Paeds Flashcards

1
Q

Indication for serial casting in MTA?

A

Rigid deformity with medial crease

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

How do you reduce a nursemaid’s elbow?

A

Supinate forearm and flex elbow to 90 deg

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

2 options for tendon transfers of HMSN?

A

tib post to dorsum of foot

peroneus longus to brevis

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

4 signs of AVN of femoral head following treatment for DDH (radiographic)?

A
  1. failure of appearance or growth of the ossific nucleus 1 year after reduction
  2. broadening of femoral neck
  3. increased density and fragmentation of ossified femoral head
  4. residual deformity of proximal femur after ossification
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Diagnosis and most common site/cause

A

Congenital pseudoarthrosis of the clavicle

Caused by extrinsic compression by the subclavian

Right middle 1/3 of clavicle 90%

Left only if situs inversus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do you differentiate CVT and oblique talus on x-ray

A

oblique talus:

navicular will reduce on plantarflexion latearl

Meary’s angle <35 degrees

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

WHen i say Olecranon apophysis avulsion fracture, you say:

A

osteogenesis imperfecta

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

What is Nail-Patella syndrome?

A

Hypoplastic Nails and Petallae

AD inheritance

Also includes:

Laxity

scoliosis

scapular hypoplasia

presence of cervical ribs

amongst other things

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

Reduction Maneuver for displaced medial epicondyle fracture into joint?

A

Robert’s Technique

  • Supination of the forearm - stretches flexor/pronator mass
  • Valgus stress on the elbow - opens up ulnohumeral joint medially and stretch FP mass
  • Extending the wrist and fingers - causes a pull on FP mass
  • Early motion within 3-5 days minimizes risk of stiffness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Most common cause of revision following early spica casting of a femur fracture in paeds?

A

Loss of reduction

Although rare

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

Classification of Sprengel’s:

A

see chart

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

What fracture type has the highest rate of growth arrest in the body?

A

SH4 of medial malleolus

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

Describe the spectrum of myelodysplasia

A

Spina bifida oculta:

  • Defect in vertebral arch with confined cord and meninges

Meningocoele:

  • Protruding sac without neural elements

Myelomeningocoele:

  • Protruding sac with neural elements

Rachischisis

  • Neural elements exposed with no covering
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What zone of the growth plate does Little Leaguer’s shoulder occur?

A

Hypertrohpic zone

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

4 factors predictive of physeal arrest in distal femur physeal fracture

A

SH classification

Presence of displacement

open fracture

Hardware penetration into physis from surgical management

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

Valproic acid has what detrimental effect on surgery?

A

Increases bleeding time

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

Complications of clubfoot correction (non op: 2, op: 6)

A

Nonop complications

  • deformit relapse
  • dynamic supination

Operative complications

  • Residual cavus
  • pes planus (due to overcorrection)
  • undercorrection
  • intoeing gait
  • Osteonecrosis of talus
  • dorsal bunion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Should kids with MRSA attend school?

Play sports?

A

Yes, only if their wound/abscess/draining pus can be adequately covered up

They should not use pools or treatment pools

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

What is normal thigh foot angle?

A

0-20 of ER

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

Contraindications to Pavlik harness (4)?

A
  1. Abnormal muscle function (i.e. spina bifida, spasticity)
  2. Age over 6 months
  3. Teratologic hip dislocation
  4. Failure of Pavlik treatment for 3 weeks.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Preferred surgical option for a large talocalcaneal coalition?

A

Triple fusion

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

in osteo with community acquired MRSA, what should you consider doing?

A

Screen for DVT

Rapid CT-PE if any suggestive signs

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

Why do you need a pre-op MRI in sprengels?

A

To identify omovertebral bar

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

Three technical factors that can increase risk of compartment syndrome when using hip spica for femur fracture?

A
  1. Rough cast edge at popliteal fossa
  2. Excessive traction
  3. Knee flexion > 90
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Cause and treamtent of stiff-knee gait in CP?

A

Cause: rectus femoris firing out of phase

Treatment: transfer of distal rectus femoris tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

dDx for bilateral valgus (3)

A

Physiologic

Renal osteodystrophy (Rickets)

Skeletal dysplasia

  • Morquio
  • Spondyloepiphyseal dysplasia
  • Chondroctodermal dysplasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Treatment of hallux varus

A

Conservative:

  • most resolve with time

Can do abductor hallucis release

excsision of central epiphyseal bracket

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Workup of Arthrogryposis at 3 months? (3)

A

Perform at 3-4 months of age

  1. neurologic studies
  2. enzyme tests
  3. muscle biopsies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

2 methods of percutaneous reduction of radial head fracture

A
  1. K-wire joystick technique
  2. Metaizeau technique

involves retrograde insertion of a pin/nail across the fracture site

fracture is reduced by rotating the pin/nail

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Anterolateral bowing:

what’s the chance this patient has NF?

What is the chance an NF patient has anterolateral bowing?

A

what’s the chance this patient has NF?

50%

What is the chance an NF patient has anterolateral bowing?

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Name 4 non-ortho manifestations of myelodysplasia

A

Neurosurgical manifestations

  • Arnold-chiari manifestation (Type II); Most common associated congenital abnormality
  • Hydrocephalus
  • Tethered cord

Urological manifestations

  • Neurologic bladder

IgE mediated latex allergy

  • Results in profound anaphylaxis
  • Present in 20-70% of patients with this disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What part of the acetabulum is deficient in a NON-neuromuscular hip dysplasia?

A

Anterior or anterolateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

4 indications for surgery in infantile Blount’s

A

Stage I and II in children > 3 years

Stage III, IV, V, VI in children <3 years

failure of brace treatment

metaphyseal-diaphyseal angles > 20 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Muscle imbalance in equinovalgus foot?

A

Opposite of equinovarus

TA/TP weak

PB/PL strong

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the Safe zone in DDH reduction?

how do you increase it?

A

ROM at which hip stays reduced

typically:

90-100 degrees flexion

mild abduction of 20-45 degrees

increase it with adductor tenotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Paediatric trigger finger - waht must you release?

A

A1 pulley + 1 slip of FDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is a reason why intra-thecal baclofen is preferred over PO for CP?

A

PO associated with cognitive impairment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is contraindicated in the treatment of DMD scoliosis?

A

Bracing

may interfere with already compromised respiraotry function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is angle A and how does it help evaluate DDH?

A

Acetabular Index

varies with age (decreases)

normal is less than 25 deg 2yo kid

(remember 2yo is ~20deg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Name 5 reduction techniques of radial head reduction:

A

Elastic bandage

Patterson

Israeli

Metaezeau (retrograde pin)

K-wire joystock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Indications for hemivertebrectomy in congenital scoli

A

Progressive curve >40 degrees

Patient <5

lumbosacral vertebra best (but can be done in thoracic)

(JAAOS 2004)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

BLocks to reduction in DDH

A

Labrum

Inverted limbus

capsule

transverse acetabular ligament

ligamentum teres

pulvinar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Give general principles of operative treatment for PFFD

A

Limb Lengthening

  • if predicted LLD <20cm
  • If femoral length >50% of opposite side

Amputation ±prosthesis

  • If femoral length <50% contralateral side or LLD >20cm
  • If foot is proximal to level of contralateral knee
  • If prosthetic knee will not be below the level of the contralateral knee

*based on level of knee - must have it normal to walk normal

Hip Fusion

  • If absent acetabulum (Aitken D), fuse residual limb to pelvis and make knee into a hip
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

5 Risks for CP

A

Prematurity (most common)

Anoxic injury

Prenatal intrauterine factors

Perinatal infections (ToRCH, toxoplasmosis, rubella, CMV, Herpes)

Meningitis

Brain malformations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Best predictor of success with tendon transfers in CP?

A

Patients with good voluntary control had the greatest improvement in functional use scores.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Name this implant, procedure, and what its done for:

A

telescopic rod for Schofield-Miller realignment procedure for OI

Can use telescoping or non-telescoping rods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Pin configuration post CRPP of distal femoral physeal injury

A

antegrade

avoids going intra-articular and avoids pin-tract infection into joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Kid with MPS comes in with burning in radial 3 digits, worse at night, some clumsiness of the hands. Top 2 dDx

A

Carpal tunnel syndrome: MPS is one of the most common causes of CTS in kids

cervical myelopathy (unless its San Fillipo - no C-spine issues)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What part of the physis does a SCFE occur in?

A

Hypertrophic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

4 non-orthopedic manifestations of Downs?

A
  1. mental retardation
  2. heart disease (50%)
  3. endocrine disorders (hypothyroidism)
  4. premature aging
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How do you screen for and diagnose MPS?

A

Screen: urine

Diagnose: enzyme assay for activity in skin fibroblasts or WBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Orthopaedic Manifestations of Charcot Marie Tooth (HMSN)? (4)

A

pes cavus

hammer toes

hip dysplasia

scoliosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Good prognostic signs of anterolateral bowing? (2)

A

Duplicated hallux

Delta-shaped osseous segment in concavity of bow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Indications for anterior approach in addition to posterior approach in scolisis

A

Large curve (>75 degrees)

Stiff curves

Skeletally immature (Risser grade 0, boys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Most common complication of lateral condyle fracture?

A

Lateral overgrowth/spurring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Indications for contralateral pinning in SCFE

A

High risk patients:

Endocrinopathy

Obese

Young age, indicated by:

  • Boys
  • Girls
  • Open Triradiate cartilage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Genetic transmission of DMD

A

X linked recessive

Important to counsel patients of risk of subsequent kids with the disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Non-ortho manifestations of Down (3)

A

Cardiac abnormaltieis (50%)

Endocrine (hypothryoidism)

mental retardation

premature aging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

3 complications of radial head/neck fractures

A

AVN

synostosis

loss of ROM (pronation > supination)

radial head overgrowth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is the most common manifestation of child abuse?

A

Skin manifestations (bruises, burns)

Fractures are the second most common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

When do you IMN a femur in paediatrics (age & weight)

A

> 11 years

>49 kg

Remember to use lateral start point

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Pediatric elbow dislocation - most common nerve injury

A

Ulnar nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Kid with hemihypertrophy. What must you do?

A

serial ultrasounds q3 months until age 7,

then physical exam q6 until skeletal maturity

TO RULE OUT WILM’S TUMOUR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Complications seen with too much flexion in Pavlik?

A

Femoral nerve palsy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

2 complications of transphyseal distal humerus fracture?

A

Cubitus varus

Medial condyle AVN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Name 3 differences in the upper airway of a paediatric patient vs. adult

A

floppy epiglottis

large tongue

small larynx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

NIH Consensus Development Conference Statement diagnosis criteria for NF1?

A

Two or more of the following:

  • six or more café-au-lait macules over 5 mm in greatest diameter in prepubertal individuals and over 15 mm in postpubertal individuals.
  • two or more neurofibromas of any type or one plexiform neurofibroma.
  • freckling in the axillary or inguinal region.
  • optic glioma.
  • two or more Lisch nodules (iris hamartomas).
  • a distinctive osseous lesion such as sphenoid dysplasia or thinning of long bone cortex with or without pseudarthrosis.
  • a first-degree relative (parent, sibling, or offspring) with NF-1 by the above criteria.is based on presence of both
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What are three ways to assess coronal deformity of the L/E on AP xrays?

A

1) mechanical axis
2) mLDFA 88 (range 85°-90°) and mMPTA (range 85°-90°)
3) Tibial Femoral Angle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

6 signs of preganglionic brachial plexus injury

A

Winged scapulae (long thoracic)

Absent rhomboid function (dorsal scapular nerve)

Absent RTC (suprascapular nerve)

Absent Latissimus dorsi (thoracodorsal nerve)

Horner’s syndrome (sympathetic chain)

Elevated hemidiaphragm (phrenic nerve)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

CP hip management based on Reimer’s Migration Index

A

Soft tissue release

Children 40%

VDRO + ST release

Kids >4 OR Reimer’s index >60%

Abduction osteotomy or girdlestone procedure

Chronic painful dislocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

3 orthopaedic associations with tibial deficiency.

A

Ectrodactyly (cleft hand)

preaxial polydactyly

ulnar aplasia

high rate of MSK anomalies (75%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

How do you decide what size of nancy nail?

A
  • nail size determined by multiplying width of narrowest portion of femoral canal by 0.4
  • the goal is 80% canal fill
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Spinal manifestations of achondroplasia vs. pseudoachondroplasia

A

Achondroplasia

  • foramen magnum stenosis
  • kyphosis
  • lumbar stenosis/decreased interpedicular distance

Pseudoachondroplasia

  • cervical instability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Complications seen with too much abduction in Pavlik?

A

AVN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What are two options to treat AVN

following proximal femur fracture?

A

● Vascularised free fibula graft

● Core decompression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

By the time you transition from casting to boots and bars for Ponsetti, how much abduction should the foot be in?

A

70 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

MPS with least spinal abnormalities?

A

San Filippo

only has scoliosis, and even that is rare

JAAS 2013

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

2 factors prognostic of long term neurologic sequelae from paediatric trauma:

A

O2 sat at presentation

GCS 72 hours post injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

In surgical correction of blounts, what do you have to include in Langenskiold V, VI?

