Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

X Pediatrics 2 > Orthopedics > Flashcards

Orthopedics Flashcards

(109 cards)

Start Studying
1
Q

Characteristics of the periosteum

A

Metabolically more active (promotes callus formation, remodeling ability)
Thicker and more durable (less likelihood of displacement and gives unique fracture presentations)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some apophyseal injuries?

A

Fibrocartilage
Fusion over time
Site of tendon or ligament attachment
Prone to overuse with inflammation or avulsion injuries
(bony prominences arising from separate ossification centers)
-growth plates that don’t add to length of bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are occult fractures?

A

Fractures not initially evident on plain radiographs

Toddlers, Salter Harris 1, non-displaced elbow fractures or stress fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the epiphysis vs metaphysis?

A

Epiphysis is at the end of the bone past the growth plate and metaphysis is between growth plate and shaft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Salter Harris Classification

A 
1- Separate/straight across
2- Above into metaphysis
3- Lower/beLow into epiphysis
4- Two/Through both
5- Reduced/ERasure of growth place/cRush
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What the the type 1/ slipped fracture?

A

“Epiphyseal slip”
Separation through the physis
Excellent prognosis- non operative management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the type 2 fracture?

A

Above physis
Fracture through part of physis that extends through metaphysis
Excellent prognosis- likely non-operative management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the type 3 fracture?

A

Lower to physis
Fracture through part of physis that extends through epiphysis and often involves joint space
Unstable prognosis
+/- operative management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the type 4 fracture?

A

Fracture through metaphysis, physis and epiphysis
Unstable prognosis and can lead to limb length discrepancies
+/- operative management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the type 5 fracture?

A

ERasure of the physis
Crush injury to the physis
Unstable prognosis can lead to limb length discrepancies
+/- operative management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Types of fractures unique to kids

A

Bowing
Torus/buckle
Greenstick

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the elbow ossification centers?

A

CRITOE (in order of ossification)

1: Capitellum
3: Radial head
5: Internal (medial) epicondyle
7: Trochlea
9: Olecranon
11: External (lateral) epicondyle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the most common pediatric elbow fracture?

A

Supracondylar humeral fracture (most <10 YO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

MOI for supracondylar humeral fracture

A

Fall from moderate height (FOOSH typically with hyperextension)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Presentation of supracondylar humeral fracture

A

Swelling, pain, maybe deformity

Must do NV exam (median nerve at anterior interosseus nerve-pt not making an OK sign)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What diagnostics are used for a supracondylar fracture?

A

Xray: AP, lateral and oblique

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What wouldn’t be seen on the x-ray for a supracondylar fracture?

A

Anterior humeral line will not intersect the capitellum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Management for type I/II supracondylar fracture

A

Splint with light overwrap (avoid elastic bandages)
Sling, NSAIDs
Ortho refer and maybe reduction for type II
Then immobilize for 3 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Management for type III supra condylar fracture or ones with neurovascular concerns

A

Emergent ortho consult

Closed reduction percutaneous pin fixation or open reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Most common Salter Harris fracture

A

II- above

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Presentation of lateral humeral condyle fracture

A

Soft tissue swelling concentrated to lateral elbow

TTP over lateral condyle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How might a lateral humeral condyle fracture look on xray?

A

Like small sliver on the imaging due to large cartilaginous portion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Diagnostic views for lateral humeral condyle fracture

A

AP, lateral and internal oblique focused on lat. condyle

maybe MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When do you need an emergent referral and surgery for lateral humeral condyle fracture?

