Peds ortho

Question 1

Osteogenesis imperfecta

Answer 1

Multiple recurrent fx.
Type 1: mild or no deformities, blue sclera
Type 2: bones very brittle, lethal in utero

Question 2

Legg-calves-perthes disease

Answer 2

Avascular nerosis of proximal femur due to interruped vascular supply.
Males 4-11 small for age
S/sx: painless limp, limitied ROM
Xr: flattened femoral head
Tx: hip replacement

Question 3

Scoliosis

Answer 3

Most common is idiopathic adolescent in females 9-10 yo
Greater than 10 degree cobb angle
Tx: <20 degree observe
20-40 bracing
40 or more: surgery

Question 4

Most common benign bone tumor in kids

Answer 4

Osteochondroma
Epi: under 20
Sx: presents as painless mass

Question 5

Enchondroma

Answer 5

Nest of benign cartilage w/in long bones
Epi: 20-30. men=women
Sx: usually asymp, incidental finding on x-ray

Question 6

Osteoid osteoma

Answer 6

benign idiopathic bone-forming lesion

Sx: night pain improves with NSAIDs

Question 7

Chondroblastoma

Answer 7

Benign chondral origin lesions, typically in the epiphyses.

Sx: pain around a joint

Question 8

Giant cell tumor

Answer 8

Rare: 5-9% of primary bone tumors
Epi: only occur after epiphyseal plates have closed.
Benign but locally aggresive

Question 9

Osteosarcoma

Answer 9

Most common malignancy of bone cancer
Epi: peak age 18-20, men>women
Pain in long bone, loss of function, mass, or limp
Xr: Sunburst

Question 10

Ewing sarcoma

Answer 10

Diaphysis of long bones, highly malignant
Age: 10-20
Sx: pain, tenderness, swelling over weeks-months +/-: fever and leukocytosis
XR: onion skin appearence

Question 11

Transient tenosynovitis of the hips

Answer 11

Overuse injury, systemic disorders, may be viral source.

S/sx: pain with movement, swelling, limp

Question 12

Osteomyelitis

Answer 12

Path: S. aureus 85%
Most commonly hematogenous spread from other infected or colonized area
S/sx: Subtle in infants,
Tx: oxacillin, nafcillin, clinda
Most require both debridement aof necrotic bone and prolonged abx

Question 13

Septic arthritis

Answer 13

Usually hematogenous spread
MC: S. aureus, group A strep (pyogenes)
_ adolescense: N. gonorrhea, esp the knee
S/sx: fever, pain with weight decreased ROM
Tx: surgiccal washout, IV abx, tap encapsulated joints

Question 14

MSK injuries that raise concern for child abuse

Answer 14

• multiple injuries at multiple stages of healing
• injuries beyond scope of age
• epiphseal / metaphyseal fx
• spiral fx
• posterior nondisplace rib fractures can indicate squeezing
• skull fractures >3mm wide, complex fractures

Question 15

Most common salter harris fracture in kids

Answer 15

Salter harris type 2

Question 16

Most common painful limp

Answer 16

Transient tenosynovitis of the hip