Orthopedics (pestana)

Question 1

FHx of newborns w/ uneven gluteal folds, and hips that can easily be dislocated posteriorly w/ a jerk and returned to normal w/ a snapping sound.

Answer 1

Developmental dysplasia of the hip

Question 2

If signs are equivocal, what diagnostic test should you use for developmental dysplasia of the hip?

Answer 2

Sonogram

Question 3

Tx of developmental dysplasia of the hip?

Answer 3

Abduction splinting w/ Pavlik harness for ~6 months

Question 4

Why is it not helpful to order hip Xrays in newborns?

Answer 4

Hip hasn’t calcified yet

Question 5

6 yo p/w insidious development of limping, decreased hip motion, and hip or knee pain. Walks w/ antalgic gait; passive motion of the hip is guarded. Dx?

Answer 5

Legg-Calve-Perthes dz (AVN of the capital femoral epiphysis)

Question 6

How do you dx legg-calve-perthes dz?

Answer 6

Lateral and AP hip xrays

Question 7

Tx of legg-calve-perthes dz?

Answer 7

Contain femoral head w/in acetabulum w/ casting + crutches

Question 8

Chubby, limping 13 yo boy w/ c/o knee or groin pain. When he sits w/ his leg dangling, the sole of the foot on the affected side points toward the other foot. PE: limited hip motion; hip flexion–> thigh becomes externally rotated and can’t be rotated internally. Dx?

Answer 8

Slipped capital femoral epiphysis

Question 9

Slipped capital femoral epiphysis: Dx?

Answer 9

Xrays

Question 10

Slipped capital femoral epiphysis: Tx?

Answer 10

Surgically pinning femoral head back into place (surgical emergency!)

Question 11

Toddler s/p febrile illness who now holds hip flexed in slight abduction and external rotation and refuses to move it or let it be moved passively. Increased ESR. Dx?

Answer 11

Septic hip

Question 12

Septic hip in a kid: dx?

Answer 12

Aspirate hip under general anesthesia

Question 13

Kid w/ septic hip- you aspirated hip and found pus. Whatcha do next?

Answer 13

Further open drainage

Question 14

Little kid s/p febrile illness who p/w severe, localized bone pain and w/o hx of trauma to that bone. Dx?

Answer 14

Acute hematogenous osteomyelitis

Question 15

Imaging to dx acute hematogenous osteomyelitis?

Answer 15

MRI

Question 16

Tx of acute hematogenous osteomyelitis?

Answer 16

Abx (duh)

Question 17

Fancy name for being bowlegged?

Answer 17

Genu varum

Question 18

Up to what age is genu varum considered normal?

Answer 18

3 yo (so don’t treat if < 3 yo!)

Question 19

Persistent genu varum after age 3 is MC due to…?

Answer 19

Blount disese

Question 20

What is damaged in Blount disease?

Answer 20

Medial proximal tibial growth plate

Question 21

How do you tx Blount disease?

Answer 21

Surgery

Question 22

Fancy name for knock-knees?

Answer 22

Genu valgus

Question 23

Btwn what ages in genu valgus normal?

Answer 23

4 - 8 yo

Question 24

Teenager w/ persistent pain over the tibial tubercle. Pain is worse w/ contraction of quads, and there’s no knee swelling. Dx?

Answer 24

Osgood-Schlatter disease

Question 25

What is Osgood-Schlatter disease?

Answer 25

Osteochondrosis of the tibial tubercle

Question 26

Initial management of Osgood-Schlatter disease?

Answer 26

Conservative: RICE

Question 27

What's the most an orthopedic surgeon would do for Osgood-Schlatter disease?

Answer 27

Extension or cylinder cast for 4-6 wk

Question 28

Fancy name for club foot?

Answer 28

Talipes equinovarus

Question 29

NB w/ both feet turned inward w/ plantar flexion, foot inversion, forefoot adduction, and inward rotation of the tibia. Dx?

Answer 29

Talipes equinovarus

Question 30

Basic tx of talipes equniovarus?

Answer 30

Serial plantar casts starting in the neonatal period--> sequential correction, starting w/ adducted forefoot, then hindfoot varus, finally equinus.

