Lecture 21: Pediatric Orthopedics Flashcards
1
Q
The 3 red flags of groin pain are:
- () wt
- () hip
- Pain more than () hrs
A
- Refusal to bear weight
- Refusal to move hip
- Pain more than 24-48 hrs
More suggestive of a fx.
2
Q
In a child presenting with groin pain, you must always rule out a…
A
Slipped capital femoral epiphysis
3
Q
A groin strain is really a…
A
Adductor strain
4
Q
The MC knee fx in children are (2)
A
- Tibial spine
- Osteochondral
5
Q
A ballottment test checks for..
A
Effusion
6
Q
The main MOI for a tibial spine fx is…
A
Hyperextension of knee with concurrent rotation of femur on tibia
Same as ACL MOI i think
7
Q
Tibial spine fx show:
- () joint
- () pain
- () ROM
A
- Hemarthrosis
- Joint pain
- Markedly decreased ROM
8
Q
Tx of a non-displaced, tibial sleeve fx is via…
A
- Knee in full extension
- Ortho f/u
9
Q
Osteochondral fx frequently accompany () dislocation, () tears, or () injuries
A
- Patellar dislocations
- Ligament tears
- Meniscal injuries
10
Q
The screening of choice for osteochondral fx is…
A
MRI
11
Q
Your ped pt complains of knee pain that occurred right after they dunked on their little kiddie hoop. There is significant swelling at the knee joint and difficulty extending the knee against gravity. Your initial knee XR shows a high riding patella. You suspect that they have a….
A
Patellar sleeve avulsion fracture
12
Q
The tx for a patellar sleeve avulsion fracture is…
A
Immobilization of knee with ortho referral for surgery
13
Q
What is more predictive of a patellar sleeve fracture: Hemarthrosis/PE findings vs radiographic evidence?
A
Hemarthrosis/PE findings
14
Q
Chronic knee pain is diagnosed via…
A
Exclusion
15
Q
If you suspect JIA causing knee pain in a child, you should be ordering () and ()
A
- ANA
- RF (rheumatoid factor)
16
Q
Osteochondritis Dissecans is osteonecrosis of subchondral bone due to…
A
Overuse
17
Q
As the lesion of osteochondritis dissecans progresses, focal areas of demineralization and repeated shear forces causes () of bone and ()
A
Detachment of bone and overlying cartilage
18
Q
Initial imaging of Osteochondritis dissecans is (), but the diagnostic of choice is ()
A
XR initial, MRI choice
19
Q
Tx of osteochondritis dissecans is via…
A
Immobilization for 3-6 mos vs surg
20
Q
If osteochondritis dissecans is left untreated, it can develop into…
A
Premature arthritis
21
Q
Generally, the tx for knee popping is…
A
Bracing + PT
Do MRI if you suspect a meniscal tear
22
Q
The two MC ankle ligaments sprained are…
A
CFL + ATFL
23
Q
Tx of acute ankle pain/sprain is via… (4)
A
Brace, support, NSAIDs, controlled ROM
24
Q
You would expect an ankle inversion to sprain the () ankle ligament
A
Lateral ankle ligament
25
Ankle sprains are graded from 1-3. Each grade corresponds to...
1. Grade 1: stretch, small tears
2. Grade 2: Large, incomplete tear
3. Grade 3: Complete tear
26
A child presents with a **unilateral limp and pain in their hip**. They had a **recent URI.** You suspect it is most likely (), but you should be sure to rule out ()
* Toxic synovitis (MCC of inflammatory childhood limp)
* Septic arthritis (bacterial infection of hip)
27
The 4 kosher criteria used to determine severity of septic arthritis are:
1. Fever over ()
2. ESR > ()
3. WBC > ()
4. (wt)
* Fever > 101.3F
* ESR > 40
* WBC > 12k
* Non-wt bearing
28
What kind of XR views should you order for a childhood limp?
* AP Pelvis
* Frog leg views
29
ABX coverage of suspected septic arthritis is geared towards covering what organism?
Staph Aureus
30
Tx for transient/toxic synovitis is.. (3)
Tylenol + Advil + Rest
31
The MCC of INtoeing for children up to 1 year of age is...
Metatarsus adductus
| Metarsal bones are adducted. MC left foot.
## Footnote
Also the MC congenital foot deformity in children < 1 year old.
32
Your **6 month old** patient presents with a **C shaped/kidney shaped foot.** There is **inward deviation of the forefoot** to the hindfoot, but **NO ankle involvement**. You suspect this is...
