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OITE Review Flashcards

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1
Q

MRI indications scoli (5)

A 
L thoracic curve
Pain
Neuro sx - asym abdominal reflex, hyper-reflexia
Rapid progression
Apical kyphosis
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2
Q

What factor is most predictive of predicting AIS progression?

A

Age = skeletal maturity

Risser sign

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3
Q

What is the most correlative XR finding for AIS progression?

A

Tanner whitehouse = hand XR

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4
Q

Bracing rules for AIS

A

<25 = nothing
<40 + skeletally mature = watch
Immature < 40 = brace (reduce risk surg 50% if bracing done at least 12hrs per day, compliance is MOST important factor for det prog to surgery)

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5
Q

If very skeletally immature and must fusion spine, do you do post or ant approach?

A

Ant to prevent crank shaft phenom

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6
Q

Delayed infx bugs (2) for AIS vs acute

A

P.acnes & S.epi (NOT aureus!!!)

Acute = aureus

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7
Q

Curve & age for infantile idiopathic scoli

A

LEFT thoracic

Age = <3yo

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8
Q

What is the measurement for infantile IS?

A

RVAD > 20 = high risk progression

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9
Q

Treat infantile IS

A

Body cast
RVAD>35 - MRI +/- growing rod (less effective the longer is in)
Don’t fuse b/c get alveolar aka pulm insuff

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10
Q

Which type of scoli is highest risk of neural axis involvement

A

Juvenile = 3-10yo

Think arnold chiari malform

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11
Q

What deform is the worst outcome for congenital scoli

A 
Failure formation vs segmentation vs mixed
Worst prog = 
1. Uni lat var 
\+ 
CL hemi vert 
100% risk progression
GET MRI****
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12
Q

Which spine deform has highest risk neurologic compromise from surgery?

A

Congenital kyphosis

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13
Q

DMD inheritence

A

XL recessive - more common BOYS

  • High creatine kinase
  • Gower’s sign
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14
Q

What is a pars stress frx called? Most sensitive test?

A

Spondy-lo-lysis

SPECT = single proton…. = most sensitive

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15
Q

What level is most common spondy in kids?

A

L5-S1

- HAMSTRING tightness on exam

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16
Q

What is the most important determinant of pain and non-union for spondy (how they’ll do once they get it)

A

Slip angle >45 deg

VS PI - dets if you will get a spondy at all

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17
Q

How measure pelvic incidence

A

total of sacral slope + pelvic tilt

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18
Q

What is Scheurmann’s kyphosis

A

Idiopathic kyphosis - usual brace

Normal kyphosis in T spine 20-50deg

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19
Q

What is Klippel Feil

A

= abnormal cervical segmentation (AA fusion)
Sprengel’s deform on right - scapula is up with limited ROM
Deafness (the other one that isn’t paget)
Webbed neck
Trt = conservative, NO CONTACT SPORTS

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20
Q

AA instability

A

Down’s
JRA
Treat if >5mm EXCEPT Downs > 10mm b/c lig lax at baseline

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21
Q

What is the most common level for pseudo sublux

A

C2/3 - don’t have to do anything about it

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22
Q

Association w/ C1/2 rotary sublux

A

Think after retrophayngeal infx/URI

SCM spasm on SAME SIDE as chin (aka actue torticollis)

