Peds Ortho

Question 1

Describe the disease that fits this picture: 6-7 year old boy who starts falling, early fatigue, calfs are enlarged

Answer 1

Duchenne’s muscular dystrophy

Question 2

What is the most common congenital hand deformity

Answer 2

syndactyly = webbed fingers

Question 3

managenent of polydactyly

Answer 3

XR - can ligate ulnar digit

Question 4

risk factors for developmental dysplasia of the hip

Answer 4

girls, first born child, breech position in third trimester, oligohydramnios

Question 5

management of developmental dysplasia of hip

Answer 5

harness splinting for first 6 months

Question 6

management of club foot?

Answer 6

serial casting followed by heel cord release and nighttime bracing

Question 7

Bone tumor at physis of long bones (knee and shoulder)

Answer 7

Osteosarcoma

most common childhood bone cancer

Question 8

Long bone tumor, onset in teenage years

Answer 8

ewing’s sarcoma

second most common childhood bone cancer

Question 9

What is the most common congenital foot deformity?

Answer 9

Metatarsus adductus

• 85%-90% resolve by one year

Question 10

What is the most common cause of intoeing?

Answer 10

Internal tibial torsion: patella facing forward and feet intoeing

• 90% resolve by age 8

Question 11

Name this finding: patella facing forward and feet intoeing

Answer 11

Internal tibial torsion

• 90% resolve by age 8

Question 12

Name this finding: both knees and feet pointing inward

Answer 12

Femoral anteversion

• tendency to sit in a W position
• 80% improve by age 9-10
• surgery at age 9-10 if more severe

Question 13

What is transient synovitis and when should you consider septic hip?

Answer 13

• Hip pain after infection
• non weight bearing
• ibuprofen to shorten course
• obtain XR to rule out bony process
• consider septic hip if febrile, elevated ESR, CRP, WBC

Question 14

What is slipped capital femoral epiphysis and how to you manage it?

Answer 14

• slipped femoral head at the epiphysis
• occurs 11-16 yo, male, obese
• obtain XR
• surgical referral should be immediate

Question 15

What is osteochondritis dissecans and what is initial management?

Answer 15

• Occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen.
• initial management is observation and reduction in activity

Question 16

What is traction apophysitis

Answer 16

• overuse injury where excessive pull by a large tendon causes damage to the unfused apophysis to which it is attached.
• ex: osgood-schlater
• Treatment is often ice, stretching, rest

Question 17

What is little league elbow and how do you manage it?

Answer 17

• seen in teen baseball players
• progressive medial elbow pain, diminished throwing speed and distance
• refrain from throwing for 3-6 weeks until pain free, then progressively increase.

Question 18

What is osgood-schlatter’s and how do you treat it?

Answer 18

• anterior knee pain
• traction apophotisits caused by patellar tendon
• tenderness at tibial tuberosity
• add quad and hip flexor stretches

Question 19

What is sever’s and how do you treat it?

Answer 19

• posterior heel pain and tenderness at calcaneus
• traction apophotisits caused by achilles tendon
• add heel lifts

Question 20

What are growing pains and how do you manage them?

Answer 20

• benign nocturnal limb pains of childhood
• deep cramping pain that awakens from sleep
• resolves by morning with no limb
• management: reassurance, heat, massage, warm baths, decrease exercise to non-aggravating levels, mild analgesics

Question 21

In adolescent scoliosis, what is management for the following cobb angle?

< 30 degrees

Answer 21

Observation and resial radiographs q6 months until physeal closure

Question 22

In adolescent scoliosis, what is management for the following cobb angle?

30-40 degrees

Answer 22

Bracing

Question 23

In adolescent scoliosis, what is management for the following cobb angle?

> 40 degrees

Answer 23

Surgery