A

Epiphysiolysis (bar resection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

First line treamtent in tarsal coalition?

A

trial of non-op with immobilization or orthotics - always

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

2 indications for exploring the artery in a supercondylar fracture

A

Pulse is lost after reduction

Persistance of pulseless hand after reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

3 nonorthopaedic conditions of marfans?

A
  • cardiac abnormalities
  • aortic root dilatation
  • possible aortic dissection in future
  • mitral valve prolapse
  • superior lens dislocations (60%)
  • spontaneous pneumonthoraces
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

AAOS guidelines for paediatric femoral shaft fractures

A

6 months - 5 years: spica

5 years - 11 years: TENS, IMN or submuscular plating

>11 years: submuscular plating or TENS

They make NO reommendations on weight in the official criteria

JAAOS 2011 states:

We believe that regardless whether a patient has an unstable comminuted or oblique fracture, rigid nails are appropriate for patients aged >11 years who weigh >49 kg.

We recommend the lateral trochanteric approach to avoid the risks associated with starting at or near the piriformis and near the tip of the trochanter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Who gets Gower’s sign? Describe it

A

Rises by walking hands up legs to compenate for gluteus maximum and quadriceps weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

2 life-threatening intra-operative complications in DMD:

A

intraoperative cardiac event

malignant hyperthermia

Consult anesthesia & cardio preop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

tarsal coalition

Chance of it being bilateral?

Patient with 1 coalition has what percentage of having another?

A

50% chance of being bilateral

20% chance of a second coalition if they have 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Complication with too mcuh abduction in DDH treatment?

A

AVN of femoral head

via impingement of the posterior-superior retinacular artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What is the risk of AVN for Delbet Type 1B?

A

Nearly 100%

(transphyseal proximal femur fecture with displacement of epiphysis out of acetabulum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

MRSA infected kids have higher levels of what on admission?

A

ESR, CRP, WBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Indications for selective thoracic fusion:

A

Non-structural lumbar curve (Lenke 3 or above)

Lower end vertebra touches CSVL

Lenke 1C, 2C, 3C, 4C

No significant sagittal imbalance

Major Thoracic Curve

Double thoracic Curve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Risk factors for AVN post pinning of a SCFE. (5)

A
  1. unstable SCFE
  2. over-reduction of an acute slip
  3. attempted reduction of a chronic slip
  4. pins in the superolateral quadrant
  5. femoral neck osteotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

7 options for interpositional graft after resection of physeal bar:

A

Fat

PMMA

Cranioplast (like PMMA: takes longer to set, less exothermic reaction, less chance of heat necrosis)

Bone wax

Cartilage

Muscle

Silicone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Who gets Duchenne muscular dystrophy?

A

Males only

X-linked recessive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

How does TA compare to PL in:

a) Clubfoot
b) Cavo - varus foot

A

a) TA stronger
b) TA weaker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

BBFF: malrotation at what level has what effect?

A

Midshaft malrotations lead to decreased supination

(vs distal malrotation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

3 ways that Beckers differes from Duchennes?

A
  1. dystrophin protein is decreased instead of absent
  2. later onset with slower progression and longer life expectancy (average diagnosis occurs at age 8 compared to 2 years of age with Duchenne’s)
  3. more prone to cardiomyopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

4 radiographic signs of osteopetrosis?

A

“erlenmeyer flask” proximal humerus and distal femur

“rugger jersey spine” with very dense bone

loss of medullary canal “bone within a bone” appearance

block femoral metaphysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Name 3 syndromes with abnormal ossification of secondary growth centers

A

Spondyloepiphyseal dysplasia

Multiple epiphyseal dysplasia

diastrophic dysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

5 Orthopedic (non-spine) manifestations of Achondroplasia?

A
  • facial features
    • frontal bossing
    • button noses
    • small nasal bridges
  • trident hands (inability to approximate extended middle and ring finger)
  • bowed legs
  • radial head subluxation
  • muscular hypotonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What percentage of LCP patients will eventually need THA?

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What part of the growth plate does SCFE secondary to renal osteodystrophy occur?

A

Secondary spongiosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Torticollis: head tilt and rotation which direction?

A

Tilt: towards side of pathology

Rotation: chin rotates away from pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

2 optioins for treating elbow flexion contractures

A

Clarke’s pectoral transfer

Steindler’s flexorplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What condition can be confirmed using fibroblast culturing to analyze type I collagen in equivocal cases?

A

OI

(best for type 4)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

You plan a femoral derotational osteotomy on a child with femoral anteversion.

Where do you make your osteotomy?

How much correction do you need?

A

intertrochanteric osteotomy

amount of correction = (IR-ER) / 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What is von Recklinghaussen disease?

A

NF1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

3 positive effects of bisphosphonates in OI (not the side effects)

A

Improves mobility

decreases fracture rate

improves vertebral bone density

Improves vertebral height (not overall height)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What is the Sofield-Miller procedure?

A

Realignment osteotomy with rod fixation for OI

Fassier-Duval rods can be used.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Age range for open reduction and hip spica +/- femoral osteotomy?

A

18 months - 4 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Describe the GMFCS scale.

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Most important thing to look for when examining tibal hemimelia?

A

Is the extensor mechanism intact and is there a flexion contracture of the knee.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

5 conditions associated with Cavovarus foot?

A
  1. Charcot-Marie-Tooth
  2. Freidreich’s ataxia
  3. Cerebral palsy
  4. Polio
  5. spinal cord lesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Never do what when ORIFing a lateral condyle fracture?

A

Never dissect posteriorly

Blood supply comes from there and will cause AVN if you disrupt it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

You cant reduce a galleazzi fracture. What is most likely blocking reduction and which approach do you take to remove it?

A

ECU

Dorsal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Should Down syndrome kids avoid contact sports? If yes, what indication?

A

Avoid sports if progressive radiographic instability or signs of myelopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

INdications for hemiepiphysiodesis in congenital scoli

A

Failure of formation (hemivertebra)

patient <4

Curve < 40 deg

(only get about 15 degrees of correction. Contraindicated in failure of segmentation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

How many ossification centers in the proximal humerus?

A

3: HH, GT, LT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

What 2 actions may help reduce AVN rates in femoral head/neck fractures in paediatric patients?

A

early reduction

Joint decompression (hematoma aspiration or core decompression)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Second most common nerve palsy in SCHF?

A

radial

AIN most common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Post tibial spine fracture, what is the factor most highly linked to arthrofibrosis?

A

Prolonged immobilization > 4 weeks

So start mobilizing before then

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Surgical treatment of hip dislocation in myelodysplasia is controversial b/c of high failure rates. What is the anatomic cause of failure? Be specific

A

Paralytic hip dislocation (not teratologic)

B/c of paralysis of the hip abductors and extensors and unopposed pull of the hip adductors and flexors

This leads to high relapse rates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Foot muscular Imbalances in Hereditary Motor Sensory Neuropathy?

A
  • plantar flexed 1st ray is initial deformity
  • cavus caused by peroneus longus (normal) overpower weak tibialis anterior
  • varus caused by tibialis posterior (normal) overpowering weak peroneus brevis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

When do you mobilize a medical epicondyle fracture in paediatric patients?

A

Early - after about a week if nondisplaced/displaced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Phase 1 or 2 rib at an increased risk of progression?

A

Phase 2: rib overlap with apical vertebra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Characteristic lesion in Fredrich’s ataxia

A

Spinocerebellar degenerative disease, therefore, lesions in:

  • Dorsal root ganglia (peripheral)
  • Corticospinal tracts (central)
  • Dentate nuclei in the cerebellum
  • Sensory peripheral nerves
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Describe the Beighton-Horan scale.

A

5 or more on 9-point Beighton-Horan scale defines joint hypermobility

  • passive hyperextension of each small finger >90° (1 point each)
  • passive abduction of each thumb to the surface of forearm (1 point each)
  • hyperextension of each knee >10° (1 point each)
  • hyperextension of each elbow >10° (1 point each)
  • forward flexion of trunk with palms on floor and knees fully extended (1 point)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

In LCP, when do you want to perform surgery (if indicated)

A

initial or fragmentation phase

no positive effect has been found for containment surgery performed after initial or early fragmentation stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What is the best indicator of peak growth?

A

Risser 0 or closure of triradiate (occurs at same time)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

How does MRSA get its virulence and resistance?

A

Virulence:

  • panton-valentine leukocidase (PVL)
  • It is released and kills WBC

Resistance:

  • mecA gene
  • Makes an altered penicillin-binding protein with less affinity for penicillin, giving it resistance. Normally, PBP binds penicillin into cell wall, inhibiting cell wall synthesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

WHat joints are most commonly invovlved in JIA?

A

knee > hand/wrist > ankle > hip > C-spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Most common nerve palsy in SCHF?

A

AIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

4 risk factors for DVt in pediatric psteomyelitis?

A

CRP > 6

surgical treatment

age > 8-years-old

MRSA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

7 donor options for nerve transfer in Brachial plexopathy?

A

sural

intercostal

spinal accessory

phrenic

cervical plexus

contralateral C7

hypoglossal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

Name a contraindication to hemiepiphysiodesis in congenital scoliosis:

A

Segmentation defects (ie bars)

b/c there is no chance for the concave side to catch-up i growth

Therefore, part of the indication for hemiepeiphysiodesis is a failure of formation (hemi-vertebra - b/c when you epiphysiodese the wedged side, the concave side has the ability for catchup growth)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

Classification of tibial spine/eminence fractures

A

Meyers & McKeevers

I: undisplaced

II: displaced with posterior hinge

III: completely displaced with no bony contact

IV: comminuted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Treatment of hip abduction contracture in myelodysplasia

A

Ober-Yount Procedure:

proximal division of fascia lata and IT band release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

4 options for elbow release in arthrogryposis

A

Triceps to biceps

Steindler flexorplasty

Pec Major to biceps

Triceps V-Y lengthening and posterior capsulectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

dDx of toe walking (4)

A

CP

DMD

Tethered Cord/spinal dysraphism

Diastematomyelia

CMT

Unilateral Short limb causing unilateral toe walking

Non-ortho

Autism

Schizophrenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

DDH U/S:

What is beta angle and what is normal?

A
  • angle created by lines along the labrum and the ilium
  • normal is less than 55°
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

Order of correction in ponsetti method

A

Cavus first (midfoot)

Then adduction & Varus (hindfoot)

Equinus last

(CAVE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

Indication for surgery in LCP?

A

Lateral pillar B, B/C, C in kids >8 (bone age >6)

They do better with pelvic/femoral osteotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

Diagnosis?

A

CVT

Clues:

talus is vertical

navicular dorsal dislocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

You do an iliac crest biopsy to confirm diagnosis of OI.

3 positive findings?

A

decrease in cortical widths

decreased cancellous bone volume

increased bone remodeling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

In neuromsucular scoliosis that affects lungs, at what FVC can you safely perform surgery

A

30% and above

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

You reduce a dislocated DDH hip. Development of what radiologic landmark in the next few months is considered a positive prognosticator?

A

Teardrop - not usually present in a dislocated hip.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

What is the most common type of child abuse?

A

Neglect

Followed by physical > sexual > emotional maltreatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

3 conditions that are commonly found with tibial hemimelia?

A
  1. ectrodactyly
  2. preaxial polydactyly
  3. ulnar aplasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

Risk factors for SMA syndrome in AIS surgery (7)

A

shorter (by a mean of 7.1 cm, p = 0.03)

weighed less (by a mean of 11.5 kg, p = 0.001)

had a lower body mass index (p = 0.003)

had a greater minimal thoracic curve magnitude achieved by bending (a mean of 12 degrees greater [45 degrees for subjects with superior mesenteric artery syndrome and 33 degrees for controls], p = 0.015)

had a lower percent correction of the thoracic curve on bending (a mean of 11% lower, p = 0.025)

and had more lumbar lateralization (88%, compared with 61% in the control group, had a Lenke lumbar modifier of B or C instead of A, p = 0.008)

Multivariate logistic regression analysis identified:

A staged procedure (odds ratio, 31.0)

the lumbar modifier (odds ratio, 9.06)

body mass index (odds ratio, 7.75)

thoracic stiffness (odds ratio, 6.67)

as the most predictive of the development of superior mesenteric artery syndrome

(Braun et al. 2006 JBJS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

How do you tell the difference between posteromedial bowing and calcaneovalgus foot?

A

Posteromedial bowing: apex is in distal tibia

Calcaneovalgus foot: apex is at ankle joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

Describe, in detail, the Ponseti method

A
  • Corrects in order CAVE
  • All casts are LLC
  • weekly cast changes

1st cast:

  • Supinate the foot
  • elevate 1st ray (MT)
  • This will maintian all the MT heads in a row

2nd cast:

  • corrects MT adductus and hindfoot varus
  • abduct forefoot against counterpressure on the head of the talus (not CC joint or fibula)
  • This will correct MT adductus by reduction of the MT and navicular on head of talus and cuboid on calc
  • With further casting, the calc will evert and move under talus
  • Must perform abduction with the forefoot in supination and the foot in equinus so that the calc an evert and abunct under talus
  • Keep performing serial casts until full correction of “A” and “V”

TAL

  • In the office
  • Then cast for 2 more weeks
  • Then Denis-Brown brace (boots and bars)
  • These go on 24hrs a day for 3 months, then nighttime and naptime for 2-3 years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Mainstay of treatment in duchenne muscular dystrophy? What effect does it have (3)

A

Corticosteroids

  • prolongs ambulation
  • slows scoliosis
  • slows deterioration of FVC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

4 indications for operative management of proximal humerus fracture (peads)?