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23
Q

Association for sacral agenesis

A

Maternal diabetes

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24
Q

What disease has palpable SCM mass - treat and what to r/o

A

Cong muscular torticollis
PT + stretching
R/o DDH

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25
RF DDH
Breech Female (left side most common) First born
26
Packaging disorders associated with DDH
Torticollis - SCM away from chin | Metatarsus adductus
27
When does O&B not helpful - what test do you use
6mo | Galeazzi test - does one leg look shorter than other when knees flexed
28
2 US findings for DDH
``` Alpha angle > 60 = normal Less means the tab is SHALLOW = bad (in adults alpha bigger is bad) Beta angle > 55 Image - White line = ilium - Muscle is LATERAL ```
29
When can you get XR for DDH
>4mo - FH starts to ossify
30
What is normal AI and CEA
AI < 25 = normal | CEA < 25 = ABnormal
31
What are 4 things that might prevent hip reduction
Inverted labrum vs limbus Lig teres IP tendon
32
How treat stable vs unstable sublux hip?
``` Stable = watch Unstable = Pavlik ```
33
How treat dislocated or dislocate-able hip?
Non-reduce -> OR | Reduce -> Pavlik
34
Palvik - ant vs post strap roles & 2 comp of Pavlik
Ant strap - stop flexion (less than 90) Too much - fem nerve palsy Post strap - stop aBduction Other comp = AVN (post sup retinacular art)
35
What is Pavlik disease?
Post acetabular wear - why check every week via US
36
Who can't you use Pavlik?
NM kids - Pavlik works on your muscles to keep hip in place
37
What do you do for kids with DDH who are walking
Surg: open reduction // osteotomy
38
What are the 6 pelvic osteotomies for DDH
``` Salter Pemberton Triple Dega - CP young kid Shelf - salvage Chiari - salvage ```
39
What do you if a young kid fails Pavlik?
Give 3 wks Abduction brace If that fails, closed reduction casting + hip arthrogram to check reduction
40
What is Legg Calve Perthes
Idiopathic AVN 4-8yo boys Associated with ADHD, protein C and S def, and thrombophilia
41
What is the classification for LCP
Pillar - LATERAL physis >50% of the femoral head = BAD -> probs needs surg Young and lower Pillar classification = better outcomes
42
Who gets SCFE
Fat boy with knee pain
43
What zone is SCFE affect vs atypical SCFE
``` Hypertrophic zone (same as SH frx) Atypical = primary spongiosa ```
44
What is a stable SCFE
Anything the kid was walking on no matter how bad the XR looks
45
How do you fix SCFE surgically?
IN SITU - dont reduce anything Screw fixation Unstable = HIGH risk AVN
46
What is atypical SCFE
``` <10yo Do an endocrine work up - won't be fat - Hypo thyroid - Renal osteodystrophy THESE are the kids you prophylactically do the other size ```
47
Where is your screw start point for SCFE?
Center through the physeal line >5 threads through the physis Start point not directly lateral - might need to start slightly anterior If screw head is medial to the inter troch line can get labral tears
48
Who do you do bilateral SCFE screws on?
Endocrine abnormalities | Tri-rad cart open aka v young
49
LE physis grown
3 9 6 5
50
What are the rules for distal femur vs prox tibial for limb length discrep
Distal femur: 0.9cm/yr Prox tibia: 0.6 cm/yr Girls grow until 14 // boys 16
51
Treat limb length discrp
<2cm = shoe lift 2.5cm - 4 = epiphysiodesis 4+ cm - lengthening
52
Volkman law
Tension accelerates growth
53
14 yo boy, complete growth arrest at distal femoral physis - what is the predicted leg length discrp
2yrs left to grow x .9cm = 2cm
54
What association x2/ treat op vs non-op for congenital knee dislocation
Larsen syndrome And ipsi hip dislocation - have to treat knee first b/c can't put a Pavlik on dislocated knee Trt: close reduction and splinting in FLEXION IF can't get 30 deg flexion after 3mo casting -> surg
55
What does O vs B positive test mean?
Ortolani + = reducible | Barlow + = dislocatable
56
Gene for long femoral deficiency
SHH - longitudinal growth
57
Mutation for pseudoachondroplasia
COMP (collagen)- AD - normal faces, cervical instability
58
Mutation for diastrophic dysplasia
Sulfate transport protein, AR, "cauliflower ears, club foot + achondroplasia", kyphoscoli - urgent treatment for kyphosis b/c high rates neurologic involvement
59
What is multiple epiphyseal dysplasia presentation
Bilateral Perthes (NEVER bilat w/ Perthes) -> next step skeletal survey to r/o MED
60
Presentation for Poland syndrome
