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Pediatrics- Noelle > orthopedics > Flashcards

orthopedics Flashcards

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1
Q

what causes buckle fracture, treatment

A

FOOSH

cast if symptomatic

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2
Q

what are greenstick fractures

A

incomplete fractures of long bones

typically children <10 yo

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3
Q

what is the salter Harris clasification

A

SALTR
type I
slipped
5-7%
fracture plane passes all the way through the growth plate, not involving bone
cannot occur if the growth plate is fused
good prognosis

type II
above
~75% (by far the most common)
fracture passes across most of the growth plate and up through the metaphysis
good prognosis

type III
lower
7-10%
fracture plane passes some distance along with the growth plate and down through the epiphysis
poorer prognosis as the proliferative and reserve zones are interrupted

type IV
through or transverse or together
intra-articular
10%
fracture plane passes directly through the metaphysis, growth plate and down through the epiphysis
poor prognosis as the proliferative and reserve zones are interrupted

type V
ruined or rammed
uncommon <1%
crushing type injury does not displace the growth plate but damages it by direct compression
worst prognosis
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4
Q

Ossification centres about the elbow

A 
ossification centers always appear in a specific sequence
Capetellum- 1
Radius- 3
Internal (medial) epicondyle- 5
Trochlea- 7
Olecranon- 9
External (latreral) Epicondyle- 11
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5
Q

what is monteggia fracture

A

fracture of proximal 1/3 of ulna and radial head dislocation

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6
Q

A corner fracture is pathognomonic of what?

A

child abuse

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7
Q

what is the treatment for sever’s disease?

A

achilles stretching activity modifications and symptomatic treatment
nelsons: relative rest, ice, massage, stretching and strengthening the achilles tendon
symptoms frequently improve in 4- 8 weeks

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8
Q

name 3 overuse syndromes

A

osgood schlauer disease
sinding-larsen Johansson
sever’s disease
tx: symptomatic with NSAIDs, rest and and activity modification, physiotherapy

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9
Q

what is considered to be the threshold for scoliosis

A

10 degree curve is considered to be the threshold for scoliosis

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10
Q

congenital scoliosis is associated with what?

A

VACTERL

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11
Q

what are some red flags for scoliosis

A 
history:
pain
gait changes
weakness
rapid progression
bowel/bladder

physical:
foot deformity
hypnotic thoracic spine
abnormal reflexes
abnormal pattern
signs of dysraphism (Myelomeningocele: Can cause incontinence, hydrocephalus, tethered cord, sensory loss, orthopedics deformities, leg weakness and/or or paralysis.)
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12
Q

what are some risk factors for progression for adolescent idiopathic scoliosis? (4)

A 
larger curve (>30)
thoracic curve (> lumbar)
double primary curve
physiologic age (based on menarche Risser grade)
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13
Q

curve <20
>20
risk of progressing?

A

<20- low risk of progressing

>20- higher risk of progressing therefore should refer to ortho

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14
Q

what degree for surgery for scoliosis? bracing?

A

surgery >40

bracing >25

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15
Q

who should you refer with scoliosis? (5)

A 
atypical curve (left sided)
skeletally immature, curve >/= 20 at presentation
skeletally immature, progressive curve
rapid progression/pain
skeletally mature, curve >45
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16
Q

Clubfeet- CAVE

A

C- cavus
A- adductus
V- varus
E- equinus

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17
Q

what is the treatment for club feet

A

ponseti method

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18
Q

what type of intoning do we see for
infants
toddlers
child/adolescent

A

infants- metatarsus adductus
toddlers- internal tibial torsion
child/adolescent- increased femoral anteversion (internal hip rotation)

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19
Q

what is the treatment for intoeing

A

typically improves with growth and development
no evidence of significant long term effects
no imaging required
takes years to improve
would not operate until done growing (>12 anyways)

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20
Q

what are some warning signs of genu valgum

A 
progressive deformity
asymmetry
persistence beyond expected age
short stature
beyond 2 standard deviations
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21
Q

what are some urgent causes of limp? (6)

A 
septic arthritis hip
SCFE
osteomyelitis
discitis
fracture
neoplasia
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22
Q

DDx limping child >10

A

Non-painful:
LLD

Painful:
SCFE
Juvenile arthritis
overuse syndromes
osteo/septic arthritis
tumors
discoid meniscus
osteochondritis dissecans
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23
Q

osteochondritis dissecans

A

small segment of bone begins to separate from its surrounding region due to a lack of blood supply.