A

Adolescent with severe deformity (> 45 degrees or

Vascular Injury

Open fracture

Intra-articular displacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

Define Baumans Angle

A

Line down axis of Humerus

Line through lateral condylar physis

Angle between them

SHould be 70-75

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

Define Arthrogryposis

A

Non-progressive congenital disorder involving multiple rigid joints (usually symmetric), leading to severe limitation in motion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

What part of the growth plate does a SCFE occur in?

A

Hypertrophic zone

caused by weakness in the perichondral ring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

What is the most common complication of proximal femur fracture?

A

AVN

(Coxa vara and non-union also important)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

When do you brace congenital scoliosis?

A

To control supple compensatory curves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

Non-ortho associations of hemihypertrophy (2 major types)

A

Malignant intra-abdominal tumours

  • Wilm’s - most common
  • adrenal carcinoma
  • hepatoblastoma

GU abnormalities

  • medullary sponge kidney
  • polycystic kidney
  • inguinal hernia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

Best xray to ID a SCFE?

A

lateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

Acceptable criteria for distal radius fractures

A

<9 years old: 30 degrees dorsal angulation. Bayonette apposition <1cm

>9 years old: 20 degrees dorsal angulation

No rotational deformities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

What disorder is Botox contraindicated in?

A

Spinal muscular atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

What is a Charnley WIlliams rod used for?

A

ORIF of NF tibial pseudoarthrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

Asymptomatic Paediatric Isthmic spondy, soccer player. Do you limit sports?

A

No

Manage with close observation and no restrictions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

3 facets of first line treatment for JIA?

A

  1. steroid injections
  2. DMARDs
    - etanercept, rituximab, azathioprine
  3. Opthamologic Exams
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

Assume growth in males and females stop at what age?

A

Males: 16

Females: 14

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

Treatment of dislocated hip in myelomeningocele?

A

Surgical reduction of hips in patients with spina bifida is associated with a high failure rate and therefore treatment indications are controversial.

Reduction for patients with L4 level is most controversial and may be considered if unilateral.

Dislocated hips in patients with L3 level and above are typically left alone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

3 things affecting Proliferative Zone

A

Achondroplasia

Multiple Hereditary Exostoses (MHE)

Gigantism

“A Giant Me”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

You treat a femur fracture with hip spica:

1) Where do you mould?
2) What is dreaded complication and how to prevent it?
3) What do parents need before leaving hospital?

A

1) Distal femur and buttocks
2) Compartment syndrome of the thigh, prevent by smoothing cast around politeal fossa, avoiding excessive traction and knee flexion
3) Special car seat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

8 risks for brachial plexus birth injury

A

Large of gestational age

High birth weight

Cephalopelvic disproportion

Shoulder dystocia

Forceps delivery

Difficult presentation

Breech position

Prolonged labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

DDH U/S:

What is minimal age?

A

4-6 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

Name 3 conditions that can present with teratologic hip?

A

arthrogryposis

myelomeningocele

Larsen’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

3 surgical treatment options for Adolescent Blounts?

A
  1. Transient lateral hemiepiphysiodesis
  2. Permanent lateral hemiepiphysiodesis
  3. Valgus HTO with ORIF or gradual corrrection (ilizarov or TSF)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

4 radiographic signs of hemophila on knee xray?

A
  1. squaring of patella and femoral condyles (Jordan’s sign)
  2. ballooning of distal femur
  3. widening of intercondylar notch
  4. patella appear long and thin on lateral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

Indications for poor prognosis in bracing of AIS

A

poor in-brace correction

hypokyphosis (relative contraindication)

male

obese

noncompliant (effectiveness is dose related)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

Preferred treatment of congenital vertical talus

A

Reverse ponsetti casting +

surgial reduction & pinning of talonavicular joint +

TAL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

What are the stages of LCP?

A

Initial:

  • infarction produces a smaller, sclerotic epiphysis with medial joint space widening

Fragmentation:

  • femoral head fragmentation (result of neovascular process)

Reossification:

  • Ossific nucleus undergoes reossification

Remodeling:

  • Femoral head remodels until skeletal maturity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

WHere does a Salter osteotomy hinge on?

A

Symphysis Pubis

1 cut from AIIS to sciatic notch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

How much bend do you want in a nancy nail?

A

3x canal size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

7 Physical or radiologic signs of child abuse?

A
  1. long bone fxs in infant that is not yet walking
  2. multiple bruises
  3. multiple fxs in various stages of healing
  4. corner fxs
  5. posterior rib fractures
  6. bucket handle fractures
  7. transphyseal separation of the distal humerus
  8. single transverse long bone fractures
  9. skull fractures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

Manifestations of Gauchers (5)

A

Systemic Manifestations

  • fatigue (anemia)
  • prolonged bleeding (thrombocytopenia)
  • fever, chills, sweats (infection)
  • seizure, developmental delay (CNS involvement)

Orthopaedic Manifestations

  • bone pain (fracture, osteomyelitis)
  • joint pain or contracture
  • bone crisis (osteonecrosis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

3 keys to surgical treatment of CVT?

A
  1. release of tight dorsal lateral structures
  2. pinning of talonavicular joint
  3. reconstruction of spring ligament
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

What are the weak and spastic muscles in equinovarus foot?

A

Spastic: TP and TA

Weak: PB, PL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

Sillence Type I and IV:

a) What is the diesease?
b) What is quickest way to differentiate on exam?
c) Which has better prognosis?
d) Inheritance patterns?

A

a) OI
b) Type 1 has blue sclera
c) Type 1 is milder
d) Both AD

Bonus: DIvided into A and B based on tooth invovlement. Type 1 more likely to lose hearing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

3 blocks to reduction in proximal humerus reduction

A

long head biceps

capsule

periosteum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

DDH U/S:

What is alpha angle and what is normal?

A
  • angle created by lines along the bony acetabulum and the ilium
  • normal is greater than 60°
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

4 ortho and 2 nonortho associations with Friedrich’s ataxia

A

Ortho

  • cavovarus foot: often rigid
  • scoliosis
  • ataxia
  • areflexia (but with positive plantar response)

Non-ortho

  • Cardiomyopathy
  • nystagmus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

paeds patient with femur fracture. >100lbs. Result with flexible IM nail?

A

Increased risk of complications such as nonunion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

Indications for MRI in scoliosis case

A

atypical curve pattern

  • left thoracic curve
  • short angular curve
  • apical kyphosis

rapid progression

Any child

excessive kyphosis

structural abnormalities

neurologic symptoms or pain

foot deformities

asymmetric abdominal reflexes

a syrinx is associated with abnormal abdominal reflexes and a curve without significant rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

Othopaedic Manifestations of CMT?

A

Scoliosis

Pes Cavus

Hammertoes

Hip dysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

Explain how the Silfverskiöld test works!

A
  1. Improved ankle dorsiflexion with knee flexed = gastrocnemius tightness
  2. Equivalent ankle dorsiflexion with knee flexion and extension= achilles tightness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

newborn comes in with congenital dislocation of knee and DDH, which do you treat first and why?

A

Knee

b/c you can’t get a pavlik on with a dislocated knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

DDH U/S:

What is maximal age (for usefulness)?

A

4-6 months

(i.e. use xray)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

Name (9) associated conditions with fibular deficiency

A

Anteromedial tibial bowing

Ankle instability: ball & socket ankle

Equinovalgus foot deformity

Tarsal coalition (50%)

Absent lateral rays

Femoral abnormalities

  • PFFD
  • Coxa Vara

Cruciate ligament deficiency

Genu valgum: Due to lateral femoral condyle hypoplasia

Significant leg shortening discrepancy

  • Shortening of femur and/or tibia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

How much does a leg grow in a year and where does the growth come from?

A

23 mm /year

  • proximal femur - 3 mm / yr (1/8 in)
  • distal femur - 9 mm / yr (3/8 in)
  • proximal tibia - 6 mm / yr (1/4 in)
  • distal tibia - 5 mm / yr (3/16 in)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

Conditions that may cause SCFE?

A
  • obesity (most important)
  • hypothyroidism (labs show elevated TSH)
  • osteodystrophy of chronic renal failure
  • Rickets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

I say absent clavicles, you say:

A

Cleidocranial dysplasia

failure of intramembranous ossifciation

leads to failure of formation of midline structures

ie failre of pubis to ossify

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
197
Q

2 techniques to reduce a radial head fracture

A

Patterson maneuver

hold the elbow in extension and apply distal traction with the forearm supinated and pull the forearm into varus while applying direct pressure over the radial head

Israeli technique

pronate the supinated forearm while the elbow is flexed to 90° and direct pressure stabilizes the radial head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
198
Q

Best surgical appraoch to CP HV?

A

1st MTP fusion +/- Akin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
199
Q

Risk factors for birth fractures

A

Vaginal deliveries

breech presentation

prolonged labor

macrosomia (>4.5 kg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
200
Q

3 types of CP gait

A

toe walking

crouched

stiff-knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
201
Q

in SCHF with median sensory symptoms, what is the major complication that is now at increased risk/most commonly to be missed?

A

Compartment syndrome

They cannot give the regular symptoms (pain) of compartment syndrome so the risk goes up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
202
Q

Why would you do a squatting skyline xray?

A

To diagnose symptomatic bipartate. Compare with static and if there is separation then there may be a fracture of the fibrocartlaginous connection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
203
Q

What pulleys need to be released in childresn’ trigger finger?

A

A2 & A3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
204
Q

Best x-ray view for lateral condyle fracture?

A

internal oblique

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
205
Q

List the normal progression of leg angulation:

A

Born: max varus

1.5 years: neutral (actually just under 2 years, but 1.5 easier to remember)

3 years: max valgus

7 years: physiologic valgus

as per Selenius

(0 –> 1.5 –> 3 –> 6)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
206
Q

Most common inheritance pattern of hereditary motor sensory neuropathy (HMSN). Name 2 other types

A

AD most most common

So counsel parents and patients on risks of future generations

can be AR and X-linked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
207
Q

What percentage growth of the humerus comes from the proximal growth plate?

A

80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
208
Q

Principals for bladder extrophy repair?

A

Multidiosciplinary

Gen surg + Urologist

stage I: primary closure of bladder (newborn)

stage II: epispadias repair in males (1-2 y/o)

stage III: bladder neck reconstructions (4 y/o)

pelvic osteotomies may be performed at any stage of process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
209
Q

Contraindication to treatment of paediatric femur fracture (open physes)

A

Piriformis start femoral nail

b/c of increased risk of AVN

superior retinacular vessels of MFCA are at risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
210
Q

When evaluating function of CP kid, what are 6 areas to ask about?

A
  1. nutritional status
  2. respiratory function
  3. sitting/standing posture
  4. upper and lower extremities function
  5. communication skills
  6. acuity of hearing and vision
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
211
Q

What is the strongest independent risk factor for septic arthritis in paeds?

A

CRP >20mg/L

(even though it’s not on the Kocher criteria)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
212
Q

Physiologic Classification of CP

A

Spastic

Athetoid

Ataxic

Mixed (Usually Spastic/Athetoid)

Hypotonic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
213
Q

4 technical considerations for fixation of pediatric distal femur fracture?

A
  • avoid multiple attempts at reduction
  • avoid physis with hardware if possible
  • if physis must be crossed (SH I and SH II with small Thurston-Holland fragments), use smooth k-wires
  • SH II fracture, if possible, should be fixed with lag screws across the metaphyseal segment avoiding the physis
  • postoperatively follow closely to monitor for deformity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
214
Q

Bado Classification

A

Monteggia Fractures

Dislocation goes where the apex is (THINK the apex pushes the radial head out)

I: apex anterior proximal ulnar fracutre with anterior dislocation of radial head

II: Apex posterior ulna fracture with posterior dislocation of the radial head

III: Apex lateral ulna fracture with lateral dislocatio nof the radial head

IV: BBFF with anterior dislocation of radial head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
215
Q

Most common cause of septic hip in neonates?

A

Group B Strep

(one of the practice mcq’s says that this is only for community kids, if they are aditted to nicu with multiple lines and stuff then it is Staph. Aureus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
216
Q

Two indications for endocrine workup in a SCFE?

A
  • child is < 10 years
  • weight is < 50th percentile
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
217
Q

Stretching is a reccomendation for flexible flatfoot. If it is flexible wtf are you stretching?

A

Tight heel cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
218
Q

How do you immobilize a Galleazzi fracture?

A

In supination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
219
Q

3 indications for CRPP of pediatric distal radius fracture.