Symbrachydactyly | UniL chest wall hypoplasia
61
Alpert syndrome mutation and presentation
AD - FGFR2 | Complex syndactyly - its either this or Poland
62
What is the mutation and chromosome and region of cartilage for achon
AD - FGFR3 Chr 4 Proliferative zone
63
Most common cause rickets in US
hypophos X-linked R
64
What are the labs for rickets + treatment
Normal Ca, low PO4, high alk phos | Treat with vit D and phos
65
Common presentations of OI
Olecranon frx | Basilar invagination
66
Treat med + surg for OI
IV pamidronate (bisphos - x osteoclasts) Osteotomies w/ IM implants (not plating) Scoli - FUSE them
67
Mutation and chromosome for osteopetrosis
Chr 11 AR - no carbonic anhydrase - bad osteoclasts
68
NF mutation and presentation
``` Chr 17 (17 letters in NF) - neurofibromin Smooth cafe au lait Ant lat bowing Tibia pseud-arthrosis Neuro sx - malignant neuro sheath tumors ```
69
Rough cafe au lait
McCune Alright | Cafe au lait - fibrous dysplasia - precocious puberty
70
Marfans mutation, presentation
``` Ch 15 - fibrilin - AD Superior lens dislocation TGF-beta -> heart and lungs Dural ectasia -> need to fuse not brace Hip stuff ```
71
How is the ADI to fuse a Down's kid
>10 (higher than normal b/c baseline lig lax)
72
Kid w/ multiple joint dislocations - disease + mutation
Larsens - filamin B mutations | Cervical kyphosis
73
What is a Sprengel's deformity
Scapula doesn't descend - don't confuse with scoli Don't nee to treat KF disease
74
What must you do for total radius gone but have a thumb
MUST do CBC peripheral smear and cardiac work up - kid could die
75
What is CI to centralizing the ulna for radial def conditions
No elbow flexion - without this no point in centralizing
76
Diseases if missing a thumb and key question
``` Key question - CMC stable? unstable - amp the thumb, move the index finger over and make it into a thumb Holt Oram - cardiac US Fanconi - chromosomal breakage analysis TAR - CBC and peripheral blood smear ```
77
What is a Madelung deformity
Volar-ulnar issues cause distal radius malformation Tear drop of the radius on lateral XR SHOX gene mutations
78
Do you need to do anything about a prox rad-ulnar synostosis?
Nope
79
How treat thumb duplication
Keep ulnar thumb for UCL | 1-3: fuse the digit
80
Poor prognosis for brachial plexus
No biceps after 6mo - More ulnar to biceps, median to brachialis Horner's Pregang - no sympa, no rhomboids, C spine muscular weak, positive histamine test
81
What is the risk of SH 2 vs SH 3/4
SH 2 - physeal bar, look on MRI | SH 3/4 - growth arrest
82
Kids both bone
Short arm cast!!!! | Unless you have a supracondylar - fix at the same time
83
When do you un-reduce a supracondylar
Lose perfusion in the hand
84
When does ROM return to normal for supracondylars
6mo after - no formal PT needed
85
What is the 2 biggest problems with lat condyle frx
Inadequate reduction of periosteum -> loss ROM Do NOT to post-lat approach b/c AVN -> cubitus valgus -> tardy ulnar nerve palsy (later in life post-lat rotatory instab)
86
What degrees do you need to fix a ped radial head and neck frx
>6mo
87
Which kids who have a Chance frx what is the other injury you need to look for
Intra-ab (seat belt sign)
88
Open or closed for peds hip fractures?
OPEN b/c MUST get anatomic reduction
89
Rules for SPICA
Do not apply short leg first then rest - higher risk compartment syndrome Avoid 90-90 - femoral n palsy Cast wedging - if your femur fracture falls into varus, this will put them into valgus
90
How treat femoral shaft fractures by age
0-6mo Palvik 6mo-5yrs Spica >5yo stable - flexible nail (>85% canal filled) >5yo unstable - plate >5yo + >100lbs = rigid nail - MUST do GT start very lateral (MFCA becomes dom BS after 4yo, before was lig teres)
91
What is trapped that is fucking with your tibial eminence reduction
Ant horn med men
92
What deformity is worst and seen in peds tibia fractures
Valgus - prox metaphysis b/c med growth plate grows faster than lateral - self correcting
93
What is a Tillaux frx
AITFL avulsion SH 3 of distal tibia MUST get CT ORIF >2mm displaced
94
What is a triplane frx
SH 4 frx - SER Tillaus + physis + metaphysis AP looks like SH3 Lat looks like SH 2
95
Treat transient synovitis
Hx viral illness with normal ESR/CRP | Trt NSAIDS -> doesn't improve MRI
96
What is the involucrum vs sequestrum
NEW bone vs DEAD bone (debride this)
97
What are the RF for DVT after osteomyelitis
MRSA CRP >6 >8yo

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