Question 31

What other treatment modalities are often added to serial plantar casting in talipes equinovarus?

Answer 31

Achilles tenotomy and part-time, long-term use of braces

Question 32

Talipes equinovarus: those who don't respond to casting are treated surgically around what age?

Answer 32

9-12 mo

Question 33

Teenage girl with thoracic spine curved toward the right. Dx?

Answer 33

Scoliosis

Question 34

Most sensitive screening finding in scoliosis?

Answer 34

Look at girl when she bends forward, and you can see a hump over her right thorax

Question 35

Until what time does scoliosis continue progressing?

Answer 35

Until skeletal maturity is reached

Question 36

What percent of skeletal maturity is present at onset of menses?

Answer 36

80%

Question 37

What's the major concern in severe cases of scoliosis?

Answer 37

Decreased pulmonary fxn

Question 38

How do you arrest progression of scoliosis?

Answer 38

Bracing

Question 39

How do you treat severe cases of scoliosis?

Answer 39

Surgery

Question 40

Normally, kids remodel and heal bone much better than adults. However, there are 2 types of fractures which are classically much worse in kids than in adults. What are these 2 types?

Answer 40

Supracondylar fractures of the humerus | Growth plate fractures

Question 41

Kid falls on hand w/ arm extended, leading to hyperextension of the elbow. What kind of fracture are you worried about?

Answer 41

Supracondylar fracture of the humerus

Question 42

Which type of contracture are you worried about 2/2 vascular/nerve injuries associated with supracondylar fracture of the humerus?

Answer 42

Volkmann contracture

Question 43

General tx of supracondylar fracture of the humerus?

Answer 43

Casting or traction

Question 44

What do you need to monitor for with supracondylar fracture of the humerus?

Answer 44

Compartment syndrome

Question 45

For a growth plate fracture where the epiphysis and growth plate are laterally displaced from metaphysis but are in one piece, what type of reduction can be used?

Answer 45

Closed reduction

Question 46

How do you treat a growth plate fracture where the plate is in 2 pieces?

Answer 46

Open reduction and internal fixation to provide very precise alignment

Question 47

What happens if you don't correctly align a broken growth plate?

Answer 47

It will grow unevenly--> deformity of extremity.

Question 48

17 yo boy w/ persistent low-grade knee pain x3 mo w/ "sunburst pattern" on xray. Dx?

Answer 48

Osteosarcoma

Question 49

10 yo boy w/ persistent low-grade leg pain x3 mo w/ "onion-skinning" on xray. Dx?

Answer 49

Ewing sarcoma

Question 50

Old man w/ fatigue, anemia, and localized, focal bone pain in several spots. Renal dysfxn + proteinuria. Dx?

Answer 50

Multiple myeloma

Question 51

Relentlessly growing soft tissue mass that's firm and fixed to surrounding structures +/- lung mets. Dx?

Answer 51

Soft tissue sarcoma

Question 52

Patient s/p UE injury who holds arm close to body and rotated outward +/- numbness in small area over delt.

Answer 52

Anterior dislocation of shoulder

Question 53

Patient s/p seizure or electric shock who holds arm close to body and internally rotated.

Answer 53

Posterior shoulder dislocation

Question 54

Old osteoporotic lady falls on an outstretched hand--> deformed and painful wrist w/ a dorsally displaced, dorsally angulated fracture of the distal radius.

Answer 54

Colles fracture

Question 55

Direct blow to forearm that's raised in a protective manner (think someone shielding themself)--> diaphyseal fracture of the prox ulna w/ anterior dislocation of the radial head.

Answer 55

Monteggia frx

Question 56

Direct blow to distal third of the radius--> distal radial Fx w/ dorsal dislocation of the distal radioulnar joint.

Answer 56

Galeazzi frx

Question 57

Young adult falls on an outstretched hand and p/w c/o wrist pain. Localized tenderness on palpation of the anatomical snuffbox.

Answer 57

Scaphoid frx

Question 58

Pissed off guy punches a wall and p/w swollen tender hand. Dx?

Answer 58

Metacarpal neck frx

Question 59

Old lady s/p fall p/w hip pain and on stretcher is found to have shortened and externally rotated leg.

Answer 59

Hip frx