Pediatric Orthopedics

Question 1

Head leans to one side, chin rotates to the other side ear to the ground, eyes to the sky

Answer 1

Torticollis

Question 2

Tx for congenital torticollis

Answer 2

stretching of SCM. rarely needs surgical release

Question 3

Talus plantar flexed. Heel cord tight. Fore foot adducted/supinated

Answer 3

clubfoot (Talipes equinovarus)

Question 4

Tx for clubfoot (talipes equinovarus) that involves casting and percutaneous heel cord lengthening

Answer 4

Ponseti method

Question 5

Loss of normal femoral head-acetabular relationship/stability. Caused by ligamentous laxity, hormonal and familial factors
Breech position and congenital deformities

Answer 5

congenital hip dysplasia

Question 6

Test where hip is reduced but can be dislocated

Answer 6

Barlow

Question 7

Test where hip is dislocated but can be reduced

Answer 7

Ortolani

Question 8

Conservative Tx of congenital hip dysplasia

Answer 8

If hip can be reduced, harness or pillow first 6 months of age. If hip will not stay in, reduce under anesthesia, hold with spica cast.

Question 9

Orthopedic hip emergency

Answer 9

septic arthritis of hip

Question 10

most common organism to cause septic arthritis of hip

Answer 10

s. aureus

Question 11

Sx include: fever, acutely ill. hip flexed and externally rotated pain with attempted motion

Answer 11

septic arthritis of the hip

Question 12

When does normal arch develop in foot?

Answer 12

age 4

Question 13

age that genu varum (bow legs) corrects

Answer 13

age 4

Question 14

damage to epiphysis that may need bracing or surgery and causes bow legs

Answer 14

blount’s disease

Question 15

at what age would you need surgery for marked genu valgum (knock knees) if it hasn’t corrected

Answer 15

age 11

Question 16

radial head subluxation caused by sudden pull on extended, pronated arm. painful elbow held flexed/pronated. will not allow supination

Answer 16

nursemaid’s elbow

Question 17

tx for nursemaid’s elbow

Answer 17

Gently flex, supinate and press on radial head to reduce

Question 18

Most common pediatric fracture

Answer 18

clavicular

Question 19

Heel pain associated with overuse. Late childhood. Diagnosed with squeeze test

Answer 19

CALCANEAL APOPHYSITIS

Question 20

tx for calcaneal epophysitis

Answer 20

rest, heel pad, achilles’ stretching

Question 21

Loss of blood supply to femoral head. Head can collapse and subluxate. Eventually revascularizes but may not occur until fixed deformity present

Answer 21

Perthes disease

Question 22

Males 6-8 yrs. Variable hip/knee sx (limp). Limited internal rotation and adduction of the hip

Answer 22

Perthes Disease

Question 23

Most common cause of hip (groin) pain in adolescents

Answer 23

SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE)

Question 24

Metaphysis slides superior and head stays in socket. Most patients above 95th percentile for weight

Answer 24

SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE)

Question 25

Tx for SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE)

Answer 25

surgical (pinning in situ)

Question 26

Iliotibial band slipping over the great trochanter.

Answer 26

snapping hip

Question 27

Tx for snapping hip

Answer 27

lateral hip stretching

Question 28

Location of overuse injuries in kids vs adults

Answer 28

Adults – musculo-tendinous junction. Children – bone tendon junction

Question 29

Most common overuse injury in kids

Answer 29

PATELLO-FEMORAL ARTHRALGIA (PFA)

Question 30

Sx include: sore kneecap, anterior discomfort, pain with stairs, can't sit with bent knee

Answer 30

PATELLO-FEMORAL ARTHRALGIA (PFA)

Question 31

Inflammation where patellar tendon inserts on tibia. Leaves a lump – prominent, tender tibial tubercule. Xray may show apophysitis

Answer 31

Osgood Schlatter's

Question 32

Tendinitis where patellar tendon originates. Anterior knee pain worse with jumping

Answer 32

jumper's knee

Question 33

Tender lateral femoral epicondyle at 20-30 degrees of flexion. IT band tender, posterior edge. Mal-alignment internal rotation

Answer 33

ilio-tibial band tendinitis

Question 34

Tx for ilio-tibial band tendinitis

Answer 34

rest, cortisone injections, surgery- partial release, debride bursa

Question 35

Externally rotating on bent knee. pop and giving way. Reduce with extension

Answer 35

patellar dislocation

Question 36

Medial tibial stress syndrome. Inflammation of tibial periosteum from repetitive muscle contraction. Tender along posterior medial border

Answer 36

Shin splints

Question 37

What can shin splints lead to?

Answer 37

exertional compartment syndrome

Question 38

Cause of most ankle injuries

Answer 38

inversion- anterior talo-fibular ligament

Question 39

What finding on PE when examing a potential ankle sprain needs an xray?

Answer 39

posterior lateral malleolus tenderness

Question 40

Stress fracture of pars. Repetitive hyperextension of back. Progressive low back pain with activity

Answer 40

spondylolysis

Question 41

osteochondrosis of the spine ring. apophyses do not develop normally resulting in wedged vertebra. usually seen in boys. sharper, more rigid curve

Answer 41

Scheuermann’s disease

Question 42

Fracture of 4th or 5th metacarpal neck. Treated with splint unless angulated more than 15 degrees

Answer 42

boxer's fracture

Question 43

Presentation includes: athlete with sudden pain above groin, may have had some aching

Answer 43

avulsion of iliac apophysis