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Ortho Pediatrics Flashcards

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1
Q

idiopathic avascular necrosis of proximal femoral epiphysis

A

Legg-Calve-Perthes disease

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2
Q

how is avascular necrosis different in children vs adults?

A

can heal and remodel in children

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3
Q

what are 4 risk factors for Legg-Calve-Perthes disease?

A

+ family history
low birth weight
abnormal birth presentation
secondhand smoke

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4
Q

what is the pathophys of LCP disease?

A

osteonecrosis d/t lack of blood supply to femoral head

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5
Q

what is the presentation of LCP disease? (2)

A

change in gait
painless limp

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6
Q

a patient presents with loss of abduction and internal rotation of hip, and a limp (antalgic gait/trendelenburg gait). Dx?

A

Legg-Calve-Perthes disease

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7
Q

what is a late sign of Legg-Calve-Perthes disease?

A

limb length discrepancy

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8
Q

how is an xray taken for Legg-Calve Perthes disease? what will be seen? (3)

A

frog leg

joint space widening
irregular femoral head ossification
crescent sign

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9
Q

Dx?

A

Legg-Calve Perthes disease

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10
Q

what should be considered when determining treatment of Legg-Calve Perthes disease?

A

age + bone age
degree of necrosis

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11
Q

what patients should be treated for Legg-Calve Perthes disease non-operatively? (2)

A

patient < 8 yrs
bone age < 6 yrs

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12
Q

what is the non-op treatment for Legg-Calve Perthes disease? (2)

A

activity restriction
physical therapy

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13
Q

what is the operative treatment for Legg-Calve Perthes disease?

A

osteotomy

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14
Q

what is the most common complication of Legg-Calve Perthes disease?

A

premature physical arrest

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15
Q

what 2 situations lead to a good long term prognosis of Legg-Calve Perthes disease?

A

spherical femoral head
<6 at presentation

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16
Q

abnormal development resulting in dysplasia, subluxation, and dislocation of hip secondary to capsular laxity and mechanical instability

A

developmental dysplasia of the hip

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17
Q

what is the most common orthopedic disorder in newborns?

A

developmental dysplasia of the hip

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18
Q

where is developmental dysplasia of the hip most common?

A

left hip

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19
Q

what are 4 risk factors for developmental dysplasia of the hip?

A

female
first born
frank breech
+ family history

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20
Q

what classification is developmental dysplasia of the hip if it is subluxable?

A

barlow-suggestive

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21
Q

what classification is developmental dysplasia of the hip if it is dislocatable?

A

barlow-positive

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22
Q

what classification is developmental dysplasia of the hip if it is dislocated? (2)