A
  1. Failure of cast management
  2. SH 1 or 2 with NV compromise (reduces the need for constricting cast)
  3. Fractures which required reduction under anesthesia (ie. failed ER reduction)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
220
Q

What must you do for workup in patient with congenital scoliosis?

A

Echo: cardiac defects - 10%

Renal ultrasound and GU workup - genitourinary defects - 25%

MRI - spinal cord malformations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
221
Q

What is normal range for IR and ER of hip?

A

IR = 20-60

ER = 30-60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
222
Q

What protein is elevated in 75% of fetus in second trimester if they have spina bifida?

A

alpha-fetoprotein (AFP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
223
Q

What is the sudden cause of death in a patient with FGFR3 mutation

A

FOramen magnum stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
224
Q

4 radiographic findings in OI

A

thin cortices

generalized osteopenia

saber shins

skull radiographs reveal wormian bones

Metaphyseal bands (bisphosphonate use)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
225
Q

Surgical treatment of flexible cavovarus foot?

(4 elements)

A
  1. plantar fascia release
  2. Tib Post transfer
  3. 1st ray dorsiflexion osteotomy
  4. TAL (says orthobullets, but this is wrong as achilles is already loose in cavovarus - incr calc pitch - as in SPORC2016)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
226
Q

What part of acetabulum is deficient in neuromuscular hip dysplasia?

A

posterior superior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
227
Q

Describe an NF1 patient’s risk of cancer

A

Increased risk of benign and maligant tumours, including:

melanoma

leukemia

rhabdomyosarcoma

pheochromococytoma

carcinoma

pancreatic endocrine tumours

astrocytoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
228
Q

LLD Principals:

a)

b) 2-5 cm
c) > 5 cm

A

a)

b) 2-5 cm = shorten long side
c) > 5 cm = lengthen short side +/- shorten long side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
229
Q

What does Hilgenreiner’s-Epipyseal angle predict?

What are the values?

A

Predicts natural history of coxa vara

Normal:

Will resolve spontaneously if

Will need surgery if >60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
230
Q

Most common long term sequelae of brachial plexus birth injuries

A

Glenoid retroversion

Due to IR of shoulder due to Erb’s palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
231
Q

At what level of SPina Bifida is hip dislocation most common and why?

A

L3 - uopposed hip flexion and adduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
232
Q

8 injury patterns suspicious for child abuse

A

Long bone fractures in infant who is not walking

Multiple bruises

Multiple fractures in various stages of healing

Corner fractures: High specificity for child abuse

Posterior rib fractures

Bucket handle fractures (Same as corner fractures,

Avulsed bone fragment is seen en face as a bucket handle)

Transphyseal separation of the distal humerus

Skull fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
233
Q

RIsk of AVN with paediatric hip factures

A

Type I: 80-100%

Type II: 50%

Type III: 30%

Type IV: 10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
234
Q

PFFD:

4 indications for limb lengthening with the goal of ambulation without prosthesis.

A
  1. predicated limb length discrepancy of >20cm
  2. stable hip and functional foot
  3. femoral length >50% of opposite side
  4. femoral head present (Aiken classifications A & B)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
235
Q

What is the primary treatment for Gauchers?

A

IV enzyme replacement therapy.

Not effective in type 2.

Medications end in -glucerase.

Also consider bone marrow transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
236
Q

4 conditions associated with CVT?

A
  1. myelodysplasia (common)
  2. arthrogryposis
  3. diastematomyelia
  4. chromosomal abnormalities

High association with genetic or neuromuscular disorder (50%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
237
Q

Compare infantile and adolescent Blounts

A

Infantile

  • pathologic genu varum in children 0-3 years of age
  • more common
  • deformity rarely from femur
  • typically bilateral

Adolescent Blount’s

  • pathologic genu varum in children > 10 years of age
  • more likely to have femoral deformity
  • less common
  • less severe
  • more likely to be unilateral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
238
Q

dDx for anterolateral bowing (2)

A

NF

tibial deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
239
Q

3 associated endocrine disorders with SCFE

A

Hypothyroidism

Osteodystrohpy of CRF

Growth HOrmone Treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
240
Q

Where should pins be placed and why, for pediatirc femur ex-fix?

A

Laterally

To reduce quads scarring.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
241
Q

Treatment for lateral pillar A/B in kid less than 8 (bone age less than 6)

A

Nonoperative

They do well regardless

242
Q

Start point for retrograde femoral nancy nails?

A

2-2.5 cm proximal to distal physsi

243
Q

What is the angle of Drennan and what is it used for?

A

Metaphyseal-diaphyseal angle (Drennan)

  • Infantile Blounts
  • angle between line connecting metaphyseal beaks and a line perpendicular to the longitudinal axis of the tibia
  • >16 ° is considered abnormal and has a 95% chance of progression
  • Less than or equal to 10 has a 95% chance of self-resolution
244
Q

Name the syndrome associated with polyostotic fibrous dysplasia. Name the other associated abnormalities

A

McCune Albright

  • Polyostotic fibrous dysplasia
  • unilateral cafe-au-lait spots (Coast of Maine)
  • Endorcine pathlogies affecting hormone excess (precocious puberty, hyperthyroidism, cushings)
  • ± scoliosis

Do testing to rule these things out

245
Q

Name 4 life-threatening perioperative complications with MPS

A

post-extubation stridor (may require emegent re-intubation, consider pre-procedure trach)

cardiac death

Stroke

acute pulmonary edema

*Recommendation is to consult anesthesia, cardio and otolaryngology prior to surgery

246
Q

Diagnosis?

A

Sacral agenesis

247
Q

2 xray views to assess clubfoot?

A

dorsiflexion lateral (Turco view)

AP

Look for parallelism, low talocalcaneal angle, and negative talus-first metatarsal angle

248
Q

Treatment algorithm of femur fractures in paeds:

A
  • pavlik or early spica casting

7m - 5 years:

    • >2-3cm shortening: traction with delayed spica casting or ORIF

6-11 years:

  • length stable: flexible IM nails
  • Length unstable: ORIF (plates) vs. ex-fix

Approaching skeletal maturity (>11 years)

  • length stable or
  • Length unstable or >100lbs: IM nail with lateral start point
  • Length unstable in proximal or distal end: ORIF plate/screws
249
Q

Plantarflexion lateral of two cases with rockerbottom sole deformity.

What is the diagnosis in A and B?

A

A = Congenital oblique talus

B = Congenital vertical talus

(Difference is that Oblique talus corrects the talonavicular joint with stress plantarflexion lateral)

250
Q

Name the physeal zone associated with:

Metaphyseal “corner fracture” in child abuse

Scurvy

A

Primary Spongiosa

251
Q

What is the biggest risk factor for re-fracture after surgical treatment of pediatric femur fracture?

A

Use of ex-fix

(Especially with transverse or short oblique fractures)

252
Q

4 manifestations of CMT?

A
  1. pes cavus
  2. hammer toes
  3. hip dysplasia
  4. scoliosis
253
Q

What operative intervention is contraindcated in CP patient with crouched gait

A

Isolated heel cored lengthening

will worsen hip and knee flexion (you’ll tip them over even more)

Must do multiple releases at one (heel, knee, hip)

254
Q

Diagnosis?

A

Equinovalgus

i.e. CP foot

Clues:

Inferior tilt of talus

Loss of medial arch

255
Q

When do lateral condyle pins come out after ORPP of lateral condyle fracture

A

6 weeks

256
Q

What are physical exam findings consistant with equinovarus foot?

A
  1. intoed gait
  2. inverted heel (tib post)
  3. supinated forefoot (tib ant)
  4. callous and pain along lateral border
257
Q

Treamtnet of CP hips

A

Adductor and psoas release ± abduction bracing

  • Kids < 4 & Reimer’s index >40%

Proximal femoral osteotmy & soft tissue release

  • kids > 4 OR Reimer’s index > 60%

Abduction osteotomy or girdlestone

  • Chronic painful dislocation in GMFCS 5

Salvage acetabular procedure (Chiari, shelf)

  • Skeletally mature with subluxation/dislocation
258
Q

DDX for Genu Valgum?

A
  • bilateral genu valgum
    • physiologic
    • renal osteodystrophy (renal rickets)
    • skeletal dysplasia
      • Morquio syndrome
      • spondyloepiphyseal dysplasia
      • chondroctodermal dysplasia
  • unilateral genu valgum
    • physeal injury from trauma, infection, or vascular insult
    • proximal metaphyseal tibia fracture
    • benign tumors
      • fibrous dysplasia
      • osteochondromas
      • Ollier’s disease
259
Q

3 poor prognostic indicators for subtalar coalition

1 contraindication to surgery

A

Coalitions >50% the size of the posterior facet

Hindfoot valgus >16 degrees

Narrowing of the posterior TC facet

Contraindicaton:

massive coalition: 100% of middle + 50% of posterior facet

260
Q

Risk factors for SCFE (7)

A

Obese (single greatest risk factor)

Males (3 : 2)

African Americans

Pacific islanders

Period of rapid growth

Femoral retroversion

History of previous radiation therapy to femoral head region

261
Q

5 Ortho manifestations of OI (there are many)

A

Bone fragility & fractures

  • Bone heals normally initially but does not remodel

Genu varum

Ligamentous laxity

Short stature

Scoliosis

Codfish vertebrae (compression fracture)

Basilar invagination

Olecranon apophyseal avulsion fracture

262
Q

4 dDx for leg bowing in kids?

A

Physiologic

Blount’s disease

Osteogenesis imperfecta

Rickets/osteomalacia

Syndromic

263
Q

Diagnosis

A

Bisphosphonates on OI

Results in metaphyseal banding at each dosing

264
Q

Name 4 social risk factors for child abuse

A

recent job loss of parent

children with disabilities (cerebral palsy, premature)

step children

Premature child

265
Q

3 indications for ORIF in pediatric distal femur fracture?

A
  1. open fracture
  2. failed closed reduction of SH1 or SH2
    1. perisoteum usually infolded in these case
  3. SH 3 - 4 in order to get anatomic reduction of joint surface
266
Q

dDx of knee or thigh pain paediatric patient:

A

Knee pathology

Hip pathology

  • SCFE
  • LCP
  • Septic hip
  • Transient synovitis hip

*knee/thigh pain mandates a workup for SCFE

267
Q

What degree of scoliosis do pulmonary and cardiopulmonary complications happen in the immature and mature patient?

A

Pulmonary: 60 deg

Cardiopulmonary: 90 deg

Mature: 100 deg (Agabegi Jaaos 2015)

268
Q

Name 6 syndromes/diseases assocated with basilar invagination

A

Klippel-Feil

Osteogenesis imperfecta

Morquio syndrome

achondroplasia

spondyloepiphyseal dysplasia

occipitocervical synostosis

269
Q

3 ultrasonographic measurements in DDH

A

Alpha angle (N: >60)

Beta angle (N: 55)

Line extending from ilium should bisect femoral head

Femoral head should be bisected by a line drawn down the ilium

Pubofemoral distance

  • If there is asymmetry in pubofemoral distance >1.5mm, then side with larger pubofemoral distance is dysplasic

(JAAOS 2014)

270
Q

X-ray findings of clubfoot

A

Dorsiflexion lateral (Turco)

  • hindfoot parallelism between talus and calcaneus (talocalcaneal angle <35 deg)

AP:

  • Kite’s talocalcaneal angle <20 degrees (N = 20-40)
  • Talus - 1st MT angle <5 degrees
271
Q

minimally invasive technique to treat congen. vertical talus: describe steps

A
  1. reverse ponseti casting until TNJ reduced (LLC)
  2. pin TNJ
  3. perc TAL (like clubfoot)
  4. LLC x 5 weeks (one cast change)
  5. cast off, pin out, AFO until 2yo

as per Dobbs et al. 2006 JBJS

272
Q

List 5 features associated with in-toeing that necessitate further workup:

A

Pain

LLD

Progressive deformity

Family history of rickets, skeletal dysplasias, mucopolysaccharidoses

Limb rotational profiles 2 standard deviations outside the normal

273
Q

dDx for global hypotonia (2). How do you tell the difference?

A

SMA:

  • absent DTR
  • fasciculations (including tongue)

Duchnne muscular dystrophy

  • present DTRs

Also:

Emery-Dreifuss dystrophy

limb girdle dystrohpy

Guillain-Barre syndrome

274
Q

Management of unilateral pars defect at L4 that has failed conservative management.

A

Pars Repair

Indiated at L4 and above

L5: must fuse in-situ

275
Q

What x-ray is this?

What is the diagnosis?

A

45 degree oblique

Calcaneonavicular coalition

276
Q

What is the anatagonist of peroneus Longus?

A

Tibialis anterior

277
Q

Treatment algorithm for tibial deficiency

What is is based on?

A

Based on function of knee extensor mechanism

No active knee extension:

  • knee disarticulation

active knee extension:

  • synostosis of fibula to remaining tibia + syme amputation

Ankle diastasis

  • Syme/boyd amputation

DO NOT do a Brown’s Centralization procedure. High failure rate

278
Q

What dysplasia has metaphyseal changes of the tubular bones with normal epiphysis?