A

Displacement > 2 mm on internal oblique view

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Management for lateral humeral condyle fracture
``` Splint, sling, NSAIDs Casting vs surgery Immobilize for 6 wks Open reduction with screw fixation High risk for complications! ```
26
MOI for medial humeral epicondyle fracture
``` (think baseball player) Muscle attachment avulsion- throwing or gymnast FOOSH with arm fully extended Secondary to posterior elbow dislocation Hear a "pop" ```
27
Presentation of medial humeral epicondyle fracture
Localized pain Pain with resisted flexion Ulnar nerve dysfunction
28
Imaging views for medial humeral epicondyle fracture
AP, lateral and external oblique
29
What do you need to r/o in medial epicondyle fracture?
Incarceration of fragment in joint (use advanced imaging if needed)
30
Management for medial epicondyle fracture
Emergent if trapped fragment Splint with wrist also or sling NSAIDs Short term immobilization vs open fixation
31
Complications for medial epicondyle fracture
Ulnar nerve palsy Nonunion Angular deformity Decreased ROM
32
Presentation of radial neck fracture
TTP over radial head/neck Pain with supination and pronation is worse than with flexion and extension Young kids may have wrist pain!
33
Diagnostic view for radial neck fracture
AP, lateral and external oblique (to flatten head of the radius)
34
How to diagnose a radial neck fracture in a kid younger than 3-5?
Clinical b/c radial head not ossified yet
35
Management of radial neck fracture
Immobilize with wrist (sling) NSAIDs Cast vs surgery
36
Complications for radial neck fractures
Premature physeal closure Loss of ROM Nonunion
37
What is nursemaid's elbow?
Subluxation of the radial head (commonly 1-3 YO) due to sudden pull of pronated arm
38
Presentation of nursemaid's elbow
Arm fully extended or slightly flexed and pronated Refuse to use arm but maybe use fingers! Mild pain over radial head Pain increased with supination
39
Imaging for nursemaid's elbow
Not usually required
40
Management of nursemaid's elbow
Reduce by either hyperpronation with pressure over radial head OR supination/flexion with pressure over radial head Lollipop/popsicle test (grab with injured arm)
41
Common causes of wrist fracture
Direct fall (FOOSH) or direct trauma
42
Most common wrist fracture
Distal radius at metaphysis (maybe ulnar involvement)
43
Presentation of wrist fracture
Point tenderness, swelling, ecchymosis | Dinner fork deformity
44
Imaging for wrist fracture
AP/lat and maybe oblique | SH I is clinical without any xray findings
45
When is a wrist fracture emergent?
Significant clinical deformity or NV compromise
46
Management for wrist fracture
Splint and NSAIDs | Ortho: cast, reduction vs surgery
47
Presentation of femur fracture
History of trauma Pain in groin or butt Unable bear weight/walk If proximal femur then hold leg in slight adduction and external rotation (Shorten limb)
48
What is a femur fracture due to when less than 1?
Child abuse
49
Diagnostics for femur fracture
Must xray entire length of femur for proper eval
50
Management for femur fracture
Ortho: hip spica cast or surgery | complication: shorten or lengthening, angulation
51
What is a patellar sleeve fracture?
Unique to kids (most common patellar fx <13) Caused by forced extension with knee in flexion Either at superior or inferior pole of patella *jumping/kicking etc
52
Management for patellar sleeve fracture
Knee immobilizer (in full extension), NWB, elevate NSAIDs Cast vs surgery
53
MOI for toddler fracture
Falling while running/twisting (slides!!)-spiral fx
54
Presentation of toddler fracture
Limp or NWB (might mistake for foot) | TTP along tibia typically mid to distal diaphysis
55
Problem with diagnostics in toddler fracture
May be occult on initial films
56
Management for toddler fracture
Immobilize (splint/wee walker) | NWB, NSAIDs, elevate
57
What is a triplane fracture of the ankle?
MOI external rotation SH III on AP and SH II on lateral (SH IV- b/c growth plate had started to fuse) CT to assess displacement* Surgical fixation vs closed reduction
58
Management for fracture or ankle sprain
Initial the same Posterior vs stirrup splint Elevate, NWB, NSAIDs Refer most pediatric ankle injuries
59
How do you prevent recurrence or ankle sprain or fracture?
Reconditioning (PT and home exercise programs)
60
What is a torticollis?
Unilateral contraction of SCM muscle with visible shortening
61
Cause of torticollis
Compartment syndrome of SCM secondary to venous outflow obstruction
62
Presentation of torticollis
Head tilt to shortened muscle and chin rotation to contralateral side (evaluate for plagiocephaly-flat head)
63
Tx for torticollis
Stretching/PT and positioning education
64
What is scoliosis?
Lateral curvature of spine >10 degrees
65
Types of scoliosis
Congenital/infantile: 0-3 Juvenile: 4-9 Adolescent: over 10 (younger is more concerning)
66
Presentation of adolescent idiopathic scoliosis
