Orthopedics

Question 1

Most likely demographics to have developmental dysplasia of hip and you should US them all

Answer 1

female breech

Question 2

Are hip clicks benign or worrisome?

Answer 2

benign

Question 3

What other abnormalities are associated with DDH?

Answer 3

Torticollis, metatarsus adductus

Question 4

Work up for DDH in children <4 months?

Answer 4

US

Question 5

Workup for DDH in children >4 months

Answer 5

Xray

Question 6

What does DDP look like on Xray

Answer 6

Femor goes up and out, delayed ossification, acetabulum angle bigger

Question 7

Rx for DDP <6m

Answer 7

Pavlik

Question 8

Rx for DDP 6-18mo

Answer 8

Operate or cast

Question 9

Rx for DDP 18m

Answer 9

Open reductin, acetabular osteotomy

Question 10

What is complication of HHP

Answer 10

AVN of femoral head

Question 11

What are the three causes of in-toeing and at what age?

Answer 11

Metatarus adductus <1yrs
Medial tibial torsion 1-3yr
Femoral torsion 3-9yr

Question 12

Which cause of intoeing is seen more often in breech or twin

Answer 12

Metatarsus adductus

Question 13

Which of the intoeing causes requires casting

Answer 13

Metatarsus adductus - if flexible, observe but cast if persist at 9-12 months. If rigid, will need to cast

Question 14

What are associated anomalies with clubfoot?

Answer 14

DDH, myelodysplastia, arthrogyprosis, myotonic dystrophy

Question 15

Rx for torticollis?

Answer 15

SCN release at 12-18 months

Question 16

Age of benign paroxysmal torticollis

Answer 16

2-8 months

Question 17

Age of resolution of benign paroxysal torticollis

Answer 17

2-3 yrs

Question 18

Pattern: cervical spinal fusion with shortening of neck and neck stiffness

Answer 18

Klippel-Feil syndrome

Question 19

What can be associated with Klippel-Feil?

Answer 19

Congenital scoliosis, renal/cardiac abnormalities, deafness, sprengel deformity, congenital elevation of scapula

Question 20

What can be seen with Erb’s?

Answer 20

Unilateral diaphragmatic paralysis

Question 21

What can be seen with Klumpke’s

Answer 21

Horner’s

Question 22

Which has worse prognosis, Erbs or Klumpke’s

Answer 22

Klumpke’s

Question 23

What are causes of bowlegs?

Answer 23

Poor bone mineralization, skeletal dysplasia, trauma, infection, abnormal diet, tibia vara

Question 24

When does bowlegs usually resolve?

Answer 24

by 2 yrs

Question 25

What are warning signs of casting?

Answer 25

1. Not improving by 2 years 2. Asymmetry or severe bowing. 3. Short stature 4. + rickets, skeletal dysplasia 5. Abnormal diet 6. Positive family history 7. H/o trauma/infection

Question 26

What do knock knees usually result from?

Answer 26

Exaggerated by hyperextension of knees

Question 27

When do knock knees resolve?

Answer 27

by 10 years

Question 28

What is the cause of tibia vara?

Answer 28

Abnormal growth of medial proximal growth plate

Question 29

Pattern: AA, obese, unilateral or bilateral bowing and painless

Answer 29

tibia vara

Question 30

Rx for tibia vara

Answer 30

Brace, osteotomy, kill growth plate on opposite side

Question 31

Pattern: Painful limp, refusal to walk in 3-6 yr old, low fever, leg internal rotation is decreased, mild/mod pain with hip movement worse in morning

Answer 31

Transient synovitis of hip

Question 32

Rx for transient synovitis of hip

Answer 32

Bed rest, NSAIDs

Question 33

If presumed diagnosis of transient synovitis of hip doesn't improve, what should you think about?

Answer 33

LeggCalve-Perthes

Question 34

Pattern: child refused to bear weight, may crawl, with localized tenderness or swelling pain with gentle twisting of tibia in 9mo to 3yr

Answer 34

Toddler's fracture - non displaced spiral fracture of distal tibial metaphysis

Question 35

What is the pathology of Legg-Calve-Perthes?

Answer 35

idiopathic ischemia and necrosis of femoral head

Question 36

Pattern: 3 to 12yr male, short stature, with decreased internal rotation, insidious onset, limp w/ or w/out pain, +/- pain with passive rotation, positive Trendelenburg, leg length discrrepancy

Answer 36

Legg-Calve Perthes

Question 37

What are the causes of Legg-Calve-Perthes disease

Answer 37

Trauma, steroids, hypoth, epiphyseal dysplasia, mucopolysaccharidosis, infection, sickle cell disease

Question 38

Picture of LCP on xray

Answer 38

widening of joint, patches and deformation

Question 39

Rx of LCP?