Metatarsus adductus
33
Metatarsus adductus occurs due to...
Intrauterine molding and womb position
34
Dx of metatarsus adductus is via... and tx is ...
* Clinical diagnosis
* Passive ROM to treat.
| 90% resolve by first year.
35
The only time you need to do corrective casting of metatarsus adductus before 8 months is...
(SEVERE) Unable to correct deformity to midline.
| Mild and Mod are just stretching.
36
A baby presents on birth and prenatal US with the **soles of their feet facing each other.** Their **foot appears to be internally rotated at their ankle.** **Smoking during pregnancy** can increase the risk of this. The **achilles tendon is also shortened**. You suspect this baby has...
Clubfoot/Talipes Equinovarus
37
The 3 primary features of **clubfoot** are:
1. () flexion of the foot and ankle
2. () of the heel
3. () deviation of the forefoot
1. Plantar flexion of the foot and ankle
2. Inversion of the heel
3. Medial deviation of the forefoot
38
Syndromic clubfoot is related to spina bifida. Positional is related to twins, breech, and low amniotic fluid. However, the MC type is...
Congenital, which is idiopathic!
39
Clubfoot is treated usually by...
Ponseti method
| Serial casting
## Footnote
Other methods are surgery for achilles tendon release + braces
French functional metho
40
Knock Knees is the same as genu ()
Genu Valgum
41
The MCC of intoeing AND out-toeing in **older children** is...
Tibial torsion
42
Specifically, the MCC of intoeing in children aged 1-3 is...
Internal tibial torsion
| Bilateral in 2/3 of cases
## Footnote
Fun-fact: Fastest runners are typically in-toed
43
You only treat tibial torsion if the feet are still turned greater than () degrees by age 5.
> 15 degrees
| Refer to ortho once theyre 8.
## Footnote
**Orthotics are ineffective**
44
The Dx of tibial torsion is via...
Physical exam
| XR is for hip dysplasia r/o
## Footnote
She wrote CT scan is standard for dx but physical exam is diagnostic too.
45
The MCC of OUT-TOEING in toddlers/young children is...
External tibial torsion
| Asymptomatic!
46
Medial mallelous anterior to the lateral malleolus is suggestive of ()
External tibial torsion
47
Once a child is older than 3, the MCC of intoeing becomes...
Femoral anteversion
48
Your **5 year old** patient likes **sitting in a W** and has a **egg-beater/windmill pattern of walking**. The parent notes that **other family members have this too**. Upon closer examination, you note that the patient has **inward facing feet and patellas.** You suspect he has...
Femoral anteversion
| Refer if persistent past age 11!
49
In-toeing has 3 common causes depending on the age.
* < 12months old: ()
* 12 months to 3 years: ()
* > 3 years: ()
* < 12 months = metatarsus adductus
* 12 months to 3y = tibial torsion
* 3+ years = femoral anteversion
50
The tx of femoral anteversion is...
Femoral derotational osteotomy
51
Hip terms
52
The biggest 3 RFs for Developmental Dysplasia of the Hip (DDH) are all related to pregnancy, which are ()
* BREECH
* Twins
* First borns
| Familial link is the biggest RF (30x)
53
DDH usually affects the (left/right) hip the MOST
Left hip
54
In a patient with **trendelenburg sign**, you notice that they tend to dip towards their **right side**. You suspect that their () hip is weak.
Left hip
| The leg that is STRAIGHT is the WEAK side
55
T/F: Hip clicks suggest DDH
False, they can be normal!
56
DDH is diagnosed using the two baby hip maneuvers. Describe both!
* Barlow: Adduct and push
* Ortolani: Abduct and pull
| Bad Barlow = trying to dislocate by pushing hip out.
57
Out of subluxated, dislocated, and dislocatable, the most severe form of DDH is...
Dislocated
58
The standard way to diagnose DDH is...
US
59
There are 3 indications to US an infant for DDH:
1. () on examination
2. Any child born () >= 34 weeks gestation
3. () of DDH
* Instability on examination
* Born breech
* FHx
60
Generally, you do not XR for DDH until...
6 months
| FYI iknow her slide says 4, but i think she said 6 months verbally twice
61
If you have a positive (Barlow/Ortolani), you REFER TO A SPECIALIST
Ortolani
| get On the phone with Ortolani!!!
## Footnote
Barlow is observe and follow.
