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Flashcards in Peds - Facts Deck (30):

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

40% to 50% of normal

For surgery, the replacement should be
to 100%


? correct pelvic osteotomy ?

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Chiari or Shelf  (salvage for unreducible head)

both depends on fibrocartilge metaplasia for successful results

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

Ability to sit independently by age 2 years 


test of choice for dx

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- Lateral radiograph of the foot in maximum plantar flexion 


treatment algorithm

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< 3 yo try KAFO



> 3 yo

stage IV-V (bony bar)

failed brace

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


natural history leg bowing

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


Q image thumb

MTP arthrodesis


Femur fracture treatment by age

< 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)


normal alpha angle

greater than 60 deg

(pic is abnormal)

A image thumb

DDH treatment by age

< 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


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

anterior superior


Duchenne Scoliosis

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


Kocher criteria septic hip

weight bearing


ESR > 40

WBC > 12,000


Perthes treatment

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


CP hip treatment

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


surgical indications in scheuermann's

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

neurologic deficit
spinal cord compression
severe pain in adults


unacceptable closed reduction BBFA fx

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


BBFA fx:

apex volar = __________ injury

apex dorsal = _________ injury




treat accordingly with closed reduction of deforming force


OI scoliosis treatment numbers

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


curly toe treatment age

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


typically self corrects, observation before then


age and indications for surgical releases for clubfoot

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


abduction/ER # to remember for Ponseti FAO

70° in clubfoot and 40° in normal foot

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


indication for surgery in femoral anteversion

  • < 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


Bones with an intra-articular metaphyses (4)

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




Growth rates mm/yr for lower extremity

proximal femur-4

distal femur-9

proximal tibia-6

distal tibia-5


LLD treatment based on length

< 2 cm observation

2-5 cm shortening long

>5 cm lengthen short side (often shorten long)


excise bar < 50% and 2 yr growth left


Kocher criteria septic hip

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)


Q image thumb

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



convex hemiepiphysiodesis/arthrodesis indications

- young age (<5)

- concave growth potential


- short curves (<5 segments)

- smaller curves (< 70)




lysosomal storage diseases last minute facts

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)