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24
Q

DDx limp 4-10

A 
Non-painful
DDH
congenital limb deficiencies
neuromuscular conditions
LLD
discoid meniscus

Painful
septic arthritis
Perthes
transient synovitis
osteomyelitis
disci tis
trauma
tumors
overuse apophysitis
osteochondritis dissecans
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25
Ddx limp <4
Non-painful DDH congenital limb deficiencies neuromuscular conditions ``` Painful: toddlers fracture osteomyelitis septic arthritis transient synovitis reactive arthritis juvenile arthritis tumors trauma ```
26
what is the most common bug to cause pediatric septic arthritis?
staph aureus
27
what is the treatment for septic arthritis?
aspiration of the joint
28
what imaging should you do for SCFE
xray AP and frog leg pelvis
29
Ottawa ankle rules
An ankle X-Ray series is only required if there is any pain in the malleolar zone and... Bone tenderness at the posterior edge or tip of the lateral malleolus (A) OR Bone tenderness at the posterior edge or tip of the medial malleolus (B) OR An inability to bear weight both immediately and in the emergency department for four steps
30
foot x ray rules
A foot X-Ray series is only required if there is any pain the midfoot zone and... Bone tenderness at the base of the fifth metatarsal (C) OR Bone tenderness at the navicular (D) OR And inability to bear weight both immediately and in the emergency department for four steps
31
Risk factors for DDH (4)
``` Risk Factors: • First Born • Female • Family history • Frank breech ```
32
where does sever's disease occur
at the insertion of the Achilles tendon into the calcaneus | - present with pain with squeezing the heel (positive squeeze test)
33
where do we see osteosarcoma
metaphysis of long bones
34
what 2 conditions predispose you to osteosarcoma
hereditary retinoblastoma | Li-Fraumeni syndrome
35
what is the classic X-ray finding for osteosarcoma? tx?
sunburst appearance | chemo, surgery
36
where do we see Ewings sarcoma? what is the classic xray finding
diaphysis of long bones, axial skeleton onion skinning appearance tx: chemo, surgery +/- radiation
37
what is spondylolysis
common cause of back pain in athletes stress fracture of the pars interarticularis most likely at L4/L5 acute hyperextension causes an acute fracture
38
what is spondylolethesis
with spondylolysis you get displacement of one vertebrae over another
39
what is the treatment for SCFE
admit to hospital bed rest percutaneous pinning partial weight bearing with crutches for 4-6 weeks after surgery
40
2 complications of SCFE
avascular necrosis | chondrolysis (destruction of articular cartilage)
41
what are some risk factors for SCFE (5)
``` obese male African American history of radiation therapy endocrinopathies (GH and hypothyroid) ```
42
what is the natural history of untreated DDH
• Dysplasia: Inadequate development of femoral head and/or acetabulum or both – Maybe associated with degenerative arthritis • Subluxation – Associated with degenerative arthritis ``` • Dislocation – Early degenerative arthritis – Limb length inequality – Scoliosis – Ipsilateral knee pain – Gait abnormality – Low back pain ```
43
What are some complications of missed DDH (5)
``` Clinically disabling degenerative arthritis Limb length inequality (if unilateral) Scoliosis Ipsilateral knee deformity and pain gait abnormality ```
44
what are two treatment options for DDH
Pavlik (for 6 weeks) | closed reduction and spica cast(if older than 6 months of failed pavlik)
45
30. A 14-year-old girl with spina bifida at the T12 level presents with a one-day history of a swollen leg and foot with erythema over the anterior tibia. Temp 37.8. WBC 16. ESR 22. Most likely: a) fracture b) cellulitis c) osteomyelitis d) deep venous thrombosis e) erythema nodosum?
Fractures in children with myelomeningocele can present with marked swelling and redness, and may be mistaken for osteomyelitis. Physeal fractures in children with myelomeningocele can compromise bone growth.
46
A patient has a scoliosis Cobb angle of 50 degrees. What is the treatment ? Spinal fusion Repeat x-ray Orthotic brace
spinal fushion
47
what is the kocher criteria? (4)
1. fever >38.5 2. wbc >12 000 3. ESR >40, CRP >20 4. unable to weight bear
48
In children suspected of having an anterior shoulder dislocation, which nerves should you check are intact?