``` Usually asymptomatic (maybe pain) Obstructive lung sxs if severe ```
67
Exam for adolescent scoliosis
Shoulder or pelvic obliquity Asymmetry of scaps Adams forward flexion exam (paraspinal prominences) Abdominal reflexes
68
Imaging for adolescent scoliosis
AP/PA standing regular xray on long cassette | Cobb angle
69
Tx for scoliosis
TLSO:brace for 25 degrees (bending) Surgery: 45 degrees and internal rod fixation
70
What is a septic hip diagnosis?
Emergent!!!! | peak in first few mos and then b/w 3-6
71
Reasons for a septic hip
Direct inoculation from trauma or surgery Hematogenous seeding Spreading of osteomyelitis from adjacent bone
72
Presentation of septic hip
Febrile and toxic appearing Monoarticular pain: severely exacerbated with passive ROM NWB (might think psoas abscess or transient synovitis)
73
Most common cause of pediatric hip pain
Transient synovitis
74
Presentation of transient synovitis
Appear well (afebrile) Pain worse in AM and improves during day Recent URI (3-8 YO and male)
75
Management for transient synovitis
NSAIDs (improves in first 2 days and resolve in 1 wk) | Must rule out septic arthritis
76
How do you differentiate septic hip and transient synovitis?
``` Kocher criteria: WBC>12,000 ESR>40 Fever >101.3 NWB on affected side 2/4 warrants joint aspiration (if have 3 then 93% chance of septic hip) Also CRP>2 ```
77
Imaging for septic hip
AP and frog leg lateral pelvic (normal early and might see potential joint space widening) US for effusion and aspiration and maybe MRI
78
Septic hip management
Operative: surgical I&D (joint aspiration or surgical ID is diagnostic) Abx: cephalosporing IV (b/c s aureus mostly) Older pt might be due to n gonorrhoeae so high dose penicillin
79
What is legg-calve-perthes?
Juvenile idiopathic osteonecrosis of the femoral head | Necrosis--fragmentation--re-ossification--healed/remodel
80
Who do you see legg-calve-perthes in more?
Whites (4-8) and male | maternal smoking or second hand smoke
81
Association of legg-calve perthes
Hyperactivity (ADHD)
82
Presentation of Perthes
Painless limp or insidious onset of pain (hip, groin, thigh or knee)-activity related so worse at end of day and relieve with rest Muscle spasticity History of minor trauma
83
Most useful PE finding for Perthes
Limited internal rotation or abduction of hip | (may also see antalgic limp or trendelenburg limp_
84
What is a later finding in Perthes?
Limp length discrepancy for positive Galeazzi
85
Mainstay imaging for Perthes
AP and frog lateral radiograph (usually normal initially)
86
What is seen on imaging with disease progression of Perthes?
Fragmentation and remodeling
87
Best prognostic factor in Perthes
Age (younger onset is better outcome)
88
Perthes tx
Symptomatic control and preserve hip function
89
When do you see slipped capital femoral epiphysis most?
M, African Americans (10-16) | Obesity is a risk!!
90
Presentation of SCFE
Limp or NWB c/o dull/achy hip or knee pain Restricted ROM: abduction and internal rotation Stable vs unstable based on WB status
91
Highly suspicious of SCFE but negative x ray
MRI (after have done AP pelvis and frog lat)
92
Tx for SCFE
In situ single screw fixation | NWB is admit to hospital!
93
What do you evaluate for in developmental dysplasia of the hip (DDH)?
Laxity, subluxation or dislocation
94
Risk factors for DDH
1st born, female, breech position, FHX
95
Test for DDH
Positive Barlow or Ortolani (clunking sensation) | Galeazzi: affected hip is shortened in comparison
96
Management DDH
Ortho (pavlik harness), not tight clothes | Monitor with U/s monthly and x-ray to monitor after 6 mos
97
What is Osgood-schlatters?
Inflammation and irritation of patellar tendon insertion on tibial tubercle (osteochondritis) Traction at tibial tubercle apophysis
98
Presentation of Osgood-schlatters
Focal tenderness to tibial tubercle | Enlargment or bony protrusion of tibial tubercle
99
Imaging for Osgood-schlatters
Lateral xray to r/o avulsion
100
Management for Osgood-schlatters
Good days and bad Rest, NSAIDs, ice, stretching, chopat strap Pain flares at rapid growth times (10-11 in girls and 13-14 in boys)
101
What is calcaneal apophysitis/Severs?
Irritation and inflammation of calcaneal apophysis due to overuse and pull of achilles Pain at apophysis
102
When see Severs more often
6-12 YO (soccer players and gymnasts)
103
Tx for severs
Stretch, Ice, NSAIDs
104
What is congenital talipes equinovarus?
Club foot- fixed deformity | Risks: FHX or mom smokes
105
Types of clubfoot?
``` CAVE midfoot Cavus forefoot Adductus hindfoot Varus hindfoot Equinus Might not need to memorize ```
106
How to tell which foot is affected with clubfoot
Affected limb has smaller foot and calf with shortened tibia
107
Tx for clubfoot
Ponseti method for 4-6 wks
108
Normal alignment by age
6 mos slight varus 18 mos straight 4 yrs slight valgus Young adult straight
109
Blount's disease
Varus due to vit D deficiency

X Pediatrics 2 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions