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Ortho Flashcards

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1
Q

Salter-Harris I

A

Transverse physeal fracture with widening. Seperate.

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2
Q

Salter-Harris II

A

Fracture through the metaphysis and the physis. Most COMMON! Above.

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3
Q

Salter-Harris III

A

Fracture through the Physis and Epiphysis. Lowers

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4
Q

Salter-Harris IV

A

Fracture through all three (metaphysis, physis and epiphysis). Through.

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5
Q

Salter-Harris V

A

Physeal compression or crush fracture. Only seen in high energy injuries. Reduced.

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6
Q

Fat Pad Sign

A

Occult fracture that has released blood into the area.

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7
Q

Supracondylar Fracture Causes

A

Most common peds elbow fracture. Usually occurs during snapping back (falling off monkey bars)

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8
Q

Supracondylar Fracture Xray

A

AP, Lateral and oblique. The anterior humeral line should intersect the capitellum.

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9
Q

Supracondylar Fracture Type I/II Treatment

A

Posterior splint with light overwrap, sling, RICE, Refer to ortho.

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10
Q

Supracondylar Fracture Type III Treatment

A

Emergent ortho consult

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11
Q

Lateral Condylar Fracture of the Distal Humerus Xray

A

AP, Lateral and internal oblique

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12
Q

Lateral Condylar Fracture of the Distal Humerus MRI Indications

A

If needed to differentiate from a transphyseal fracture (Type I).

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13
Q

Lateral Condylar Fracture of the Distal Humerus Treatment

A

Splint, Sling, RICE, refer to ortho. Emergent ortho consult if displacement is greater than 2mm.

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14
Q

Lateral Condylar Fracture of the Distal Humerus Complications

A

Fish tail deformity (common to all distal humerus fractures)

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15
Q

Medial Epicondylar Fracture of the Distal Humerus Causes

A

Common in pitchers and gymnasts. Muscle attachment avulsions (throwing) or elbow dislocations (Need CT to find the medial epicondyle).

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16
Q

Medial Epicondylar Fracture of the Distal Humerus Xray

A

AP, Lateral, and external oblique

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17
Q

Medial Epicondylar Fracture of the Distal Humerus CT

A

To rule out incarceration of the fragment in the joint if you can’t find the piece on xray. Emergent ortho consult.

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18
Q

Medial Epicondylar Fracture of the Distal Humerus Treatment

A

Splint including the wrist. RICE. Refer to Ortho.

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19
Q

Medial Epicondylar Fracture of the Distal Humerus Complications

A

Ulnar nerve palsy, angular deformity, decrased ROM

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20
Q

Radial Neck Fracture Causes

A

Fall on outstretched hand with valgus stress. Elbow dislocation/relocation (persistent pain over radial head after relocation).

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21
Q

Radial Neck Fracture Presentation

A

Tenderness over the radial head. Pain with supination and pronation. Young kids may complain of wrist pain. Can often diagnose clinically in children less than 5.

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22
Q

Radial Neck Fracture Xrays

A

AP, lateral and external oblique

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23
Q

Nursemaid’s Elbow Cause

A

Dislocation of the radial head common in 1-4 yo. Due to sudden pull of a pronated arm.

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24
Q

Nursemaid’s Elbow Presentation

A

Extended or slightly flexed pronated arm, refusal to use arm but able to use fingers, mild pain over the radial head, pain increases with supination.

