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Pediatrics 1 > Ped orthopedics > Flashcards

Ped orthopedics Flashcards

(63 cards)

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1
Q

intoeing

A

metatarsus adductus

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2
Q

what is genu valgus

A

vaLgus- “knock knees”

L is out

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3
Q

what is gen varus

A

vaRus- “bow legs”

Return back in

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4
Q

two examples of genu varum

A

blount’s disease

rickets (vitamin D deficiency)

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5
Q

Salter-harris type 1

A

S-slipped “ephiphyseal slip”
separation through the physis (growth plate)

excellent

non-operative management

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6
Q

Salter-harris type 2

A

A-above physis
fracture through a part of the PHYSIS that extends through the METAPHYSIS

excellent

likely non-operative

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7
Q

Salter-harris type 3

A

L-lower to physis
fracture through part of the PHYSIS that extend through the EPHIPHYSIS often involving the joint space

often unstable
+/- operative management

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8
Q

Salter-harris type 4

A

T-through the physis
fracture through the METAPHYSIS, PHYSIS, and EPHIPHYSIS

unstable can lead to limb length discrepancies

+/- operative managment

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9
Q

Salter-harris type 5

A

ER- ERasure of physis (reduced)
crush injury to PHYSIS (growth plate)

unstable, can lead to limb length discrepancies

+/- operative management

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10
Q

what is C.R.I.T.O.E and what does each letter stand for

A 
CRITOE is the order of ossification of bone
(# means years old)
1: capitellum
3: radial head
5: internal (medial) epicondyle
7: trochlea
9: olecranon
11: external (lateral) epicondyle
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11
Q

what is the fat pad sign

A

dark area around elbow on x-ray that can represent a break in the area. darkness may be from blood

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12
Q

Supracondylar humeral fractures MOI

A

fall from moderate height

fall out with outstretched hand FOOSH

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13
Q

supracondylar humeral fractures clinical presentation

A

swelling, pain, +/- deformity
Neurovascular exam is critical
Medial nerve Anterior interosseous nerve

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14
Q

supracondylar fracture diagnosis

A

xray: AP, lateral, and oblique radiographs
anterior humeral line should intersect the capitellum
type 1: intersects
type 2: is in line
type 3: completely out of line

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15
Q

supracondylar fracture management

A 
type`1/2 splint with light overwrap
sling, NSAIDs, elevation
refer to ortho +/- reduction for type 2
immobilization x3 weeks
type 3 or neurovascular concerns
CRPPF closed reduction percutaneous pin fixation
open reduction

to check neurovascular have the pt do the OK sign

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16
Q

lateral humeral condyle fx clinical presentation

A

soft tissue swelling concentrated to lateral aspect of elbow

tender palpation over lateral condyle ONLY

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17
Q

lateral humeral condyle fx diagnosis

A

x-ray: AP, lateral, and INTERNAL oblique view focused on lateral condyle
MRI if needed

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18
Q

lateral humeral condyle fx management

A 
emergent referral if displacement > 2 mm on internal oblique view
splint, sling, NSAIDs
Ortho:
immobilization 6 w
open reduction with screw fixation
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19
Q

Medial humeral epicondyle fx MOI

A

muscle attachment avulsion (throwing, gymnasts)
FOOSH with arm fully extended
secondary to posterior elbow dislocation

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20
Q

Medial humeral epicondyle fx clinical presentation

A

localized pain
pain with resisted wrist flexion
ulnar nerve dysfunction (try not to do surgery)

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21
Q

Medial humeral epicondyle fx diagnosis

A

xray
ap, lateral, and external oblique
rule out incarceration of fragment in joint
advance imaging may be needed

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22
Q

Medial humeral epicondyle fx management

A

emergent if entrapped fragment
splint including wrist sling
NSAIDs
Ortho: Short term immobilization vs open fixation