A

metaphyseal chondrodysplasia

279
Q

A SCHF patient has an ulnar nerve palsy. What fracture type is it likely to be?

A

Flexion type

Most common nerve palsy after flexion type injury is ulnar

280
Q

Best pin configuration for SCHF?

A

Lateral divergent pins (2 vs 3)

281
Q

How do you tell if the tib post or tib ant is the driving force in an equinovarus foot?

A

Confusion test

in a seated position, get patient to perform resisted hip flexion

If toes dorsiflex and supinate, then likely TA is the driving force

282
Q

4 indications for ORIF in BBFF?

A

Open fractures

Refractures

Failure of nonoperative management

BBFF kids >13

283
Q

3 non-ortho manifestations of Ehlors Danlos?

A
  1. mitral valve prolapse
  2. aortic root dilatation
  3. gastroparesis
284
Q

5 associated conditions of external tibial torsion:

A

Miserable malalignment syndrome

Osgood Schlatter disease

Osteochondritis dessicans

Early degenerative joint disease

Neuromustular conditions

285
Q

6 Dural Ectasia associations

A

Marfan syndrome

NF1

Ehlers-Danlos

Achondroplasia

Ank spond

idiopathic

286
Q

Can a Klippel Feil patient play contact sports?

A

No if they have fusion of C3 and above

287
Q

Longitudinal traction in young kid. Arm held in elbow extension and forarm pronation. What is the injury pathomechanism?

A

Inteprosition of annular ligament in radiocapitellar joint (nursemaid’s elbow)

288
Q

When do you need to excise a physeal bar in a growth arrest following distal femur fracture?

A

Indicated when deformity is present with a physeal bar of

<50% and at least 2 years or 2 cm of growth remaining

289
Q

Indications for pinning distal radius fracture in paeds (7)

A
  • Ipsilateral distal humerus fracture
  • Excessive soft tissue swelling
  • Inability to obtain a reduction
  • SH I/II with NV compromise
  • SH III/IV fracture displaced
  • Inability to maintain an adequate reduction (i.e. loss of reduction)
  • Ones that need general anesthesia to reduce
  • After 2nd attempt at closed reduction
290
Q

2 spinal deformities with OI

A

Scoliosis

basilar invagination

(NOT AAI)

291
Q

What is Friedrichs Ataxia?

A

Neuronopathy in the dorsal root ganglia, accompanied by the loss of peripheral sensory nerve fibers and the degeneration of the posterior columns of the spinal cord.

292
Q

Kid with septic hip: what position will the hip be held in?

A

Flexion, abduction, ER

293
Q

Specifically for the distal radius, when do you want to operate to excise a distal radius physeal bar?

A

If >2mm (not cm) of growth remains

progressive deformity

symptomatic

294
Q

3 advantages of nancy nailing over ORIF

A
  1. shorter surgical time than ORIF
  2. less blood loss than ORIF
  3. equal union rates, radial bow and rotation as ORIF
295
Q

What aspect of deformity will not remodel in femoral mal-unions?

A

Rotation

296
Q

What two physical exam findings are most useful to guide maanagement in fibular hemimelia?

A
  1. LLD
  2. Is the foot stable and plantigrade?
297
Q

Where does congenital pseudoarthrosis of the clavicle almost always happen? What is the exception?

A

Right middle 1/3

situs inversus is the exception

298
Q

What is the major source of blood to the physis?

A

Perichondrial artery

299
Q

Criteria/algorithm for septic arthritis vs. transient synovitis

A

History of fever (T > 38.5C)

Non-weight-bearing

ESR > 40 mm/h

WBC > 12,000 cells/mm3. T

The probability of septic arthritis is

  • 0.2% with zero predictors
  • 3.0% with one predictor
  • 40.0% with two predictors
  • 93.1% with three predictors
  • 99.6% with four predictors.
300
Q

2 indications for CR and hip spica for DDH?

A
  1. Age 6-18 months
  2. Failed Pavlik
301
Q

6 Blocks to reduction in DDH:

A

ligamentum teres

capsule

transverse acetabular ligament

inverted labrum

Psoas

Pulvinar

302
Q

3 associations with tarsal coalition:

A

Fibular hemimelia

Apert’s

PFFD

“People with tarsal coalition masturbate a lot: FAP FAP FAP”

303
Q

4 peri-operative considerations if operating on a Gauchers?

A
  1. Pre-operative enzyme replacement
  2. Hydration to reduce risk of bone crisis
  3. Increased risk of infection
  4. Increased bleeding risk
304
Q

Management of equinovarus foot

A

Flexible:

AFO, casting, botox

tendon transfer, either:

TA/TP split transfer

TA to cuboid

TP to brevis

depending on what’s tight

Rigid:

lateral closing wedge calc ostetomy

305
Q

4 treatment options for fibular hemi-melia and their indications?

A
  1. Shoe lift (
  2. Contralateral epiphysiodesis (LLD
  3. Limb lengthening (projected LLD less than 30%, stable plantigrade foot, must remove fibular anlange)
  4. AMputation (nonfunction foot or LLD > 30%) - do at 1 year of age
306
Q

Diagnosis?

Give 1 dDx

A

Multiple Epiphyseal Dysplasia

Classic for MED to present as “bilateral” Legg-Calve-Perthes disease

307
Q

In a patient with Sprengel’s, what is the most likely associated abnormality to expect?

A
  1. Scoliosis
  2. Klippel-Feil

(JAAOS)

see chart

308
Q

2 main surgical options for tibial hemimelia?

A

1) No ext mechanism/ absent tibia = knee disarticulation
2) Proximal tibia present with intact extensor emchanism = tibiofibular synostosis with modified Syme amputation

309
Q

Two MSK findings associated with bladder extrophy?

A
  1. acetabuli are ~12 degrees externally rotated
    1. without pubis to tether the anterior ring, the posterior elements externally rotate
  2. gait shows an external foot progression
310
Q

Treatment for posteromedial bowing?

What must you monitor for with your treatment plan?

A

Non-operative - will spontaneously resolve in 5-7 years

Must watch for LLD (common complication)

311
Q

How is CP gait desribed/classificed

A

Sagittal plane

  • Jump
  • Crouch
  • Stiff knee

Transverse plane

  • IR
  • ER
  • Neutral

Coronal plane:

  • Genu varum
  • Genu valgum
  • hip adduction
312
Q

4 operative indications for proximal humerus fracture in paeds

A

Severely displaced fracture in kid age >11 (Neer-Horowitz 3/4)

Open fracture at any age

Vascular injury

Intra-articular displacement

313
Q

Next step if Pavlik harness treatment fails?

A

Convert to abduction brace for 3-4 weeks.

314
Q

Zone of injury for proximal humerus fractures?

A

Zone of provisional calcification (part of hypertrophic)

However may go through several

Spares proliferative

JAAOS 2015

315
Q

Indications (3) & Contraindications(3) for Centralization procedure in Radial clubhand. What age should it be done at?

A

Indications:

  • Good elbow ROM
  • Good biceps function
  • Young patient

Contraindications:

  • Older patient with good function
  • Patients with elbow extension contracture who rely on radial deviation
  • proximate terminal condition

Should be done at 6-2 months of age

316
Q

The patella vascular supply is composed of _____ branches which stem from which 3 larger arteries?

A

6 small branches ( the geniculates plus anertior tibial recurrant)

Popliteal, Superficial femoral and Anterior Tibial

317
Q

What are the 2 cardinal manifestations of Marfan’s syndrome?

A

Aortic root dilatation

Superior lens dislocation

If both are present, do not need genetic testing - therefore test for both (Echo and optho consult)

318
Q

5 things affecting Hypertrohpic Zone of growth plate

A

SCFE

MED

SED

Schmids

Fractures (SH1)

Ricekts

Enchondromas

319
Q

What are the 5 physeal zones?

A
  1. Reserve
  2. Proliferative
  3. Hypertrophic
  4. Primary Spongiosa
  5. Secondary Spongiosa
320
Q

Risk factor for AVN of the hip

A

Trauma

Steroid use

Radiation

321
Q

Summarize treatment for COxa Vara in dwarves in one sentence.

A

Valgus intertrochanteric osteotomy for a neck shaft angle of less than 100 degrees.

322
Q

8 radiographic findings in Blount’s disease

and one physical finding

A

Varus focused at proximal tibia

Severe deformity (>16 degrees MDA of Drennan)

Bilateral bowing (Can be asymmetric even though it’s bilateral)

Progressing deformity

Sharp angular deformity

Lateral thrust gait

Lateral subluxation of tibia

Metaphyseal beaking

323
Q

How long do you wear a Pavlik?

A

23 h/day for 6 weeks then ween over 6 weeks.

324
Q

Flat top talus is a complication of what casting method?

A

Ponseti

325
Q

Main vascular concern in tibial tibercle fracture?

A

Tear of recurrent anterior tibial artery

May assess with CT-A if concerned

Leads to compartment syndrome

326
Q

Spinal manifestations of diastrohpic dysplasia

A

AAI

Cervical kyphosis

TL kyphoscoliosis

Rarely needs treatment

327
Q

What is the cuase of a fishtail deformity of the distal humerus?

A

lateral trochlear ossification center AVN

328
Q

Name the physeal zone associated with:

Achondroplasia

Gigantism

MHE

A

Proliferative

329
Q

what are the orthopaedic issues in NF?

(What type of music do NF patients listen to?)

A

Extreme SKA

1. Extremity deformities

Hemihypertrophy

Pseudoartrhosis

AL Bowing

2. Scoliosis

3. Kyphosis

4. AAI

330
Q

What is the role of enzyme replacement and bone marrow transplant in muccopolysaccharidosis?

A

Intravenous enzyme replacement therapy and hematopoetic stem cell transplantation (HSCT) improve cardiac, respiratory and somatic function, but they do not penetrate osteocartilaginous tissue and thus have no impact on skeletal abnormalities.

331
Q

Toronto score (Active Movement Scale) of what is an indication for surgery in brachial plexus injury?

A

<4

>4 = activity against gravty

(Different UE functions are graded on a scale and added together)

332
Q

General order of closure of the distal tibial growth plate?

A

Central, then medial, then lateral

This is why you get a Tillaux fracture, b/c it is the last part of fuse

333
Q

Most common cause of septic hip in adolescents? Treatment?

A

Neisseria gonorroeae

High dose penicillin (does not need OR)

334
Q

Non-ortho manifestations of DMD

A

cardiomyopathy

static encephalopathy

Respiratory issues

335
Q

Surgical option in resistant vertical talus?

A

talectomy

336
Q

Radiographic classification of subacute paediatric OM:

A

types IA and IB show lucency

type II is a metaphyseal lesion with cortical bone loss

type III is a diaphyseal lesion

type IV shows onion skinning

type V is an epiphyseal lesion

type VI is a spinal lesion

337
Q

Classification of lateral condyle fracture and treatment algorithm?

A

I: undisplaced (<2mm) (nonop)

II: 2-4mm displaced (CRPP vs ORPP)

III: >4mm displaced (ORIF or ORPP)

338
Q

4 surgical treatment options for congenital pseudoarthrosis of tibia (anterolateral bowing)

A

IM Nail with bone graft

Free (vascularized) fibular graft

Ilizarov frame

Amputation

339
Q

dDx for septic hip? (3)

A

OM

Psoas abscess

Transient synovitis

340
Q

What 3 spinal deformity conditions are bracing CONTRAindicated in?

A

Spina Bifida

SCI

Muscular dystrophy

341
Q

4 joints with intra-articular metaphyseal cortex

A

hip, shoulder, elbow, and ankle

342
Q

3 exam findings consistant with tarsal coalition?

A
  1. flattening of arch
  2. valgus hindfoot
  3. peroneal spasticity
343
Q

Congenital rib anomalies (ie fused ribs) have what association with congenital scoli?

A

occur on the concave side of the curve

makes sense

They (in and of themselves) have no effect on curve size or rate of progression

(They are not talking about phase 2 ribs here, a la Mehta angle)

344
Q

Name the physeal zone associated with:

Renal SCFE

A

Secondary Spongiosa

345
Q

Medical treatment of bone crisis for sickel cell?

A

hydroxyurea

346
Q

In congenital vertical talus what can you use as a proxy to the navicular (b/c it hasn’t ossified yet) to determine diagnosis

A

1st MT

347
Q

3 causes of painful flatfoot.

A
  1. tarsal coalition (sinus tarsi pain)
  2. congenital vertical talus (rocker bottom foot)
  3. accessory navicular (focal pain at navicular)
348
Q

Congenital knee dislocation

Give 3 syndromic associations and 3 orthopaedic associations

A

Syndromic:

  • Larsen’s
  • Meningomyelocoele
  • Arthrogryposis

Orthopaedic

  • hip dysplasia
  • clubfoot
  • metatarsus adductus
349
Q

Three conditions associated with DDH to check for on physical exam?