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25
Nursemaid's Elbow Treatment
Reduction by supinating then flexing the arm with pressure on the radial head. Can also try hyperpronation with pressure on the radial head. Lollipop test.
26
Monteggia Fracture
Ulnar and/or radial shaft fracture with dislocation of the radial head. Suspect in any isolated ulnar shaft fractures.
27
Monteggia Fracture treatment
Needs emergent reduction
28
Wrist Fracture Causes
Most common peds fracture. Caused by a direct fall (FOOSH). Fall from monkey bars, bed, soccer. Or direct trauma. Usually in the distal radius or the metaphysis.
29
Wrist Fracture Presentation
point tenderness, swelling and ecchymosis
30
Wrist Fracture Xrays
AP, lateral +/- oblique. Needed to diagnose SH type I.
31
Wrist Fracture Treatment
Emergent ortho consult for any displacement of the growth plate or neurovascular compromise. Splint or cast, +/- reduction/surgery.
32
Scaphoid Wrist Fracture Presentation
Tender anatomical snuffbox. Often diagnosed clinically.
33
Scaphoid Wrist Fracture Xray
AP, lateral and scaphoid view (AP with 30 degrees of ulnar deviation). Often Xray is negative so repeat in 10-14 days.
34
Scaphoid Wrist Fracture Treatment
Thumb spica splint. Refer if there is displacement or continued pain.
35
Scaphoid Wrist Fracture Complications
Avascular necrosis
36
Femur Fractures Presentation
NWB, limb shortening, pain in groin or buttock. Proximal fractures will be held slightly adducted with external rotation. Suspect abuse in children less than 1 yo.
37
Femur Fractures Treatment
Hip spica cast and/or surgery
38
Femur Fractures Complications
Shortening or lengthening. Angulation.
39
Patellar sleeve fracture Cause
Forced extension with the knee in flexion. Jumping, kicking, etc. Unique to kids especially less than 13 yo. Can be at superior or inferior pole of the patella.
40
Patellar sleeve fracture Treatment
Knee immobilization, NWB, RICE. Refer to ortho.
41
Toddler's Fracture Cause
Tibial shaft fracture caused by child falling while running, often with a twisting mechanism.
42
Toddler's Fracture Xray
AP, lateral, oblique. Often missed on initial films.
43
Toddler's Fracture Treatment
RICE, NWB, refer to ortho.
44
Ankle Fracture Presentation
tender to palpation (physeal injury if exquisetley tender of the physis), localized swelling and bruising, +/- weight bearing.
45
Ankle Fracture Xray
AP, mortise, lateral, internal/external oblique
46
Ankle Fracture Treatment
Posterior splint, RICE
47
Triplane Fractue Cause
External rotation. Common in teens.
48
Triplane Xray findings
SH III on AP and SH II on lateral. Need CT to assess displacement.
49
Triplane Treatment
Usually surgery
50
Jones, Pseudo-Jones/Avulsion Fracture Cause
Fracture to the base of the fifth metatarsal due to the pull of the peroneus brevis or plantar aponeurosis at their insertion site. Common in traction injuries.
51
Torticollis Definition
Unilateral contraction of the SCM with visible shortening. Due to compartment syndrome. Head is tilted with the chin rotated to contralateral side. Must evaluate for plagiocephaly.
52
Torticollis Treatment
Stretching/PT with positioning education.
53
Scoliosis Definition
Idiopathic curvature of greater than 10 degrees with a rotational component. More common in females. Congenital (0-3 yo) and juvenile (4-9) all need to be referred to ortho.
54
Scoliosis Presentation
usually asymptomatic, +/- pain, obsturctive lung symptoms if severe.
55
Scoliosis Physical exam
shoulder/pelvic obliquity, asymmetry of scapulae, adam's forward flexion exam (paraspinal prominences), abdominal reflexes.
56
Scoliosis Xray
AP/PA standing with a long cassette (may need special facility). Measure the cob angle (greater than 10 degrees).
57
Scoliosis Treatment
Refer at 20 degrees, ILSO brace at 25 degrees, Surgery at 45 degrees.
58
Septic Hip Presentation
Holds leg in flexion and abduction. Refuses to bear weight or limps.
59
Septic Hip Diagnosis
Kocher Criteria (2/4 warrants aspiration): WBC greater than 12,000, ESR greater than 40, Fever greater than 101.3 degrees, NWB.
60
Septic Hip Treatment
Admit to the hospital with an emergent ortho referral. Joint aspiration or surgical identification is diagnostic. Positive cultures only 50-60% of the time.
61
Transient Synovitis
Diagnosis of exclusion. Treat with NSAIDs and if it responds then it isn't septic hip.
62
Leg-Calve-Perthes Disease Definition
Idiopathic avascualr necrosis of the femoral head. Boys 4-8 yo. Typically thin and overactive.
63
Leg-Calve-Perthes Disease Presentation
Limp towards the end of the day. Occasional hip/knee pain. Limited internal rotation and/or abduction of the hip.
64
Leg-Calve-Perthes Disease Treatment
Observation, PT, surgery if realignment is needed. The younger the better outcome.
65
Slipped Capital Femoral Epiphysis Definition
Slippage of the femoral epiphysis on the metaphysis. "ice cream falling off the cone" Common in obese black males 10-16 yo.
66
Slipped Capital Femoral Epiphysis Presentation
Limp or NWB. Knee pain, restricted abduction and internal rotation.
67
Slipped Capital Femoral Epiphysis Xray
AP of pelvis and frog lateral.
68
Slipped Capital Femoral Epiphysis Treatment
Urgent surgical consultation for single screw fixation (maybe of both hips) NWB and get to the hospital fast.
69
Dysplasia of the Hip Risk Factors
First born, female, breech, FH.
70
Dysplasia of the Hip Diagnosis
Postive Barlow's (push back) and/or Orlanti (make an "O"). Galeazzi test to check limb length.
71
Dysplasia of the Hip Imaging
Ultrasound from 3-4 weeks, radiographs after 4-6 mo.
72
Dysplasia of the Hip Treatment
Pavlik Harness. Avoid swaddling and tight clothes. Monitor with monthly ultrasounds or Xray (6 mo) until 8 yo.
73
Osgood- Schlatter's Disease Definition
Inflammation/irritation of the patellar tendon insertion site. Common in jumpers. Usually flares during growth spurts: females 10-11 and males 13-14.
74
Osgood- Schlatter's Disease Presentation
Focal tenderness and enlargement of the tibial tubercle.
75
Osgood- Schlatter's Disease Xrays
Lateral to rule out avulsion
76
Osgood- Schlatter's Disease Treatment
RICE, quad exercises, hamstring stretches, Chopat strap.
77
Calcaneal Apophysitis (Sever's Disease) Definition
Irritaion/inflammation of the calcaneal apophysis. Overuse syndrome due to the pull of the achiles. Common in gymnasts and soccer players ages 6-12.
78
Calcaneal Apophysitis (Sever's Disease) Treatment
RICE, NSAIDs and stretching
79
Clubfoot Definition
Fixed deformity. Often diagnosed on fetal ultrasound. Increased risk with FH and maternal smoking. CAVE: Cavus, Adductus, Varus, Equinus (dorsiflexion). Affected limb will have a smaller foot and calf with a shortened tibia.
80
Blounts Disease
Unilateral Varus (bow leg)
81
Physiologic progression of leg shape
Varus to valgus to straight

Pediatrics (8 decks)

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