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23
Q

Medial humeral epicondyle fx complications

A

ulnar nerve injury/palsy
nonunion
angular deformity
decreased ROM

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24
Q

Radial neck fracture MOI

A

FOOSH with valgus stress

posterior elbow dislocations

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25
Radial neck fracture clinical presentation
tenderness to palpation over radial head/neck pain with supination/pronation>> flexion/extension young children may complain of wrist pain
26
Radial neck fracture diagnostics
xrays ap, lateral and external oblique clinical if radial head not ossified ~3-5 y
27
Radial neck fracture managment
immobilize including the wrist sling NSAIDs ortho: vast vs surgery
28
Radial neck fracture complications
premature physeal closure loss of ROM nonunion
29
nursemaid's elbow what is it and what causes it
subluxation of radial head | common cause is sudden pull of pronated arm`
30
nursemaid's elbow clinical presentation
``` arm either fully extended or slightly flexed and protonated overall refusal to use arm mild pain over radial head pain increases with attempts to supinate evaluate entire extremity ``` imaging not required
31
nursemaid's elbow management
reduction by either 1. hyperpronation with pressure over the radial head 2. supination, flexion with pressure over radial head "lollipop/popsicle test"
32
wrist fractures common causes and clinical presentation
direct fall FOOSH direct trauma distal radius typically involved at metaphysis point tenderness, swelling, ecchymosis "dinner fork deformity"
33
diagnostic for wrist fracture
xray: ap/ lat +/- oblique | SH 1
34
wrist fracture managment
emergent with significant clinical deformity or nerovascular compromise splint and NSAIDs ortho cast +/- reduction vs surgery
35
femur fracture clinical presentation
``` history of trauma pain in groin and buttock unable to bear weight/walk proximal femur fx pt will hold leg in slight adduction and eternal rotation may see limp shortening ``` * must rule out child abuse especially less than 1 y
36
femur fracture diagnostics management and complications
must xray entire length of femur for proper evaluation ortho: hip spica cast vs surgery shortening lengthening angulation
37
what is a special fracture patellar sleeve fracture and managment
unique to children but common in kids <13 y caused by forced extension with knee flexion jumping kicking can be seen either superior or inferior pole of the patella knee immobilizer, NWB, elevate NSAIDs ortho: cast vs surgery
38
toddler fracture MOI
falling while running/twisting mechanism | SLIDES!
39
toddler fracture clinical presentation
limp or refusal to weight bear often mistaken for foot injury pain with palpation along tibia typically mid to distal diaphysis
40
toddler fracture diagnosis and management
xray ap lateral and obliques immobilize NWB, NSAIDs, elevate ortho: wee walker vs cast
41
special fractures of the ankle | triplane fracture
"think high school athlete" 13-16 MOI is often external rotation SH 3 on AP view and SH 2 on lateral view = SH 4 must get CT to assess displacement ortho: surgical fixation vs closed reduction
42
fracture or ankle sprain management
posterior vs stirrup splint elevation, NWB, NSAIDs ortho consult for NWB, bony pain, concerns on imaging Reconditioning is key in preventing recurrence pt and home exercise program
43
torticollis etiology, clinical presentation, and treatment
compartment syndrome SCM secondary to venous outflow obstruction clinical presentation head tilt to shortened muscle and chin rotation to contralateral side evaluate for associated plagiocephaly stretching/PT position education
44
how is scoliosis defined and common ages
lateral curve of the spine > 10 degrees has a rotational component idiopathic W>M congenital/infantile 0-3y juenile 4-9Y adolescent >= 10 y *neuromuscular
45
adolescent idiopathic scoliosis AIS clinical presentation and physical exam
typically asymptomatic +/- pain obstructive lung sx if severe ``` physical exam shoulder or pelvic obliquity asymmetry of scapulae adam's forward flexion exam abdominal refexes ```