A

congenital muscular torticollis (20%)

metatarsus adductus (10%)

congenital knee dislocation

350
Q

SMA treatment:

  1. Hip Dislocations
  2. Scoliosis
  3. Hip Contractures
A
  1. Leave dislocated - recurrance is high and usually asymptomatic
  2. PSF to pelvis
  3. Deal with hip contractures before scoiliosis correction in order to ensure they can sit in wheel chair. Otherwise leave them alone.
351
Q

What happens if the GT apophysis is prematurely arrested?

A

hip will go into valgus

(medial side keeps growing)

352
Q

What does the VilleFranche classification describe?

A

Ehlors Danlos

Villefranche Classification (1998)

Classical - Type I (gravis) and Type II (mitis)

COL5A1 or COL5A2 mutation

There are several other sub types

353
Q

Diagnosis

What is their physical exam going to be like?

What other test do you order?

A

Congenital radio-ulnar synostosis

No pronation or supination on exam, with hand fixed in variable amounts of prosupination

Order a chromosomal analysis as they commonly have duplicated sex chromosomes

354
Q

Flat top talus

Almost pathognomonic for what?

A

Clubfoot treatment complication

355
Q

What is Little Leaguer’s Shoulder?

A

SH 1 injury of the proximal humerus

Overuse injury

356
Q

What is Arthroereisis.

What is the fusion version of this?

A

Sinus tarsi pin/screw to jack up the hindfoot out of valgus

Grice procedure involves doing this with ICBG

357
Q

4 signs of residual DDH in kid > 3 months

A

Limited hip abduction

Pelvic obliquity

+ galeazzi

Trendelenburg gait

358
Q

BBFF - initial management?

A

SAC

Found to have lower remanipulation rates

Lower pain/swelling at 1 and 7 days post reduction

359
Q

Early investigations for Larsens?

A

1) Spine - AP/Lat - look for Carvical Hyphosis
2) Hip imaging - dislocation

360
Q

What is the natural history of OI fractures with age?

A

The symptoms improve with age

361
Q

Criteria for Septic Hip

A

Kocher:

Fever >38.5C

WBC >12,000mm^3

ESR >40mm/h

Refusal to weight bear on affected side

3/4 = 93% chance of septic arthritis

362
Q

4 complications of Lateral Condyle fracture (operative)

A

AVN

Malunion/Non-union –> cubitus valgus

Tardy Ulnar Nerve Palsy

Lateral spurring

363
Q

Why is ASF indicated in spina bifida related scoliosis?

A

dysplastic posterior elements that may impair posterior fusion

364
Q

Why do you wait to get x-rays in polydactyly patients (foot)

A

To allow full ossification of phalanges and plan surgery

Surgical ablation typically done at 9-12 months of age

365
Q

What are the 4 deformities of clubfoot?

A
  1. midfoot Cavus (tight intrinsics, FHL, FDL)
  2. forefoot Adductus (tight tibialis posterior)
  3. hindfoot Varus (tight tendoachilles, tibialis posterior, tibialis anterior)
  4. hindfoot Equinus (tight tendoachilles)
366
Q

4 conditions associated with PFFD?

A
  1. fibular hemimelia (50%)
  2. ACL deficiency
  3. coxa vara
  4. knee contractures
367
Q

Predictors of poor outcome in paediatric septic hip (4)

A

Age

Associated OM

Hip joint (vs knee)

Delay > 4 days until treatment

(JAAOS)

368
Q

What is contraindicated in the treatment of atlanto-occipital dissociation in paeds?

A

Halo + traction

Risks displacement of injured occipitocervical joint

(JAAOS 2014)

369
Q

3 options to treat IR contractures fo the shoulder

A

Lat dorsi and teres major tendon transfer

Pec major and subscap lengthening

proximal humerus ER osteotomy

370
Q

4 manifestations of osteopetrosis?

A
  1. Appendicular fractures
  2. Osteomyelitis
  3. Cranial nerve palsies
  4. Coxa vara
371
Q

What antibiotic should you avoid in paeds?

A

Cipro (fluorquinolone) b/c of risk of cartilage damage

372
Q

What level myelomeningocoele has a higher risk of hip dislcoation?

A

L3

+ adductors, no abductors

= higher risk of dislocation

Marginal ambulators

373
Q

Risk of recurrence/refracture of pseudoarthrosis of tibia?

A

50%, even after initial union

374
Q

Treatment for calcaneovalgus foot?

A

observation and parental stretching

375
Q

RUNX2/CBFA1 mutation

A

cleidocranial dysplasia

They have to RUNX2 b/c they can’t use their arms (no clavicles)

376
Q

Signs of Dystrophic Curve (7)

A

Gibbous deformity: short segment kyphoscoliosis

Rib penciling

Intra-canal ribs

Vertebral body scalloping

Dystrophic pedicles

Dural ectasia

Intraspinal neurofibroma

377
Q

What is the weakest zone of the growth plate?

A

Hypertrophic zone

378
Q

Rib-Vertebral angle distance (RVAD/Mehta Angle) of what is at a higher risk of progression?

A

RVAD >20

379
Q

What is the Pirani score?

A

Determines number of casts needed & likelhood of relapse

Made up of 2 scores:

Hind foot contracture score (HCFS):

  • Posterior crease
  • Empty heel
  • Rigid equinus

Mid foot contracture score (MFCS):

  • Medial crease
  • Curvature of lateral border
  • Position of head of talus

Each one scored 0, 0.5 or 1

Score >4 = 4 or more casts

Hindfoot score >2.5 has a 72% chance of needing a tenotomy

380
Q

What is the most common cause of early death in Morquio?

A

Spinal cord stenosis

JAAOS 2013

381
Q

What are some complications specific to operative treatment of club foot?

A
  • residual cavus
    • result of placement of navicular in dorsally subluxed position
  • pes planus
    • results from overcorrection
  • undercorrection
  • intoeing gait
  • osteonecrosis of talus
    • results from vascular insult to talus resulting in osteonecrosis and collapse
  • dorsal bunion
    • caused by dorsiflexed first metatarsal (FHB and abductor hallucis overpull secondary to weak plantar flexion) and overactivity of anterior tibialis
    • treat with capsulotomy, FHL lengthening, and FHB flexor to extensor transfer at MTP joint
382
Q

Describe the deformity in congenital vertical talus

A

Rockerbottom foot:

Hindfoot: equinovalgus (everted & lateralized)

Midfoot: rigid dorsiflexion

Forefoot: abducted & dorsiflexed

383
Q

dDx for cavovarus foot (5)

A

Charcot-Marie-Tooth

Freidreich’s ataxia

Cerebral palsy

Polio

spinal cord lesions

384
Q

4 indications for osteotomy in Infantile Blounts?

What osteotomy would you do?

A
  1. Stage I and II in children > 3 years
  2. Stage III, IV, V, VI in children
  3. failure of brace treatment
  4. metaphyseal-diaphyseal angles > 20 degrees

proximal tibia/fibula valgus osteotomy

385
Q

5 causes of hemihypertrophy

A

idiopathic

neurofibromatosis

beckwith-weidemann syndrome

Klippel-trenauney syndrome

proteus syndrome

386
Q

Major cause of death for patient with Friedrich’s Ataxia

A

cardiomyopathy

Must workup with Echo

387
Q

Defect in diastrophic dysplasia?

A

DTDST gene (SLC26A2)

codes for diastrophic dysplasia sulfate transporter gene on chromosome 5

388
Q

How do you estimate blood volume in a kid?

A

75 - 80 mL/kg

389
Q

Most common complication after distal femoral physeal injury

A

LLD/growth arrest

390
Q

8 orthopedic manifestations of Downs?

A
  1. generalized ligamentous laxity and hypotonia
  2. C1-2 instability
  3. hip subluxation and dislocation
  4. patellofemoral instability and dislocation
  5. scoliosis & spondylolithesis
  6. pes planus
  7. primus varus
  8. SCFE
391
Q

In clubfoot release, what has the greatest influence on functional outcomes?

A

Extent of soft tissue release

392
Q

Surgical option for pathologic genu valgum:

a) with significant growth remianing
b) near the end or done growing

A

a) Medial hemiepiphysiodesis
b) Distal femoral closing wedge osteotomy + release of peroneal nerve

393
Q

First surgical option for resistant Clubfoot?

A

posteromedial soft tissue release and tendon lengthening

394
Q

3 INDICATIONS for nerve repair/grafting in Brachial plexopathy?

A

complete flail arm at 1 month of age

Horner’s syndrome at 1 month of age

lack of antigravity biceps function between 3-6 months of age

395
Q

Common injuries associated with TL spine trauma in paeds

A

Same as in adults:

GI: Small bowel most common

Lung contusion/pneumothorax

Head injury

396
Q

Acceptable alignment distal radius fracture

A

>9: 20 degrees dorsal angulation. No bayonet.

No rotation in either case

397
Q

My PAL Adrian eats HAM on his CPM machine.

How does this help you pass the exam?

A

PAL = Pseudoarthrosis is AL bowing

HAM = Hemimelia is AM bowing

CPM = Calcaneovalgus is PM bowing

398
Q

Last elbow ossification center fo FUSE?

A

Medial epicondyle age 17

399
Q

What is P and how does it help evaluate DDH?

A

Perkins Line

Femoral head ossification should be medial to this line

400
Q

Paediatric proximal humerus fracture classification:

A

Neer-Horowitz

Type I: nondisplaced (<5mm)

Type II: displaced <1/3 of shaft width

Type III: >1/3 but less than 2/3 of width of shaft displaced

Type IV: >2/3 of width of shaft displaced

401
Q

Main blood supply to femoral head in kids >4

A

Medial femoral circumflex artery

via: posterosuperior lateral epiphyseal branch

&

posterior inferior retinacular branch

402
Q

Normal alpha angle (DDH)

A

>60 deg

angle of bony ilium and acetabulum

403
Q

3 factors (other than age) that differentiate adolescent Blounts from Infantile Blounts?

A
  1. More likely to be unilateral
  2. More association with LLD
  3. Can have MCL laxity
  4. No metaphyseal beaking
404
Q

Name 4 sources of blood supply to the femoral head:

A

MFCA (main after 4 years)

via posterosuperior lateral epiphyseal branch & posterior inferior retinacular branch

LFCA (

Artery of ligamentum teres (

Metaphyseal vessels

405
Q

Lateral Pillar Classifiation: (LCP)

A

Group A: lateral pillar maintains full height

Group B: Lateral pillar maintains >50% height

Group B/C: Lateral pillar narrowed (2-3mm) or poorly ossified with ~50% height

Group C: Lateral pillar maintains

406
Q

What type of SCHF is not associated with cubitus varus?

A

Flexion type

It goes into cubitus valgus

407
Q

What is the pediatric equivalent of Lauge Hansen classification?

A

Diaz / Tachdjian

SAD, SER, PER, SPF (Supination plantar flexion)

(compare Lauge-Hansen which is SAD, SER, PER, PAB)

408
Q

What investigations must you do in a patient with Klippel Feil?

A

Echo (cardiac manifestations)

Renal ultrasound (renal aplasia)

409
Q

Acceptable Alignment BBFF?

A

15 degrees, rotation >45 degrees. bayonet apposition ok

>10: >10 degrees, rotation >30 degrees

New idea says NO rotation can be tolerated

both bone forearm fractures in children> 13 is an indication for surgery

410
Q

What is a common block to reduction of tibial eminence fractures?

A

Medial meniscus

411
Q

Treatment of oblique talus?

A

Treatment typically consists of observation and shoe inserts

Some require surgical pinning of the talonavicular joint and Achilles lengthening for persistent subluxation

412
Q

What single finding dictates how often slit lamp exams are necessary in JIA?

A

Presence of ANA

If negative: Every 6 months

If positive: Every 4 months

413
Q

Best test for looking at cross-sectional imaging of tarsal coalition

Best test to look for fibrous coalition

A

CT best to look at cross-sectional imging

MRI best to look at fibrous coalitions

414
Q

Non-ortho manifesataions of SMA

A

Resp - Major cause of morbidity and mortality. Consult them

GI - Common: consult them (swallowing problems)

415
Q

In SCFE, the screw should be placed in what relationship to the intertrochanteric line to avoid what complication?

A

lateral to the intertrochanteric line

To avoid screw impingement

416
Q

How does a patient with SCFE clinically present?

A

Pain

Obligatory ER

417
Q

What motion is most limited in patient with Sprengel;s?

A

Abduction

also Forward flexion

418
Q

7 indicators of poor prognosis with LCP

A

Age (bone age) > 8 (bone age 6) years at presentation

Female

Decreased hip ROM (decreased abduction)

Gage sign: radiolucency in the shape of a V in the lateral portion of the epiphysis

Calcification lateral to the epiphysis

Lateral subluxation of the femoral head

Horizontal physis

Metaphyseal cysts

419
Q

4 negative prognostic indicators of pediatirc spetic arthritis?

A

age

associated osteomyelitis

hip joint (versus knee)

delay >4 days until presentation

420
Q

What disease causes neuronopathy in the dorsal root ganglia, accompanied by the loss of peripheral sensory nerve fibers?

A

Freidrich’s Ataxia

“d” is for dorsal root ganglia

421
Q

What is the managmeent algorithm of Fibular deficiency?

A

Based on Birch classification and stability and level of foot & ankle function

Nonfunctional foot: amputation

Functional foot and:

LLD

  • Epiphysiodesis of contralateral leg

LLD 10-30%: lengthening or amputation

  • limb lengthening procedure ±epiphysiodesis of contralateral leg

LLD > 30%: amputation

422
Q

4 surgical indications for coxa-vara

A

Trendelenburg gait + Hilgenreiner-epiphyseal angle beween 45-59 degrees

Progression of coxa vara on serial x-rays

HE angle > 60

femoral neck shaft angle

423
Q

What is the most important test a patient with JIA needs to have?

A

Regular slit-lamp examination by ophthalmologist.

Iridoclyclitis (uveitis) can lead to rapid blindness

424
Q

Kid has >40 deg of ER (>3 SD) at age 12 and functionally limiting. ER due to external tibial torsion. Plan?

A

Supramalleolar derotational osteotomy > proximal tibial osteotomy

More complications with proximal

425
Q

Spinal manifestations of Achondroplasia:

A

Foramen magnum stenosis (NOT c-spine instability)

Kyphosis

Lumbar stenosis

426
Q

General treatment principle for Downs Spine

A

Nonoperative management if possible - high complication rates with surgery

427
Q

4 dDx for growth plate widening in kids:

A

Rickets

Scurvy

Schmid’s metaphyseal chondrodysplasia

Delayed maturation (illness)

Endocrine pathology

  • Excess GH
  • Hyperparathyroidism
  • Hypothryoidism
428
Q

Outcomes of CRPP vs. ORIF in BBFF: (3)

A

Shorter OR time than ORIF

Less blood loss than ORIF

Equal union rates, radial bow and rotation as ORIF

429
Q

Acceptable reduction criteria required for femoral shaft fractures in peds?

A
  • Less than 10 degrees varus/valgus
  • Less than 20 degrees AP
  • no more than 2cm of shortening or 10° of rotational malalignment
430
Q

What is is the predictable angular deformity with pediatric tibial fractures treated with LLC?

A

Varus if fibula intact.

Valgus if fibula also broken.

431
Q

4 indications for open reduction of pediatric elbow dislocation?

A
  1. open dislocation
  2. inability to acheive closed reduction
  3. incarcerated fragment - usually medial epicondyle or tip of coronoid
  4. seves instability following closed reduction
432
Q

Differential for unilateral valgus (3)

A

Proximal metaphyseal tibial fracture (Cozen’s)

UnilateralPhyseal injury

  • Trauma
  • Infection
  • Vascular insult

Benign tumour

  • Fibrous dysplasia
  • Osteochondroma
  • Ollier’s disease
433
Q

4 indications for open reduction of pediatric traumatic hip doslocation?

A
  1. nonconcentric reduction
  2. intra-articular fragment
  3. unstable acetabular rim fracture
  4. irreducible by closed means
434
Q

Indications for fusion in DMD scoliosis

A

FVC

rapid progression

poor response to steroid

non-ambulatory status (b/c they progress quickly)

435
Q

When do SCHF pins come out?

A

3-4 weeks

436
Q

General Principals of Ilizarov technique?

A

Distraction osteogenesis (Ilizarov principles)

  • initiation
    • perform osteotomy and place fixator
    • metaphyseal corticotomy to preserve medullary canal and blood supply
  • distraction
    • wait 5-7 days then begin distraction
    • distract ~ 1 mm/day
    • following distraction keep fixator on for as many days as you lengthened
437
Q

What view is best for looking at accessory navicular?

A

External oblique

438
Q

Derotational femoral osteotomy for increased anteversion:

1) What are the 2 hard indications?
2) Where is it done?
3) How much do you de-rotate?

A

1) Less than 10° of external rotation on exam in an older child (>8-10 yrs)
2) Intertrochanteric
3) (IR-ER)/2

439
Q

What are the American Academy of Pediatric’s recommendations on kids and car safety (where they sit)?

A

(1) rear‐facing car safety seats for infants up to 2 years of age
(2) forward‐facing car safety seats for children through 4 years of age
(3) belt‐positioning booster seats for children through 8 years of age
(4) lap‐and‐shoulder seat belts for all who have outgrown booster seats
(5) the requirement that all children aged

440
Q

WHat is the spine deformity in multiple epiphyseal dysplasia

A

None

441
Q

Name the physeal zone associated with:

  • Gaucher’s
  • diastrophic dysplasia
A

Reserve

442
Q

How do you clinically differentiate SMA vs. DMD

A

SMA has ABSENT deep tendon reflexes, while they are mantained in DMD

SMA has fasciculations

443
Q

What is the best treatment for Sever’s disease?

A

Calcaneal apophysitis

Best is achilles stretching - may decrease recurrence

No role for operative management

444
Q

What are “Thumb” and “Wrist” signs associated with?

A

Marfans

The characteristic Walker-Murdoch (wrist sign) is represented by full overlap of the distal phalanges of the thumb and fifth finger when wrapped around the contralateral wrist, whereas the Steinberg (thumb sign) is present when the distal phalanx of the thumb fully extends beyond the ulnar border of the hand when folded across the palm.

445
Q

3 treatments for a hemophilac knee?

i.e. for

  • chronic synovitis
  • recurrent hemarthrosis
  • joint destruction
A
  1. Surgical Synovectomy
  2. Radioactive Synovectomy
  3. TKR
446
Q

Name 3 tumours specific to NF1

A

Optic glioma

Neurofibroma

Neurofibrosarcoma (aka Malignent peripheral nerve sheath tumours)

447
Q

4 predictors of complications when doind a nancy nail?

A
  1. > 25 mm nail protruding from nail
  2. Age > 11 years
  3. Weight > 45 kg
  4. Fracture is very proximal, distal or comminuted
448
Q

Describe the anatomy of CVT

A

Dorsal structures are tight (navicular dorsally dislocated)

Rocketbottom foot

  • hindfoot equinovalgus
  • rigid midfoot dorsiflexion
  • forefoot abducted and dorsiflexed

Tib post is tight

449
Q

What are the upper limits of normal for valgum and IM distance in a patient over the age of 7?

A
  1. valgum < 12 degrees
  2. IM distance < 8cm
450
Q

Name 3 general surgical intervnetions you can do for tibial hemimelia

A
  • knee disarticulation followed by prosthestic fitting
  • tibiofibular synostosis with modified Syme amputation
  • Syme/Boyd amputation
  • Brown Procedure (centralization of fibula under femur)

(no longer recommended due to high failure rate)

451
Q

radiographic definition of vertical vs. oblique talus

A

Forced plantarflexion lateral

Meary’s angle >35 is congenital vertical talus

452
Q

What life-threatening allergy do most myelodysplastic patients have? What is the mechanism?

A

IgE mediate allergy to latex

severe anaphylaxis

Present in 20-70%

453
Q

Risk factors for congenital kyphosis progression (4)

A

Type I (failure of formation)

Type III (mixed failure of formation and failure of segmentation)

Immaturity

Curve > 40 deg

454
Q

What is the only lower limb deficiency with a defined inheritance pattern?

What is the inheritance pattern and what must you do once diagnosis is made?

A

Tibial deficiency

AD

Must counsel parents of risk with further children

455
Q

What motion is most deficient in Sprengels?

A

Abduction

456
Q

List proportionate Dwarfism

A

Mucopolysaccharidosis

  • Hunter
  • Hurler
  • San Fillipo
  • Morquios’

Cleidocranial dysplasia

457
Q

3 indications for operative percutaneous reduction of radial head fractures in peads?

A

> 30° of residual angulation

3-4 mm of translation

458
Q

Principals of Proximal tibia/fibula valgus osteotomy for Blounts?

A
  1. overcorrect into 10-15° of valgus because medial physeal growth abnormalities persist
  2. distal segment is fixed in valgus, external rotation and lateral translation
  3. temporary lateral physeal growth arrest with staples or plates can be used
  4. include a bar resection (epiphysiolysis) when a physeal bar is present (Langenskiold V and VI)
  5. consider hemiepiphysiodesis if bar > 50%
  6. medial tibial plateau elevation is required at time of osteotomy if significant depression is present
  7. consider prophylactic anterior compartment fasciotomy
459
Q

Radial Longitudinal Deficiency/Radial CLubhand associated with what conditions (5)

A

TAR: thrombocytopenia absent radius - check plt

Fanconi Anemia - check Hb

VACTERL

VATER

Holt-Oram - congenital cardiac abnormalities

460
Q

Who a I?

Multiple congenital joint dislocations

ligamentous laxity

abnormal facies:

A

Larsen Syndrome

461
Q

Ponsetti Method: be careful to avoid what during first cast?

A

pronation of forefoot

must SUPINATE so that it lines up with the hindfoot

462
Q

5 Characteristics of trigger thumb

A

25% bilateral

Associated with FPL nodule (Notta’s nodule)

Associated with thickening of FPL tendon sheath

A1 pulley release has high recurrence rates

Can resolve spontaneously, especially if dx early (before 3 years)

463
Q

In OI, fractures heal normally/abnormally?

A

Normally

They remodel abnormally

464
Q

What is H and how does it help evaluate DDH?

A

Hilgenreiners Line

A normal head should be below it.

465
Q

Highest cause of morbidity and mortality in paediatric fracutres overall and from MSK causes

A

Overall: CNS injuries (TBI)

of MSK injuries: Spine

466
Q

3 radiographic signs not involving the fibula associated with fibular hemi-melia?

A
  1. tibial spines are underdeveloped
  2. intercondylar notch is shallow
  3. ball and socket ankle joint
467
Q

dDx for abnormal dystrophin gene. How do you tell the difference?

A

DMD: complete absence

Becker’s: abnormal

468
Q

Treatment of tibial spine fractures by classification

Name 2 blocks to reduction

A

Meyers & McKeevers

I: nonp

II: CR + Cast vs. operative

III: operative

IV: operative

Blocks to reduction:

meniscus

intermeniscal ligament

469
Q

Why doe CMT pts get claw toes?

A

Increased toe extensor recruitment due to weak Tib Ant, this combined with weak foot intrisics result in claw toes.

470
Q

SCHF with cold, pulseless hand. Management?

A

Immediate CR & PP

Open is not first step

471
Q

What is best position in Pavlik and what do the straps do?

A
  1. Flexion 90-100° (controlled by anterior straps)
  2. Abduction of 50° (controlled by posterior straps)
472
Q

Treatment for a GMFCS V CP patient with pain sitting in their wheelchair

A

Proximal femoral resection

(controversial)

473
Q

Describe Birch Classification for fibular hemimelia

A

Type I: Functional foot

try to save foot

Ia: 0-5% inequality

Ib: 6-10%

Ic: 11-30%

Id: >30%

Type II: Nonfunctional

IIa: functional UE: amputation

IIb: nonfunctional UE: consider salvage

474
Q

Most common radiographic spinal finding in Down syndrome:

A

Atlanto-occipital instability (17%)

AAI is second most common at 11%

475
Q

Classification of CP Hips & Treatment

A

Hip at risk:

  • Hip abduction
  • Partial uncovering of femoral head
  • Remier’s index
  • Treatment: Prevent dislocation: Adductor release ± psoas release, Avoid obturator neurectomy

Hip Subluxation

  • Reimer’s index >33%
  • Disrupted Shenton’s line
  • Treatment: Adductor tenotomy if abduction tight, Proximal femur and pelvic osteotomy if significant dysplasia
  • Outcome: Reimer’s >60-70%, hips will dislocate

Spastic dislocation

  • Frankly dislocated hip
  • Reimer’s index >100%
  • Treatment: Open reduction with varus derotational osteotomy, ± femoral shortening & pelvic osteotomy

Windswept hips

  • Abduction of one hip with adduction of contralateral one
  • Treatment: Brace adducted hip ± tenotomy, Release abduction contracture of abducted hip
476
Q

dDx for torticollis

A

Congenital muscular torticollis

AARD

Grisel’s disease

Klippel-Feil

477
Q

4 Syndromes affecting Reserve Zone

A

Gaucher’s

Diastrophic dysplasia

Pseudoachondroplasia

Kniest

“Kontio Panics with Dinner Gratuities”

478
Q

SMN gene association

A

SMN = Survival Motor Neuron = gene mutation for Spinal muscular atrophy

479
Q

4 complications of radial head fractures

Which 2 are related to open reduction?

A
  • Decreased range of motion
  • loss of pronation more common than supination
  • Radial head overgrowth
  • Osteonecrosis
  • up to 70% of cases occur with open reduction
  • Synostosis
  • occurs in cases of open reduction with extensive dissection or delayed treatment
480
Q

Manifestations of Achondroplasia

A

Rhizomelic dwarfism

Affects Proliferative Zone of Growth plate

frontal bossing

Foramen magnum stenosis

Kyphosis

Lumbar stenosis

Decreasing interpedicular distance from L1-L5

Champagne glass pelvis

Genu Varum

Trident Hands

V-shaped Physis

481
Q

Best 2 tests for septic hip?

