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PEDS 2- clinical disciplines > Ortho > Flashcards

Ortho Flashcards

(95 cards)

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1
Q

Valgus abnormality?

A

knock knees

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2
Q

Varus abnormality?

A

bow legs

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3
Q

How are kids bones dif. from adults?

A

metabolically more active

thicker and more durable

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4
Q

What is an occult fx?

A

fracture not initially evident on plain xrays

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5
Q

Salter Harris I fx?

A

transverse physeal fx w/ widening

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6
Q

Salter Harris II fx?

A

fx through metaphysis and physis

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7
Q

Salter Harris III fx?

A

fx through physis and epiphysis

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8
Q

Salter harris IV fx?

A

fx through metaphysis, physis, and epiphysis

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9
Q

Salter harris V fx?

A

physeal compression or crush fx

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10
Q

What is the MC pediatric elbow fx?

A

supracondylar fx

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11
Q

Presentation of supracondylar fx?

A

FOOSH injury from height, typically w/ hyperextension

swelling, pain +/- deformity

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12
Q

What x-ray view will you best see a supracondylar fracture?

A

lateral

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13
Q

Tx of distal humerus supracondylar fx?

A

Type I/II: posterior splint w/ light overwrap, Ibuprofen, elevation, refer to ortho

Type III or NV concerns: emergent ortho consult

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14
Q

presentation of lateral condylar fx?

A

soft tissue swelling concentrated to lateral aspect of elbow

ttp over lateral condyle

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15
Q

Management of lateral condylar fx of distal humerus?

A

emergent referral if displacement >2mm

splint, sling, NSAIDs

ortho: casting v. surg

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16
Q

What are some complications of lateral condylar fx of distal humerus?

A

nonunion

fishtail deformity

cubitus valgus/varus deformities

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17
Q

Common causes of medial epicondylar fx

A

muscle attachement avulsion-throwing athletes

may be assoc. w/ elbow dislocation

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18
Q

Management of medial epicondylar fx?

A

emergenct if entrapped fragment

splint: wrist & sling

NSAIDs

ortho: short term immobilization v. open fixation

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19
Q

comps of medial epicondylar fx?

A

ulnar nerve palsy
nonunion
angular deformity
decreased ROM

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20
Q

Common causes of radial neck fx?

A

FOOSH w/ valgus stress

elbow dislocations: during dislocation or relocation

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21
Q

Presentation of radial neck fx?

A

TTP over radial head/neck

pain w/ supination/pronation > flexion/extension

young children may complain of wrist pain

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22
Q

Management of radial neck fx?

A

immobilize (including wrist)

sling, NSAIDs, ortho

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23
Q

comps of radial neck fx?

A

premature physeal closure

loss of ROM

nonunion

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24
Q

MC age range for nursemaid’s elbow?