Answer 39

<5yrs restrict activity, NSAIDS, ROM exercise | >8yrs Abductor brace or surgery osteotomy, keep femoral head within acetabulum

Question 40

Pathology of slipped capital epiphyses

Answer 40

Displacement of femoral head secondary to abnormal growth plate

Question 41

What do you see with slipped capital epiphyses

Answer 41

ice cream slipping off cone, use AP and frog leg lateral (more sensitive)

Question 42

Rx SCE

Answer 42

to prevent further slipping not to put it back because of concern for avascular necrosis; use percutaneous screw into epiphysis

Question 43

Pattern: discrepancy when you stand, when you sit it goes away, no fracture, no scoliosis

Answer 43

leg length discrepancy

Question 44

Which pattern of scoliosis should you most worry about at thoracic and lumbar level?

Answer 44

Left thoracic, right lumbar

Question 45

At what degree do you observe, refer, and brace scoliosis?

Answer 45

<20 degrees >20 degrees >30 degrees or >20 and progresses over 5 over 6 to 8 months

Question 46

Pattern: fixed kyphosis in thoracic older adolescent and male, vertebral body narrowing of disc spaces, irregularity of vertebral and plates, wedging of anterior vertebral bodies, Schmorl's nodules

Answer 46

Scheuermann's disease

Question 47

For Scheuermann's disease, what degree do you brace or do surgery

Answer 47

Brace >50 degrees | Surgery >70 degrees

Question 48

Best xray angle for spondylolysis and spondylolisthesis

Answer 48

Spondylolysis - oblique film (Scotty dog) | Spondylolisthesis - lateral film

Question 49

Pattern: tight hamstrings, tenderness L5-S1, limited straight leg raise, poorly defined lower back pain, pain with increased activity

Answer 49

Spondylolysis

Question 50

Pattern: gradual onset with symptoms for weeks, fever, refusal to walk in toddler, fever, limp or abdominal distress, back pain in adolescent stiffness of back and pain with motion, tenderness over different disc space, positive Gower's sign

Answer 50

Discitis, staph aureus

Question 51

Warning signs of back pain

Answer 51

Age <4yrs, pain lasting >2 to 4 weeks, sever pain, pain that wakes from sleep, fever, weight loss, painful scoliosis, neuro abnormalities, focal abnormalities

Question 52

What are child abuse patterns?

Answer 52

Metaphyseal corner (chip) fractures, femoral fracture, scapular fracture

Question 53

Pattern: radial fracture on outstretch arm

Answer 53

torus or buckle

Question 54

Describe Salter-Harris classification

Answer 54

``` Type 1 - through growth plate Type 2 - above, physis and metaphysis Type 3 - lower, physis and epiphysis Type 4 - totally through all layers Type 5 - compression with obliteration ```

Question 55

What are signs of benign bone tumors?

Answer 55

sharp or sclerotic border, small in size or multiple lesions, no cortical destruction or extension into soft tissue, do not extend across growth plate

Question 56

Nurse maid's elbow

Answer 56

radial head subluxation

Question 57

Pattern: most common in 10-20 yr old, pedunculated cauliflower like lesion painless hard mass

Answer 57

solitary osteochondroma

Question 58

Pattern: 10-12 years, multiple osteochondrosis, if grows rapidly and painful can be malignant

Answer 58

hereditary multiple osteochondrosis

Question 59

What is the location for osteoid osteoma and unicameral bone cyst?

Answer 59

Osteoid osteoma, proximal or distal femur and tibia | Unicameral bone cyst - proximal humerus and femur

Question 60

Osteochondroma, hereditary multiple osteochondrosis, osteoid osteoma, unicameral bone cyst, aneurysmal bone cyst: which are painful which are not

Answer 60

Painful - multiple osteochondrosis, osteoid osteoma, aneursymal bone cyst Not painful - solitary osteochondroma, unicameral bone cyst

Question 61

Pattern: poorly localized, wakes from sleep, pain comes and goes

Answer 61

growing pain

Question 62

Pattern: tibial tubercle - apoplysitis inflammation at growth place; fragmentation/bone pulled off of tuberosity

Answer 62

Osgood Schlatter's

Question 63

Pattern: Calcaneus at insertion of Achilles tendon. Early adolence, pain increases with activity, pain over apoplhysis or if squeeze heel, decrease dorsiflexion secondary to concurrent tight heel cord

Answer 63

Sever's

Question 64

Pattern: medial, femoral condyle of knee, bone fragment development and searption at distal femur

Answer 64

osteochondritis dessicans