A

T > 38.5

CRP > 2

482
Q

Infetion of staph aureus with what gene encoding is associated what more complex infections?

A

PVL (Panton-Valentine leukocidin) +

483
Q

What are the normal values of Staheli Rotational Profile?

A

femoral anteversion:

  • IR = ER = 30-60 degrees

tibial torsion:

  • TFA: 0 to -10 degrees ER
  • Transmalleolar: 0 to -10 degrees ER

Foot

  • Heel bisector between 2nd/3rd webspace

Foot Progression Angle

  • -5 to 20 degrees ER
484
Q

Kocher Criteria for Septic Hip

A

T > 38.5C

WBC > 12

ESR > 40

Refusal to weight bear

2/4: 40% chance

3/4: 93% chance

4/4: 99% chance of septic hip

485
Q

What is the radiographic definition of Blount’s disease? Of Physiologic varus?

A

Metaphyseal-diaphyseal angle of Drennan

Blounts >16 degrees

Physiologic

486
Q

Poor nutritional status (weight < 5th percentile) is associated with what post-op complications in paediatrics?

A

Increased complications:

  • infections
  • length of intubation
  • longer hospital stays

Make sure patient has adequate nutrition pre-op (albumin > 3.5g/dL) and consider G-tube if not

487
Q

7 characteristics of Infantile Blounts on workup?

A
  1. varus focused at proximal tibia
  2. severe deformity
  3. asymmetric bowing
  4. progressing deformity
  5. sharp angular deformity
  6. lateral thrust during gait
  7. metaphyseal beaking
  8. different than physiologic bowing which shows a symmetric flaring of the tibia and femur
488
Q

Spine changes in NF1

A

Vertebral scalloping

Rib penciling

TP spindling

Vertebral wedging

Paravertebral soft-tissue mass

Short curve with severe apical rotation

intervertebral foraminal enlargement

Wideened interpediculate distance

Dysplastic pedicles

489
Q

Patient post-SCFE c/o functional limitations. He wants a femoral osteotomy. What kind will you do?

A

Proximal femoral derotational osteotomy

Create: flexion, valgus, IR

Imhauser osteotomy (intertrochanteric osteotomy)

490
Q

How does a positive coleman block test effect treatment of cavo-varus foot?

A

Rigid hindfoot varus.

Do: calcaneal valgus producing osteotomy

491
Q

Name 5 non-ortho manifestations of OI

A

Blue sclera

Hearing loss

Brownish opalescent teeth (dentiogenesis imperfecta)

Wormian skull bones (puzzle piece intrasutural skull bones)

Increased risk of malignant hyperthermia

492
Q

3 yo presents with a 3 wk hx of back pain, fever and unable to ambulate. His CRP and WBC are elevated. You are consulted by his pediatrician. Radiographs reveal narrow disc space and endplate erosions. What should you do next?

A

Empiric Abx

NOT MRI - b/c of risks of conscious sedation with MRI/biopsy, just start abx.

This was an MCQ

493
Q

What is an Evans osteotomy and what deformity does it correct?

A

Corrects hindfoot valgus.

(calcaneal lateral column lengthening osteotomy)

494
Q

Medical treatment for AD osteopetrosis?

A

interferon gamma-1 beta

495
Q

What differentiates the McClune Albright Cafe au Lait spots from those of NF1?

A

NF1 = smooth “coast of California” borders

McCune-Albright syndrome = rough “coast of Maine” spots

496
Q

What are the main components of spondyloepophyseal dysplasia? (5)

A

Cervical myelpathy

  • Due to AAI

Kyphoscoliosis

Respiratory difficulty

  • Due to respiratory insufficiency secondary to thoracic dysplasia

Problems with vision

  • Due to myopai or retinal detachment

Hip pain

  • Due to coxa vara

Decreased walking distance

  • Due to poor muscular endurance and skeletal defomrities
497
Q

What CP medication decreases acetylcholine levels in the synaptic cleft by blocking the presynaptic release of acetylcholine peripherally?

A

Botulinum toxin A

498
Q

Indication for physeal bridge resection?

When would you do it with an osteotomy?

A

>2 years or 2cm of growth remaining in a bar less than 50% of physis

(except distal radius - less than 2mm of growth)

+osteotomy if >10-20 degress of angulation (as body will not remodel that)

499
Q

Treatment options for Delbet 1–4?

A
  • Type 1 b is always ORIF
  • Types I-III can be treated with:

0-3yrs of age = smooth wires +/- spica

4-10yrs of age = 4.5-6.5 mm cannulated screws

>10 yrs old = 6.5-7.3mm cannulated screws

  • Type IV fractures are treated with pediatric or adult DHS depending on age.

*** Consider Capsular decompression to reduce pressure, usually for type 2s, however this is controversial

500
Q

Indications for OR with medial epicondyle fracture? (4)

Preferred fixation?

A

Intra-articular entrapment of medial epicondyle (absolute)

Relative

  • >5-15mm displacement
  • fracture associated with elbow dislocation
  • ulnar nerve dysfunction
  • fracture of the dominant arm in a throwing athlete or weight bearing extremity of an athlete

Preferred fixation: single cannulated screw via ORIF

501
Q

What are the primary surgical options for the three types of CP gait?

A

Toe walker - Gastrocs release vs. TAl dependant on Silverskiold test

Crouch Walker - multiple simultaneous soft tissue releases (hip, knee, ankle)

Stiff Knee - transfer of distal rectus femoris tendon

502
Q

DMD Scoliosis

1) 1 surgical indication that is unique compared to AIS
2) To pelvis?

A

1) respiratory function
2) Controversial

503
Q

What are Woodward and Green procedures used for and what is the difference?

A

Sprengels

Woodward involves detachement of medial scapular muscles from their origin on the spinous process and re-attachemnt after inferior migration of the scapula.

Green is similar except you detach the muscular insertions off of the medial border instead.

*** Remember to consider clavicel osteotomy to reduce the chance of nerv einjury.

504
Q

Larsens Surgical Treatment:

  1. Cervical Kyphosis
  2. Hip Dislocation
  3. Knee Dislocation
A
  1. PSF (neuro intact) or P/ASF if neuor deficits
  2. Open reduction - especially if unilateral (bilateral often fails/controversial)
  3. open reduction with femoral shortening and collateral ligament excision
505
Q

3 spinal manifestations of Achondroplasia?

A

Thoracokyphosis

Lumbar Stenosis

Foramen Magnum/Upper Cervical Stenosis

506
Q

IN ponsetti method, when do you do an achilles tenotomy?

A

Prior to application of the final cast

507
Q

8 features of congenitally dislocated radial head

A

Bilateral

Hypoplastic capitellum

Convex radial head

Associated with other congenital anomalies

Lack of traumatic history

Difficult to reduce

Posteriorly dislocated

Assicated with bowing and shortening of the radius

508
Q

3 radiograhpic findings of SCFE

A

Klein’s line: will no intersect with femoral head

Epiphysiolysis: growht plate widening or lucency

Metaphyseal blanch sign of Steel: blurring of proximal femoral metaphysis

509
Q

7 reasons that in-toeing requires further investigations?

A

Developmental delay

prematurity

Pain

LLD

Progressive deformity

Family history of rickets, skeletal dysplasias, mucopolysaccharidoses

Limb rotational profiles 2 standard deviations outside the normal

Abnormal physical exam (Dwarf, syndromic, abnormal neuro exam (ie reflexes)

1.

510
Q

Most commonly used meidcation for treatment of OI?

A

Bishphosphonates increase cortical thickness, fewer fracture.

511
Q

5 risk factors for LCP

A

Positive family history

Low birth weight

Abnormal birth presentation

Second hand smoke exposure

Asian, Inuit, central european descent

512
Q

Define the types of dwarfism and give an example:

Rhizomelic

Mesomelic

Acromelig

Micromelic

A

Rhizomelic (roots): proximal bones are short (humerus, femur): achondroplasia

Mesomelic (middle): middle bones short (forearm, tibia): Leri-Weill/Madelungs

Acromelic (end): bones of hands and feet short: ??

Micromelic: entire lembs are short: Pituitary deficiency

513
Q

How much shortening is acceptable in femoral shaft fractures and why?

A

2cm

b/c if accounts for anticipated overgrowth during healing of 1-2cm

514
Q

Managmenet and timing of treatment of congenital vertical talus?

A

Start with casting to stretch dorsal structures

followed by surgery in almost all cases

OR before 27 months for best results

515
Q

How do you immobilize Bado I, III fractures?

A

Immobilize in 110 degrees of flexion for Bado I, III to relax biceps and tighten IoM

516
Q

In what direction does the ankle physis close and what part closes last?

A

central (first)

medial

posterior

anterolateral (last)

517
Q

Most common complication from tibial tubercle fracture?

A

Recurvatum

physeal arrest anteriorly while posterior continues to grow –> decreased tibial slope

518
Q

2 main presentations and gene association of multiple epiphyseal dysplasia?

A

COMP (cartilage oligometric matrix protein)

causes mutation in COL9A1, A2 & A3

2 main presentations

  • dwarfism
  • Early OA
519
Q

Describe the boney deformities of clubfoot?

A
  • talar neck is medially and plantarly deviated
  • calcaneus is in varus and rotated medially around talus
  • navicular and cuboid are displaced medially
520
Q

Surgical treatment for CMT claw toes?

A

Jones procedure

(transfers the extensor tendons of the great and lesser toes through the bone into the metatarsal neck)

521
Q

What are ideal factor levels in a hemophiliac for :

  1. acute hematomas
  2. acute hemarthrosis and soft tissue surgery
  3. skeletal surgery
A
  • acute hematomas
  • increase blood factor levels to 30%
  • acute hemarthrosis and soft tissue surgery
  • increase blood factor levels to 40-50%
  • skeletal surgery
  • increase blood factor levels to 100% for first week following surgery then maintain at > 50% for second week following surgery
522
Q

Most common 2 complications after fixation of femoral neck fracture in paeds:

A
  1. AVN
  2. coxa vara
523
Q

6 dDx for metaphyseal flaring:

A

Fibrous dysplasia

Storage diseases

Rickets

Anemia

Chronic lead posioning

bone dysplasia

524
Q

When can you determine the Herring stage in LCP?

A

Fragmentation stage (~6 months after symptoms start)

525
Q

How can you be fooled into thinking someone doesnt have an achilles contracture?

(I.e a false negative)

A
  • the hindfoot valgus deformity must be manually corrected first before testing for achilles contracture
  • a valgus heel can mask an equinus contracture by allowing a shortened path for the achilles
526
Q

Presence of what is the main finding that differentiates NF2 from NF1?

A

bilateral vestibular schwannomas

** Also the DONT get scoliosis

527
Q

4 indications for OR in pediatric pelvis fracture?

(radiographic)

A

Type 1 Avulsion Injuries with > 2-3 cm displacement

Type II Iliac Wing Fractures with > 2-3 cm displacement

Type III pelvic ring with displaced acetabular fractures > 2mm

Type IV pelvic ring with instability and > 2 cm pelvic ring displacement

528
Q

is dynamic supination caused by operative or non-operative treatment of clubfoot?

How do you treat it?

A

a) NON-OPERATIVE
b) TA tendon transfer - full thickness

529
Q

When do children achieve 1/2 of the final leg length?

A
  • girls at age 3
  • boys at age 4
530
Q

MRSA infection have a (lower/higher) chance of needing surgery and (more/less) operations until cure?

A

Higher

More

531
Q

Name 2 surgical options for treatment of Sprengel’s

A

Woodward’s

Green

Leibovic

Bellman’s

Mears

532
Q

Delbet Classification

A

Paediatric femoral neck fractures

Ia: transphyseal (epiphysis) no displacement

Ib: transphyseal (epiphysis) displacement

II: femoral neck (transcervical)

III: Basicervical

IV: Intertrochanteric

533
Q

How much fill of the femoral canal do you want with nancy nails?

A

80%

(Therefore each nail should be diameter x 0.8 / 2)

(i.e. canal is 1 cm, then use 2 x 4 mm nails)

534
Q

By definition, what three characteristics have to be present for JIA diagnosis?

A
  1. Persistant inflammatory arthritis
  2. > 6 weeks
  3. Patient < 16 years
535
Q

Congenital hallux varus is associated with what?

A

Polydactyly

536
Q

What did Sillence classify?

A

OI

537
Q

Compared to closed reduction, open reduction of radial head/neck fractures has what 3 outcomes?

A

Greater loss of motion

Increased rates of AVN

Increased rates of synostosis

538
Q

Upper extremity contractures in CP

A

Shoulder IR

Elbow flexion

Forearm pronation

Wrist flexion

Thumb in palm deformity:

  • Flexed MCP
  • Extended IP

Finger-flexion deformity

Swan neck

539
Q

What is the consequence of lateral spurring post lateral condyle fracture?

A

None - it has no effect on outcomes

540
Q

Best radiographic way to follow CP hips

A

Reimer’s Migration Index

541
Q

Name the physeal zone associated with:

SCFE (not renal)

Rickets (provisional calcification zone)

Enchondromas

Mucopolysacharide disease

SED

MED