Axillary nerve: deltoid contraction and sensory patch over deltoid Musculocutaneous nerve: biceps contraction and sensory patch on lateral forearm
49
What are the indications for open reduction?
NO CAST ``` N - non-union O - open fracture C - compromise of neurovasculature A - intra-articular fracture S - Salter Harris type 3, 4, 5 T - polytrauma ```
50
In anterior shoulder dislocation, what tests can you perform to confirm the diagnosis?
1. Apprehension test: abduct and externally rotate the arm and should see apprehension in the patient's face since it re-creates a feeling of anterior dislocation 2. Relocation test: posteriorly direct a force during the apprehension test to relieve apprehension
51
What are two conditions to rule out in a child with fever and limb pain?
1. osteomyelitis | 2. septic arthritis
52
Top common causes of septic arthritis? (3) In neonates? In sickle cell? In teenagers?
1. Staph aureus 2. Strep pneumonia 3. Non Group A strep 4. Kingella Kingae In neonates: GBS and gram negatives Sickle cell: Salmonella Teenagers: gonorrhea
53
What is the prognosis of transient synovitis? | More common in boys or girls?
typically resolves in 7-10 days | more common in boys
54
where is the most common site for metastasis for osteosarcoma?
the lungs
55
What are clinical features of osteogenesis imperfecta? (5) | -what is the diagnostic test for OI?
1. Blue sclera 2. Wormian sutures: extra bones in between sutures 3. Cortical bone thinning 4. Dentinogenesis imperfecta 5. Triangular facies 6. Late onset hearing loss in 50% of children - diagnostic test: fibroblast testing or DNA testing
56
A patient presents to you with leg pain that occurs solely at night. What is your differential diagnosis? (3)
1. Malignancy: osteosarcoma, Ewing sarcoma 2. Osteoid osteoma (benign) 3. Growing pains
57
McCune-Albright syndrome is associated with what skeletal abnormalities?
Polyostotic fibrous dysplasia
58
A 15-year-old with tibial pain (worse at night and relieved by nonsteroidal anti-inflammatory drugs) has a small lytic area surrounded by reactive bone formation on x-ray. What is the likely diagnosis?
Osteoid osteoma, a benign bone-forming tumor
59
How is metatarsus adductus treated?
passive stretching
60
How are clubfeet treated?
Most clubfeet respond well to serial casting using the Ponseti method.
61
What systemic conditions are associated with SCFE? (5)
hypothyroidism, panhypopituitarism, hypogonadism, rickets, and irradiation.
62
what are the three screening tests for DDH
barlow- clunk for dislocation (posterior force) ortolani- clunk of reduction (abduction) galeazzi- inequality in the height of the knees
63
what imaging do you do for DDH up to 6 months? after 6 months?
up to 6 months- ultrasound | after 6 months- x ray
64
when should you do an ultrasound for DDH
at 3-4 weeks of age
65
what are 4 consequences of inadequate treatment of septic hip?
1. septic hip dislocation 2. AVN 3. arthritis 4. growth arrest
66
at what age do we see perthes disease
4-12 yo
67
where do patients with SCFE feel their pain?
medial thigh or knee (referred pain from the hip)
68
Differential for painful knee (4)
``` Discoid Meniscus Osteochondritis Dissecans (Lateral portion of medial femoral condyle) Patellofemoral (Anterior) knee pain Osgood Schlatter’s Disease ```
69
calcaneovalgus foot deformity is sometimes associated with what? does it need treatment?
Sometimes associated with posteromedial bowing of tibia | due to a packaging problem resolves spontaneously
70
what is the cause of flexible flat feet? do they need orthotics?
due to ligamentous laxity arch reconstitutes with standing on tiptoes do not need orthotics or treatment
71
what causes rigid flat feet
tarsal coalition | need casting x 6 weeks then surgery
72
Valgum
gum makes your knees stick together | knock knees
73
Varum
rum makes your knees spread apart
74
Adolescent girl with scoliosis has undergone spinal surgery. She present with bilious vomiting for the last few days. What is the etiology? a. bowel adhesions b. superior mesenteric artery syndrome c. malrotation with volvulus d. Pancreatitis
superior mesenteric artery syndrome In younger patients, superior mesenteric artery syndrome is most commonly described following corrective spinal surgery for scoliosis.
75
what are 4 causes of toe walking
1. CP 2. muscular dystrophy 3. short achilles tendon 4. Autism

Pediatrics- Noelle (28 decks)

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