46
scoliosis diagnosis and treatment
cobb angle ap/pa standing plain radiographs on long cassette TLSO brace: boston, milwuakee, charleston bending brace at 25 degrees surgery at 45 degrees internal rod fixation
47
septic hip epidemiology and physiology
peak occurrence in first few months of life and again between ages 3-6 years old M>F direct inoculation from trauma or surgery hematogenus seeding spreading of osteomyelitis from adjacent bone
48
septic hip clinical presentation
FEBRILE and acutely toxic appearing monoarticular pain: severly exacerbated with passive ROM limited or refusal to weight bear
49
transient synovitis of the hip and management
appears well, typically AFEBRILE pain worse in am and improves during day recent URI etiology unclear, 3-8y M>F NSAIDs improves in 24-48 h with resolution within 1 week must rule out septic arthritis, hospitalize if suspicious
50
septic hip vs transient synovitis Kocher criteria
1. WBC >12000 2. ESR > 40 3. Fever > 101.3 4. Non-weight bearing on the affected side 2/4 warrants joint aspiration CRP independent risk factor >2.0
51
septic hip imaging
radiographs: AP and frog-leg lateral pelvic potential joint space widening ultrasound- effusion and aspiration MRI
52
septic hip management
management is emergent operative management: surgical I and D antibiotic: cephalosporin S. aureus, S. pneumo, group A strep, H. influenza non-operative: N. gonorrhoeae in adolescents: high doses penicillin
53
Legg-calve-perthes
juvenile idiopathic osteonecrosis of the femoral head peak incidence 4-8y M>F 5:1 risks: family history, Caucasian, maternal smoking associated with ADHD
54
perthes clinical presentation
painless limp or insidious onset of pain: hip, groin, thigh or knee limp pain is often activity related and worse at end of day pain relieved with rest may have muscle spasticity may have history of minor trauma
55
perthes physical exam
antalgic limp/trendelenburg gait limited internal rotation or abduction limb length discrepancy + galeazzi
56
Slipped capital femoral epiphysis SCFE etiology and presentation
``` slippage of the femoral physis "ice cream slipping off the cone" M>F peak incidence is 10-16 y obesity is significant factor ``` limp or NWB with c/o hip or knee pain restricted ROM abduction and internal rotation stability: stable vs unstable is based on WB status
57
SCFE diagnostics and treatment
plain radiographs (AP pelvis and frog lat), MRI if high suspicion and negative x-rays requires urgent surgical consultation for in situ single screw fixation NWB! admit to hospital
58
Developmental dysplasia of the hip DDH
laxity, subluxation, dislocation risk factors include 1st born, female gender, breech position birth, FHX
59
tests for developmental dysplasia of the hip
positive Barlow B= push Back to dislocate and/or Ortolani O= creating an O clunking sensation galeazzi: affected hip shortened in comparison
60
DDH treatment
pavlik harness avoid swaddling and tight fitting clothes radiographs used to monitor after 6-7 M of age casting and surgical options rarely needed
61
Osgood-schlatters's disease
inflammation and irritation of patellar tendon insertion on tibial tubercle (osteochondritis) traction at tibial tubercle apophysis clinical presentation focal tenderness to tibial tubercle enlargement or bony protrusion of tibial tubercle lateral xrays used rule out evulsion occasional rest NSAIDs, ice quad exercises and hamstring stretches chopat strap pain flares around time of rapid growth girls 10-11 boys 13-14
62
calcaneal apophysitis sever's disease
``` irritation, inflammation of calcaneal apophysis overuse syndrome pull of achilles tendon children 6-12 most commonly affected common in soccer players and gymnasts clinical: pain at calcaneal apophysis ``` treatment: stretches, ice, NSAIDs
63
clubfoot
``` fixed deformity FHX, maternal smoking may be diagnosed on fetal U/S CAVE bilateral vs unilateral affected limb will have smaller foot and calf with shortened tibia ```

Pediatrics 1 (4 decks)

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