickets/scurvy

85
Q

lead poisoning vs normal variant

A

lead poisoning does not spare fibular

86
Q

dating fractures, exceptions

A
  • periosteal reaction-<1 wk
  • complete healing ~12wks
  • exceptions: metaphyseal, skull, costochondral junction fx heal w/o periosteal rxn
87
Q

flat foot (pes planus)

A

-hindfoot valgus

88
Q

intramembranous ossification

A

mesenchyme –> bone

-skull/facial, mandible, central clavicle

89
Q

enchondral ossification

A

cartilage –> bone

-skull base, spine, pelvis, extremities

90
Q

tubulation

A

remodeling long bone shaft into normal configuration

91
Q

overtubulation

A
  • cylindrical portion of shaft is too long with short and narrowed metaphysis
  • “gracile”
  • MC: NM d.o. via decr weight bearing, ex: cerebral palsy
  • ex: absent weight bearing, neuromuscular conditions, OI, JVA, Marfan, Homocystinuria, athrogryposis
92
Q

undertubulation

A

cylindrical portion of shaft too short, wide and long metasphysis.

  • short squat bones
  • -Via decr osteoclast act.
  • ex: OPet, FD, rickets, mulstiple osteochondromas, dwarfism, storage dx (gaucher’s)
93
Q

zones of physis

A
  • resting- adj to epiph, small clusters cartilage cells
  • proliferative- cart cells div and enlarge
  • maturation zone- enlarge
  • hypertrophic zone-provisional Ca
  • degenerative-degen, death of cart cells
  • osteogenic-lateral margin physis, occasional Ca (small zpicule of bone ext distally from metaph)
94
Q

growth recovery/parke/harris lines

-when, where

A

stress

  • par to physes
  • femur > tib (fmur faster growth)
95
Q

causes of scoliosis

A 
idiopathic (75%)
leg-length discrepancy
congenital
NM d.o
NF
conn tissue d.o
trauma
tumors
radiation rx
96
Q

angle used to measure scoliosis

A

cobb angle

97
Q

juvenile kyphosis

A

> 40 degrees from T3-T4

98
Q

Scheurmann’s disease

A

thoracic kyphosis w/ vertebral body wedging, diskspace narrowing, pain and endplate irreg

99
Q

harness for ddh

A

pavlik harness-hips held in flexion, mild abduction, mild external rotation

100
Q

coxa vara

A
  • congenital vs infantile vs acquired
  • congenital= limb bud insult 1st TM, doesn’t worsen
  • infantile- worsens, BL, sx
  • acquired-trauma, SCFE, metabolic, tumors, skel dysplasia, FD, pagets
101
Q

coxa valga

A

decr tone of m’s that cross hip –> decr ambulation

-NM d.o (cerebral palsy)

102
Q

primary protrusio of acetabulum (otto pelvis)-line of reference

A

lateral margin pelvic inlet & obturator foramen

103
Q

discoid meniscus

A
  • abN growth of meniscus (circular shape rather than crescent)
  • prev normal contact of articular surfs within knee
  • high incidence of tear
  • too many bow ties on sag view
    rx: arthroscopic sculping, wrisberg, etc
104
Q

madelung deformity

A

short radius, severe shortening medially, lateral bowing, dorsal sublucation of distal ulna

  • elongated triangular fibrocartilage on mr
  • vickers ligment-distal radius to lunate lig creation
105
Q

congenital dislocation of radial heads

A
  • abN growth of radial head and capitellum

- radial head dislocated

106
Q

sprengel’s deformity

A
  • sporadic
  • scapula-cervical appendage ribs 4-6 that form wk 5 gestation
  • MC ass = klippel feil
107
Q

tibial bowing causes

A

1) NF 1
2) foot deformities
3) physiologic bowing
4) hypophosphatasia
5) rickets
6) blunts
7) OI
8) dwarfs

108
Q

NF-1 tibial bowing dir, ass findings

A

anterolateral +/- hypopastic fibular w/ pseudoarthosis

109
Q

tibial bowing w/ foot deformities-dif

A

pst

110
Q

physiologic tibial bowing

A
  • lateral
  • BL
  • 18mo-2 yr
111
Q

hypophosphatasia tibial bowing/”rickets in a newborn”

A

lateral

112
Q

rickets tibial bowing-dir, ass findings, where

A
  • lateral
  • fraying of metaph, widening of GP
  • fast growing bones-knee, wrist
113
Q

Blount tibial bowing

A
  • asymm tibial vara
  • early walking, fat, black
  • prox tibia pstmed physical growth disturbance –> deformit
114
Q

osteogenesis imperfecta-tibial bowing

A

involves all long bones

115
Q

dwarfs tibial bowing

A

short limbs

radiology (31 decks)

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