Peds - Facts

Question 1

To control most spontaneous bleeding into the knee in children with hemophilia, factor VIII must be
replaced to what percentage of normal?

Answer 1

40% to 50% of normal

For surgery, the replacement should be
to 100%

Question 2

? correct pelvic osteotomy ?

Answer 2

Chiari or Shelf (salvage for unreducible head)

both depends on fibrocartilge metaplasia for successful results

Question 3

Most prognostic sign for the ability of a young child with cerebral palsy to walk?

Answer 3

Ability to sit independently by age 2 years

Question 4

test of choice for dx

Answer 4

• Lateral radiograph of the foot in maximum plantar flexion

Question 5

treatment algorithm

Answer 5

< 3 yo try KAFO

surgery:

> 3 yo

stage IV-V (bony bar)

failed brace

overcorrect into 10-15° of valgus +/- bar excision

Question 6

natural history leg bowing

Answer 6

genu varum (bowed legs) is normal in children less than 2 years

genu varum migrates to a neutral at ~ 14 months

continues on to a peak genu valgum (knocked knees) at ~ 3 years of age

genu valgum then migrates back to normal physiologic valgus at ~ 4 years of age

Question 7

Answer 7

MTP arthrodesis

Question 8

Femur fracture treatment by age

Answer 8

< 6 mo

• Pavlik or spica

7 mo - 5 yo

• Spica

6 - 11 yo

• Flexible nail or sub-m bridge plate (by fx pattern)

12 and up (approaching maturity)

• Flexible nail (<100 lb, length stable)
• lateral entry nail (> 100 lb, length unstable)
• Sub-m bridge plate (> 100 lb, length unstable, very proximal or distal)

Question 9

normal alpha angle

Answer 9

greater than 60 deg

(pic is abnormal)

Question 10

DDH treatment by age

Answer 10

< 6 mo

• Pavlik

6-18 mo (or failed Pavlik younger)

• Closed reduction + spica

>2 yo

• open reduction + osteotomies (by side of pathology)

> 4 yo

• open reduction and pelvic osteotomy common

Question 11

quadrant of the femoral head with highest complications after in situ pinning of a chronic slipped capital femoral epiphysis

Answer 11

anterior superior

Question 12

Duchenne Scoliosis

Answer 12

early PSF with instrumentation (rare need for anterior)

• curve > 20° in nonambulatory patient (treat early, < 30° curve, before pulmonary function declines)
• can wait slightly longer (Cobb ~ 40°) if patient is responding well to corticosteroids
• FVC drops below 35%
• rapidly progressive curve

extension to pelvis is controversial

remember malignant hyperthermia and dantrolene

Question 13

Kocher criteria septic hip

Answer 13

weight bearing

fever

ESR > 40

WBC > 12,000

Question 14

Perthes treatment

Answer 14

Surgery is for > 8 yo with B or B/C (50%) lateral pillar

• less than 8 yo do fine regarless of treatment
• Pillar C greater than 8 you can’t help with surgery

Question 15

CP hip treatment

Answer 15

Soft tissue release 8yo >60% or 40% Remember dega osteotomy ai > 25deg

Question 16

surgical indications in scheuermann’s

Answer 16

kyphosis > 75 degrees that is rigid in nature in skeletally mature patient

neurologic deficit
spinal cord compression
severe pain in adults

Question 17

unacceptable closed reduction BBFA fx

Answer 17

children <10

angulation >20 degrees, rotation >45 degrees

children >10

angulation >10 degrees, rotation >30 degrees

bayonette apposition

Starting 13-14 begin to treat like adult

Question 18

BBFA fx:

apex volar = __________ injury

apex dorsal = _________ injury

Answer 18

supination

pronation

treat accordingly with closed reduction of deforming force

Question 19

OI scoliosis treatment numbers

Answer 19

bracing ineffective and side effects

PSF for curves

>45 milder forms (better bone)

> 35 severe forms

*use allograft not autograft

* ASF if very young to prevent crankshaft

Question 20

curly toe treatment age

Answer 20

> 3 yo if pain/severe deformity (FDL release)

typically self corrects, observation before then

Question 21

age and indications for surgical releases for clubfoot

Answer 21

9-10 months of age so the child can be ambulatory at one year

resistant feet in young children
“rocker bottom” feet that develop as a result of serial casting
syndrome-associated clubfoot
delayed presentation >1-2 years of age

++ casting always

Question 22

abduction/ER # to remember for Ponseti FAO

Answer 22

70° in clubfoot and 40° in normal foot

usually achieve 70° week 8, heel in valgus –> achilles tenotomy (80%)

Question 23

indication for surgery in femoral anteversion

Answer 23

• < 10° of external rotation on exam in an older child (>8-10 yrs)
• rarely needed

amount correction needed can be calculated by (IR-ER)/2

Question 24

Bones with an intra-articular metaphyses (4)

Answer 24

proximal humerus, proximal radius, proximal femur, and distal fibula/tibia.

NOT KNEE

Question 25

Growth rates mm/yr for lower extremity

Answer 25

proximal femur-4 distal femur-9 proximal tibia-6 distal tibia-5

Question 26

LLD treatment based on length

Answer 26

\< 2 cm observation 2-5 cm shortening long \>5 cm lengthen short side (often shorten long) excise bar \< 50% and 2 yr growth left

Question 27

Kocher criteria septic hip

Answer 27

WBC \> 12,000 cells/µl inability to bear weight fever \> 101.3° F (38.5° C) ESR \> 40 mm/h Added later CRP \> 2.0 (mg/dl) temperature \> 101.3° (38.5° C) is the best predictor of septic arthritis followed by CRP of \>2.0 (mg/dl)

Question 28

Answer 28

Fibular deficiency = hemimelia no known inheritance pattern linked to sonic hedge-hog gene anteromedial tibial bowing ball and socket ankle, instability ``` equinovalgus foot deformity tarsal coalition (50%) absent lateral rays ``` LLD

Question 29

convex hemiepiphysiodesis/arthrodesis indications

Answer 29

- young age (\<5) - concave growth potential - short curves (\<5 segments) - smaller curves (\< 70) - NO KYPHOSIS - NOT RIGID

Question 30

lysosomal storage diseases last minute facts

Answer 30

MPS I H Hurler á-L-iduronidase MPS II Hunter Iduronate-2-sulfatase MPS IIIA Sanfillipo Heparan-N-sulfatase MPS IVA Morquio N-acetylglucosamine -6-sulfatase MPS IVB Morquio â-galactosidase B-glucocerebrosidase- Gauchers (not MPS, sphingolipids)