A

1-3y/o

common cause is sudden pull of pronated arm

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25
Presentation of nursemaid's elbow?
arm either fully extended or slightly flexed and pronated overall refusal to use arm (may still use fingers) mild pain over radial head, pain increase w/ attempts to supinate
26
What are the 2 ways that you can reduce a nursemaid's elbow?
1. hyperpronation w/ pressure over the radial head 2. supination, flexion w/ pressure over radial head then lollipop test
27
epidemiology of capitellar osteochondrosis "panner disease"
Males 5-10yos dominant (throwing) arm baseball, gymnastics, handball
28
Presentation of panner disease?
rapid onset of pain deep, lateral pain ROM: limited extension no locking sensation
29
panner disease PE findings?
+/- swelling, TTP pain/guarding w/ passive extension lateral pain w/ valgus stress
30
Management of panner disease?
sxs care: ice, NSAIDs, rest +/- immobilization, PT avoidance of elbow stress for wks-mos
31
What is a monteggia fx?
ulnar (or radial and ulnar) shaft fracture w/ dislocation of radial head
32
When might you see a "dinner fork deformity"?
wrist fxs
33
common causes of wrist fractures?
direct fall: FOOSH direct trauma
34
MC type of wrist fx?
distal radius typically involved at metaphysis
35
Presentation of wrist fx?
point TTP, swelling, ecchymosis
36
Management of wrist fx?
emergent w/ sig. clinical deformity or NV compromise splint, NSAIDs ortho: cast +/- reduction v. surg
37
Presentation of femur fx?
hx of trauma, pain in groin/buttock, unable to bear weight/walk prox femur fx: pt will hold leg in slight adduction and external rotation-may see limb shorting
38
What must you r/o in child presenting with a femur fx?
child abuse
39
management of femur fx?
ortho: hip spica cast v. surg
40
comps of femur fx?
shortening, lengthening, angulation
41
What is the MC patellar fx seen in kids <13?
patellar sleeve fx
42
What causes a patellar sleeve fx?
forced extension w/ knee in flexion -jumping, kicking
43
Management of patellar sleeve fx?
knee immobilizer, NWB, elevate NSAIDs cast v. surg
44
MCC of toddler's fracture?
young child falling while running, twisting mechanism often clinical dx
45
Management of toddler fx?
immobilize NWB, NSAIDs, elevate ortho: wee walker v. cast
46
Presentation of fx and sprains of the ankle?
TTP, swelling, ecchymosis, WB status varies
47
Management of fx v. sprains of the ankle?
posterior v. stirrup splint elevation, NWB, NSAIDs ortho consult PRN
48
MOI for triplane fx
external rotation
49
What do you need to order to assess displacement of triplane fx (ankle)? other management?
CT ortho: surg fixation v. closed reduction
50
What is a jones, Psuedo-jones/avulsion fx?
fx of the base of the 5th MT
51
common MOI for jones fx?
traction injury
52
etiology of torticollis?
compartment syndrome SCM secondary to venous outflow obstruction
53
presentation of torticollis?
head tilt to shortened muscle and chin rotation to contralateral side eval for assoc. plagiocephaly
54
Tx of torticollis?
stretching/PT positioning education
55
What is considered scoliosis?
lateral curve of the spine >10deg W >M
56
Presentation of adolescent idiopathic scoliosis?
typically asxs +/- pain obstructive lung sxs if severe
57
PE seen in AIS?
shoulder or pelvic obliquity asymmetry of scapulae adam's forward flexion exam abd reflexes
58
What are you evaluating on imaging in pt w/ scoliosis?
cobb angle
59
tx for AIS?
TLSO brace: 25 deg surg; 45 deg
60
What is osteochondritis dissecans (OCD)?
idiopathic osteonecrosis of subchondral bone
61
Presentation of OCD?
gradual onset of poorly localized deep pain decreased ROM in elbow but not typically knee +/- limited WB in LE lesions +/- int swelling + popping, locking or catching in more advanced
62
x-ray findings seen in OCD?
flatting of articular surface (crater)
63
Tx of stage I-III OCD? stage IV?
conservative, avoid running/jumping immobilization +/- PT surg
64
Presentation of septic hip? What has a similar presentation?
leg in flexion, abduction and slight external rotation refusal to bear weight, walk w/ limp Transient synovitis can look similar septic arthritis: febrile, ill appearing transient synovitis: can follow URI
65
What is used to dif. septic hip from transient synovitis?
Kocher criteria: ``` WBC >12,000 ESR >40 Fever >101.3 NWB on affected side 2/4 criteria warrants joint aspitation ```
66
Tx of transient synovitis?
high dose NSAIDs: dx and theurapeutic outpt with obs and activity restriction
67
Tx of septic hip?
admit to hospital if concern for septic arthritis w/ emergent ortho referral -joint aspiration or surg identification is diagnostic drainage and IV abx
68
What is legg-calve-perthes disease?
idiopathic AVN of the femoral head MCly in boys 4-8 typically thin and extremely active
69
Presentation of legg-calve-perthes disease?
limp at the end of the day occasional pain (knee or hip region) limited internal rotation and/or abduction of the hip
70
dx of legg-calve-pethes?
initially dx clinical but confirm w/ x-rays
71
Tx of legg-calve-perthes?
obs, PT to improve ROM activity modification surg for re-alignment if needed
72
Course of perthes?
initial: necrosis of femoral head > fragmentation: re-absorption of bone w/ femoral head collapse > re-ossification: new bone formation Healed (remodeling): femoral head reshapes itself into normal spherical shape
73
What is slipped capital femoral epiphysis (SCFE)?
slippage of the femoral physis
74
Epidemiology of SCFE?
M> F peak: 10-16 y/o OBESITY
75
presentation of SCFE?
limp of NWB w/ c/o hip or knee pain (dull, achy) restricted ROM: abduction and internal rotation stable v unstable based on WB status
76
dx of SCFE?
plain x-rays ( AP pelvis and frog later): ice cream slipping of the cone MRI if high suspicion and negativex-rays
77
Tx of SCFE?
urgent surg consultation for in situ single screw fixation NWB = admit to hospital
78
What is the MC ortho condition in newborns?
developmental dysplasia of the hip (DDH) F > M
79
screening for DDH?
in hospital and at well-child checks: laxity, subluxation, dislocation Barlow and Ortolani
80
Greatest risk factors for DDH?
1st born breech position Fam hx
81
Barlow test
provocation maneuver for DDH flexion, adduction and provide posterior pressure to the joint
82
ortolani test
reductive maneuver for DDH flexion, abduction and posterior pressure to lift greater trochanter
83
(+) Galeazzi sign?
apparent limp length discrepancy while supine and knees flexed at 90degs may be consistent w/ unilateral hip dislocation
84
Management of DDH?
ortho referral: palvik harness avoid swaddling and tight fitting clothes pt compliance is key
85
What is osgood-schlatter's disease?
inflammation and irritation of patellar tendon insertion on tibial tubercle (osteocondritis) -traction at tibial tubercle apophysis
86
Presentation of os-good schlatter's disease?
focal TTP to tibial tubercle enlargement or bony protrusion of tibial tubercle
87
dx of os-good schlatter's disease?
lateral x-ray to r/o avulsion
88
Management of os-good schlatter?
rest, NSAIDs, ice quad exercises and hamstrings stretches chopat strap pain flares around time of rapid growth
89
What is calcaneal apophysitis, sever's disease?
irritation, inflammation of calcaneal apophysis - overuse syndrome - pull of achilles' tendon
90
Epidemiology of sever's disease?
children age 6-12 y/o common in soccer players and gymnasts
91
Presentation of sever's disease?
pain at calcaneal apophysis
92
Tx of sever's disease?
stretches, Ice, NSAIDs
93
What is club foot (congenital talipes equniovarus)?
fixed deformity ``` CAVE: midfoot Cavus forefoot Adductus hindfoot Varus hindfoot Equinus ```
94
RF for club foot?
fam hx, maternal smoking may be dx of fetal US
95
Tx of club foot?
ponseti method: casting

PEDS 2- clinical disciplines (5 decks)

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