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Disciplines II, Final Exam > Peds Orthopadaedic > Flashcards

Peds Orthopadaedic Flashcards

1
Q

Most common pediatric elbow fracture?

A

Supracondylar Fracture

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2
Q

MC cause of supracondlar fracture?

A

FOOSH injury from height–> hyperextension

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3
Q

Inability to make what kind of hand sign can indicate Supraconylar fracture

A

O.K. sign

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4
Q

What x-ray views are need to assess supracondylar fractures

A

AP
Lateral
Oblique

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5
Q

What bone misalignment is seen with supracondylar fractures?

A

Anterior humeral line must intersect the capitellum

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6
Q

How are Type I and II supracondylar fractures treated?

A

Type I/II: Posterior splint with light overwrap

Type III: Emergent ortho consult

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7
Q

How does a Lateral Condylar fracture present clinically?

A

• Soft tissue swelling concentrated
to lateral aspect of elbow

• Tender to palpation over lateral condyle

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8
Q

What x-ray views are needed to diagnose Lateral condylar fracture?

A

X-ray: AP, lateral, and internal oblique view focused

on lateral condyle

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9
Q

How is a Lateral condylar fractures treated?

A
  • Emergent referral if displacement >2 mm

- Splint, sling, NSAIDs

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10
Q

What is the most common cause of medial epicondylar fx?

A

Muscle attachment avulsion

Throwing athletes

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11
Q

What x-ray views are needed to see medial epicondylar fx?

A

AP, Lateral, and external oblique

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12
Q

How is medial epicondylar fx treated?

A

Emergent if entrapped fragment
Splint including wrist, sling
NSAIDs

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13
Q

What are complications associated with medial epicondylar fx?

A
  • Ulnar nerve palsy
    • Nonunion
    • Angular deformity
    • Decreased ROM
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14
Q

HOw does a radial neck fracture occur?

A
  1. FOOSH-with valgus stress
  2. Elbowdisloca8ons
    • During disloca8on or reloca8on
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15
Q

Clinical presentation of Radial neck fracture

A
  • Tenderness to palpation over radial head/neck
  • Pain with supination/pronation&raquo_space; flexion/extension
  • Young children may complain of wrist pain
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16
Q

What x-ray views are needed to see Radial neck fractures

A

• AP, lateral, and external oblique (flatten head of radius)

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17
Q

How is a radial neck fracture treated?

A
  • Immobilize including the wrist
  • Sling
  • NSAIDs
  • Ortho: cast vs surgery
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18
Q

What complications are seen with radial neck fracture?

A
  • Premature physeal closure
  • Loss of ROM
  • Nonunion
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19
Q

What is a Nursemaid’s elbow?

How does it occur?

A

Subluxation of radial head

Caused by swinging or pulling of pronated arm

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20
Q

How does a Nursemaid’s elbow present?

A
  • Arm either fully extended or slightly flexed and ALWAYS pronated
  • Overall refusal to use arm but may use fingers
  • Mild pain over radial head
  • Pain increases with attempts to supinate
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21
Q

How is a Nursemaid’s elbow presented?

A

Reduction by either:

  1. Hyperpronation with pressure over the radial head
  2. Supination, Flexion with pressure over radial head

Followed by Lollipop test to see if arm can reach out and grab lollipop successfully

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22
Q

How does a Capitellar Osteochondrosis present?

A
  • Rapid onset of pain
  • Deep, lateral pain
  • ROM: limited extension
  • No locking sensation
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23
Q

Who is a Capitellar Osteochondrosis typical in?

How do you treat them?

A
  • Males, 5-10 y/o
  • Dominant (throwing) arm
  • Baseball, gymnastics, handball

Conservative treatment:
-ice, nsaids, rest

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24
Q

What is seen on physical exam with Capitellar Osteochondrosis?

A
  • +/- swelling
  • May be difficult to elicit tenderness with palpation • Pain/guarding with passive extension
  • Lateral pain with valgus stress
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25
Q

What is a Monteggia Fracture?

A

Ulnar (or radial and ulnar) shaft fracture with dislocation of radial head

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26
Q

Common cause of wrist fracture

What is the most bone involved?

A

Direct Fall
• FOOSH

Distal radial head

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27
Q

How are wrist fractures treated?

A

Emergent with significant clinical deformity or
neurovascular compromise

  • Splint and NSAIDS
  • Ortho: cast, +/- reduc8on vs surgery
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28
Q

What is the clinical presentation of a femur fracture?

A
  • Pain in groin or buttock
  • Unable to bear weight/walk
  • Proximal femur fx pt will hold leg in slight adduction and external rotation.
  • May see shortening of limb.
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29
Q

What needs to be ruled out when assessing femur fractures

A

Child abuse, remember kids bones are gumpy

30
Q

What is needed to diagnose a femur fracture?

A

Must x-ray entire length of Femur for

proper evaluation

31
Q

How is a femur fracture treated?

A

Hip spica cast vs surgery

32
Q

What are complication of femur fracture?

A

Shortening
Lengthening –> growth of more bone in the fracture site
Angulation

33
Q

What is the most common patellar fracture in kids <13?

A

Patellar sleeve fracture

34
Q

How are patellar sleeve fractures caused?

