Pediatrics Flashcards
What is the algorithm for treatment of pediatric radial head/neck fractures?
Radial neck fractures are Salter Harris II fractures and occur after a valgus load in 9-10 year olds. The treatment algorithm is as follows: (1) 30º displacement, perform closed reduction. (3) >30º residual displacement, perform percutaneous reduction and pinning. (4) Unsuccessful closed or percutaneous reduction, perform open reduction.
How should you immobilize a pediatric monteggia fracture (types I-III)? Why?
immobilize in 110° of flexion and full supination for Types I and III to tighten interosseous membrane and relax biceps tendon
Most common nerve injury with pediatric monteggia?
AIN neuopraxia. 10% of cases. Most resolve
As a rule of thumb, how are pediatric both bone greenstick fractures reduced?
With regards to reduction and casting, the authors state that greenstick forearm fractures are usually supination injuries with apex-volar angulation, which can be reduced with varying degrees of forearm pronation. As a rule of thumb, most pediatric both bone fractures can be temporarily reduced by pointing the palm in the direction of the deformity.
What is Hilgenreiner’s line? Perkins? Shentons? What are they useful for?
The 3 lines are useful in evaluating hip dislocation in DDH. May be used beginning 4-6 mo.
- Hilgenreiners: horizontal line through triradiate, femoral head ossification center should be below
- Perkins: Perpendicular to Hilgeneriners on lateral edge of acetabulum. Fem Head ossify. center should be in inf medial quadrant
- Shentons line: curved line from inf edge of fem neck and sup margin of obt foramen
What are the acetabular index and center-edge angles? Useful for what?
Acetabular index: angle formed from hilgenreiners line and a line drawn from triradiate cartilage to lateral edge of acetabulum. Should be <25 deg if older than 6 mo
Center-edge angle is formed from a line from center of femoral head and a line drawn from center of head to acetabulum. <20 is abnormal. ONLY reliable if >5yo
How is ultrasound useful in evaluating DDH?
Useful before femoral head ossifies at 4-6mo. Allows view of bony acetabular anatomy, fem head, labrum, ligamentum teres and hip capsule. Allows measure ment of a and b angles. Fem head is normally bisected by a line drawn down from ilium
Alpha angle: created by line drawn along bony acetabulum and ilium. Normal >60 deg
Beta: created by lines drawn along bony acetabulum and labrum. Normal <55.
Recommendations for ultrasound as screening tool for DDH?
Recommended at 4-6 wks in pts with risk factors and positive physical findings like positive Barlow or Ortolani Also used to follow treatment with Pavlik harness for equivocal exams
What are the risk factors for DDH?
First born, female, breech position, family hx, oligohydramnios