A

ortolani-positive when reducible
ortolani-negative when irreducible

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23
Q

dislocation of hip by adduction and depression of the flexed femur

A

barlow exam

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24
Q

reduction of dislocated hip by elevation and abduction of flexed femur

A

ortolani exam

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25
limb length discrepancy
galeazzi exam
26
at what age can an xray be taken if a parent is concerned for their newborn's hip click?
4-6 months old
27
at what age can an ultrasound be taken if a parent is concerned for their newborn's hip click?
birth-4 months old
28
when should newborn patients with a hip click receive an ultrasound if they are considered high risk?
at 6 weeks old
29
what is the 1st line non-op treatment for developmental dysplasia of the hip in a patient that is younger than 6 months with a reducible hip?
pavlik harness (abducting splinting)
30
what is the 2nd line non-op treatment for developmental dysplasia of the hip in a patient that is 6-18 months? (2)
closed reduction spica casting
31
what is the operative treatment for a patient over 18 months, with developmental dysplasia of the hip, who has failed non-op treatment? (2)
open reduction spica casting
32
what is the operative treatment for a patient over 2 years, with developmental dysplasia of the hip, who has failed non-op treatment? (2)
open reduction osteotomy
33
injury that occurs with sudden, longitudinal traction to the hand with elbow extended and forearm pronated
nursemaid elbow
34
a patient presents with an audible click of their arm, the elbow is kept in flexion with the forearm pronated, they refuse to use it, and they have pain with supination. Dx?
nursemaid elbow
35
what is the treatment for nursemaid elbow?
closed reduction with supination technique OR hyperpronation technique
36
arm supinated, elbow maximally flexed with pressure over radial head
supination technique for nursemaid elbow
37
hyperpronation of arm in flexed position
hyperpronation technique for nursemaid elbow
38
tibial tubercle apophysitis; there is osteochondrosis or traction apophysitis of the tibial tubercle
osgood-schlatter disease
39
a patient presents with pain on anterior knee, exacerbated with kneeling, has an enlarged and tender tibial tubercle, with pain on resisted knee extension. Dx?
osgood schlatter disease
40
Dx?
Osgood schlatter disease
41
what is the conservative treatment for osgood schlatter disease? (3
NSAIDs RICE quad stretching
42
what is the non-op treatment for osgood schlatter disease that does not respond to conservative treatment?
cast immobilization
43
slippage of the metaphysis relative to the epiphysis; femoral neck slides off of femoral head
slipped capital femoral epiphysis
44
what is the most common disorder affecting adolescent hips?
slipped capital femoral epiphysis
45
what part of the body is a slipped capital femoral epiphysis most common?
left hip
46
an overweight male patient presents with pain that has been present for months, the affected leg is crossed over the other. On physical exam they have abnormal gait, abnormal leg alignment, externally rotated foot, and thigh weakness/atrophy. Dx?
slipped capital femoral epiphysis
47
what xray view should we obtain for a slipped capital femoral epiphysis?
frog leg
48
what labs should be ordered for a slipped capital femoral epiphysis if the patient is less than 10 yrs, pre-pubertal, short, or has a weight below 50th percentile? (4)
TSH free T4 BUN serum creatinine
49
Dx?
slipped capital femoral epiphysis
50
what is the treatment for a slipped capital femoral epiphysis?
percutaneous in situ fixation
51
in which 3 situations should a contralateral hip prophylactic fixation be done if a slipped capital femoral epiphysis occurred on the other side?
initial slip < 10 yrs old obese males + endocrine disorder
52
coronal plane spinal deformity
scoliosis
53
what side is scoliosis most common?
right thoracic curve
54
what score on a scoliometer during Adams forward bending test indicates scoliosis?
7 degree curve
55
a patient presents with leg length discrepancy, shoulder height differences, truncal shift, waist asymmetry with pelvic tilt, and a flat foot (cavovarus). Dx?
scoliosis
56
what sign in scoliosis indicates neurological involvement?
delayed bowel/bladder control
57
when should we get an xray on a patient to check for scoliosis?
cobb angle (>10 degrees)
58
when should we get an MRI on a patient to check for scoliosis? (2)
children < 10 yrs w/ curve > 20 degrees left thoracic curve
59
what is the non-op treatment for scoliosis with curves < 20 degrees?
observation w/ serial imaging
60
what is the non-op treatment for scoliosis with curves 20-50 degrees?
bracing x 16-23 hrs/day until skeletal growth is completed
61
what is the operative treatment for scoliosis of curves > 50 degrees with significant growth remaining?
non-fusion procedure
62
what is the operative treatment for scoliosis of curves > 50 degrees to prevent crankshaft phenomenon (curving/twisting of spine)?
anterior/posterior spine fusion
63
pediatric fracture involving the physis (growth plate) that is most common in active children
salter-harris fracture
64
what extremities are most commonly affected by salter-harris fractures?
upper extremities
65
in which 2 zones does a salter-harris fracture most commonly occur?
zone of provisional calcification zone of hypertrophy
66
a patient presents with a history of a traumatic event, has localized joint pain, swelling, TTP, limited ROM, and inability to bear weight. Dx?
salter-harris fracture
67
where does a type I salter-harris fracture occur?
Straight across growth plate
68
where does a type II salter-harris fracture occur?
Above growth plate
69
where does a type III salter-harris fracture occur?
Lower (below) level of growth plate
70
where does a type IV salter-harris fracture occur?
Through Everything
71
where does a type V salter-harris fracture occur?
Rush (extra-articular)
72
what is the treatment for a type I and II salter-harris fracture? (2)
closed reduction cast/splint
73
what is the treatment for a type III and IV salter-harris fracture?
ORIF
74
what is the treatment for a type V salter-harris fracture? (2)
emergent ortho consult
75
what should all patients with a salter-harris fracture be given after treatment?
re-evaluation in 7-10 days

Ortho-Rheum (27 decks)

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