A

Caused by forced extension with knee in flexion

• Jumping, kicking, etc

35
Q

How is a patellar sleeve fracture treated?

A
  • Knee immobilizer, NWB, elevate
  • NSAIDs
  • Ortho: cast vs surgery
36
Q

How is a Toddler’s Fracture of the tibia caused?

A

Common cause is young child falling while running, twisting mechanism

Causes them to non-weight bare on affected side

37
Q

How is a Toddler’s Fracture managed?

A
  • Immobilize (splint/wee walker)
  • NWB, NSAIDs, elevate if possible
  • Ortho: Wee walker vs cast
38
Q

What x-ray view should be used to assess ankle fractures vs sprain

A

AP, mortise, lateral, internal and external oblique

39
Q

How is an ankle fracture managed?

A
  • Posterior vs stirrup splint
  • Eleva8on, NWB, NSAIDs
  • Ortho consult PRN
40
Q

What is the MOI of a Triplane Fracture?

A

Mechanism of injury is often external rotation

41
Q

How is a Triplane Fracture diagnosed and treated?

A

Must get CT to asses displacement

Ortho: surgical fixation vs closed reduction

42
Q

What is a Jones Avulsion fracture?

A

Fracture to the base of the 5th MT

  • Apophysis runs parallel to MT shaa, fractures typically run perpendicular
  • Due to pull of peroneus brevis at its inser8on as well as plantar aponeurosis
43
Q

What is Torticollis and how does it present?

A

Unilateral contraction of the sternocleidomastoid muscle with visible shortening

Head tilt to shortened muscle and chin rotation to contralateral side

44
Q

How is a Toticollis treated?

A
  • Stretching/PT

* Positioning education

45
Q

What physical exam test can be done to determine scoliosis?

A

Adam’s forward flexion exam

46
Q

What are you looking for on x-ray with scoliosis?

A

Cobb Angle

47
Q

How is scoliosis managed in kids?

A

TLSO Brace: Boston, Milwaukee, Charleston Bending

48
Q

What is a Osteochondrits Dessecans (OCD)

A

Idiopathic osteonecrosis of subchondral bone

49
Q

How is a Juvenile OCD caused?

A

• Idiopathic osteonecrosis of subchondral bone

50
Q

What is the most common location for Osteochondritis Dessicans?

A

Knee-Lateral portion of medial femoral condyle

51
Q

What causes OCD in the elbow?

A

Chronic valgus stress or micro trauma with compression attributed to overhead activities

52
Q

How does Osteochondritis Dessecans presented?

A

Gradual onset of poorly localized deep pain (elbow:
typically lateral)
• Decreased ROM in elbow but not typically knee

53
Q

How does OCD present on x-ray?

A

flattening of articular surface

54
Q

Slide 68

A

slide 68

55
Q

What is the Kochner criteria?

A
  • WBC > 12,000
  • ESR > 40
  • Fever > 101.3
  • Non weight bearing on the affected side • 2/4 criteria warrants joint aspiration
56
Q

Slide 70

A

slide 70 treatment

57
Q

What is Legg-Calve-Perthes Disease?

A

Idiopathic AVN of the femoral head

58
Q

How does Legg-Calve-Perthes Ds. present?

A
  • Limp: end of the day
  • Occasional pain (knee or hip region)
  • Limited internal rota8on and/or abduction of hip
59
Q

Who is Legg-Calve-Perthes most present in

A

young boys

Thin and active kids

60
Q

How is Legg-Calve-Perthes diagnosed?

How is it treated?

A
  • Diagnostic: initially dx may be clinical but plain radiographs will confirm
  • Treatment: observation, PT to improve ROM, activity modifications, surgery for re-alignment if needed
61
Q

What is a Slipped capital femoral epiphysis (SCFE)

What is the biggest risk factor for these?

A

Slippage of the femoral physis:

“Ice cream slipping off the cone”

Risk Factor: Obesity is the BIGGEST RF

62
Q

How does Slipped capital femoral epiphysis presented?

A
  • Limp or NWB with c/o hip or knee pain (dull, achy)

* Restricted ROM: abduction and internal rotation

63
Q

How is a Slipped Capiral Femoral Epiphysis treated?

A
  • Requires urgent surgical consultation for in situ single screw fixation
  • NWB! Admit to hospital.
64
Q

What are the biggest risk factors for Displasia of the hips

A

1st born
Breech position,
FHX

65
Q

What two test are used to assess Dyplasia of the hips

A

Barlows

Ortalani

66
Q

How does the Galeazzi test done to test dyplasia of the hips?

A

Apparent limb length discrepancy while supine and knees flexed at 90 degrees

67
Q

How is Dysplasia of the hips managed?

A

Pavlik Harness

68
Q

What is an Osgood-Schlatter’s Disease?

A

Inflammation and irritation of patellar tendon insertion on tibial tubercle

69
Q

How does Osgood-Schlatter’s present?

A
  • Focal tenderness to tibial tubercle

* Enlargement or bony protrusion of tibial tubercle

70
Q

How osgood-schlatter’s treated?

A
  • Occasional rest, NSAIDs, ice
  • Quad exercises and hamstring stretches
  • Chopat strap

Disciplines II, Final Exam (4 decks)

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