62
Treatment of DDH depends on age range:
1. 0-6 months: ()
2. 6-18 months () reduction + () for 2-3 months
3. 18m - 6y = () reduction vs () reduction
4. > 6y = ()
* 0-6 = pavlik harness
* 6-18m = closed reduction and spica casting for 2-3months
* 18m-6y = open vs closed reduction
* **> 6y = no tx**
63
Your **11yo** patient presents with **pain and tenderness right below his kneecap**. He notes it worsens with activity and **improves with rest**. It's **usually just his right knee.** He is a **basketball player** and **recently had a growth spurt**; he's 5'10"! You suspect he has...
Osgood Schlatter disease
64
T/F: Complete physical rest will cure osgood schlatter dz.
False! You want them to play still, just make sure they ice and stretch.
65
The MCC of chronic anterior knee pain in an athlete is...
Patellofemoral syndrome
66
Prolonged sitting with bent knees or activity aggravates knee pain. This is known as...
Theatre sign
| Patellofemoral syndrome
67
The dx of patellofemoral syndrome is made... You recommend () and () to treat it.
* Clinical diagnosis
* Treat by discontinuing aggravating activity and building up your quads and hammies.
68
Your **obese, male adolescent** aged patient presents with **left hip pain.** He began **limping and now requires crutches** to ambulate. It **began about 2 weeks ag**o. You suspect he has a (acute/chronic) (stable/unstable) (dx)
Acute, stable, slipped capital femoral epiphysis.
69
The Dx of a SCFE is made via...
XR (prob frog leg)
| Can use U/S and MRI too
70
TOC for SCFE is...
Internal fixation via single screw.
71
SCFE is graded type 1-3 based on displacement. What displacement % corresponds to each type?
* Type 1: < 33%
* Type 2: 33-50%
* Type 3: > 50%
72
73
The biggest complication we are most concerned about with SCFE is..
Avascular necrosis of femoral head
74
Idiopathic avascular necrosis of the hip, MC in white boys aged 5-7, describes...
Legg-Calve Perthes Disease
75
A **5y M** presents with a limp, pain, and limited ROM of their left hip for 3 months. They had an **XR 2 months ago which was normal.** You take a new XR and see **joint effusions, widening of the joint space, as well as periarticular swelling. No hx of trauma.** You suspect this is...
Legg-Calve-Perthe Disease
76
Generally, LCPD is treated with (surgery vs PT/traction/casting)
PT/traction/casting
77
A **14y F** presents to your clinic for an Adam's forward bend test (AFB). Her **cobb's angle is 19 degrees**. Her **last cobb's angle was 10 degrees**. Your next step in treatment of her scoliosis is...
Refer for bracing or surgery
78
You see a spiral tibial fx on a 2year old. They refuse to bear wt on the extremity. This could either be () or ()
* CAST: Childhood accidental spiral tibial fx
* Child abuse
| Toddler's fx
79
You see a **young** pt that has **multiple fx**, **blue sclera**, thin skin, and **deformed teeth**. Their XR kinda looks like **osteoporosis.** They probably have...
Osteogenesis imperfecta
| Blue sclera = osteogenesis imperfecta probs
80
T/F: Achondroplasia comes with short stature, big head, and impaired intelligence.
False. Intelligence and sexual function are NORMAL
81
Plagiocephaly occurs due to...
Baby positioning
82
Craniosyntosis is caused when () close early
Sutures
83
**Impaired growth and rickets of the femur/tibia (aka short lower limbs) leading to varus looking legs** is indicative of what disease?
Familial hypophosphatemic Rickets or X-linked hypophosphatemia
84
X-linked hypophosphatemia is treated primarily with 3 drugs.
* Calcitriol
* Amiloride
* HCTZ
85
Nursemaid elbow commonly occurs when you () a child and describes subluxation of the () head
Tug a child, subluxing their radial head.
86
Closed reduction of Nursemaid elbow is 2 main steps:
* Supinate hand
* Flex elbow
87
# Name that diagnosis!
* Pigeon toed boy
* Inward toes
* 2yo Boy
* Knees face forward
Internal tibial torsion
88
# Name the next step!
* 2 mo old infant
* Positive Barlow
Order US of hip
| Any instability = US
89
# Name that disease!
* 14y M
* R Knee pain
* Soccer player
* swelling but no redness
* Worse during activity
Osgood schlatter disease
90
# Describe this disease fully (severity too)
* 13 yo obese M
* L knee pain + hip pain
* Cannot ambulate at all. Used to limp.
* Onset was 4 weeks ago.
Chronic, unstable SCFE
