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Disciplines II, Final Exam > Peds Orthopadaedic > Flashcards

Peds Orthopadaedic Flashcards

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1
Q

Most common pediatric elbow fracture?

A

Supracondylar Fracture

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2
Q

MC cause of supracondlar fracture?

A

FOOSH injury from height–> hyperextension

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3
Q

Inability to make what kind of hand sign can indicate Supraconylar fracture

A

O.K. sign

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4
Q

What x-ray views are need to assess supracondylar fractures

A

AP
Lateral
Oblique

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5
Q

What bone misalignment is seen with supracondylar fractures?

A

Anterior humeral line must intersect the capitellum

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6
Q

How are Type I and II supracondylar fractures treated?

A

Type I/II: Posterior splint with light overwrap

Type III: Emergent ortho consult

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7
Q

How does a Lateral Condylar fracture present clinically?

A

• Soft tissue swelling concentrated
to lateral aspect of elbow

• Tender to palpation over lateral condyle

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8
Q

What x-ray views are needed to diagnose Lateral condylar fracture?

A

X-ray: AP, lateral, and internal oblique view focused

on lateral condyle

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9
Q

How is a Lateral condylar fractures treated?

A
  • Emergent referral if displacement >2 mm

- Splint, sling, NSAIDs

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10
Q

What is the most common cause of medial epicondylar fx?

A

Muscle attachment avulsion

Throwing athletes

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11
Q

What x-ray views are needed to see medial epicondylar fx?

A

AP, Lateral, and external oblique

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12
Q

How is medial epicondylar fx treated?

A

Emergent if entrapped fragment
Splint including wrist, sling
NSAIDs

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13
Q

What are complications associated with medial epicondylar fx?

A
  • Ulnar nerve palsy
    • Nonunion
    • Angular deformity
    • Decreased ROM
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14
Q

HOw does a radial neck fracture occur?

A
  1. FOOSH-with valgus stress
  2. Elbowdisloca8ons
    • During disloca8on or reloca8on
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15
Q

Clinical presentation of Radial neck fracture

A
  • Tenderness to palpation over radial head/neck
  • Pain with supination/pronation&raquo_space; flexion/extension
  • Young children may complain of wrist pain
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16
Q

What x-ray views are needed to see Radial neck fractures

A

• AP, lateral, and external oblique (flatten head of radius)

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17
Q

How is a radial neck fracture treated?

A
  • Immobilize including the wrist
  • Sling
  • NSAIDs
  • Ortho: cast vs surgery
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18
Q

What complications are seen with radial neck fracture?

A
  • Premature physeal closure
  • Loss of ROM
  • Nonunion
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19
Q

What is a Nursemaid’s elbow?

How does it occur?

A

Subluxation of radial head

Caused by swinging or pulling of pronated arm

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20
Q

How does a Nursemaid’s elbow present?

A
  • Arm either fully extended or slightly flexed and ALWAYS pronated
  • Overall refusal to use arm but may use fingers
  • Mild pain over radial head
  • Pain increases with attempts to supinate
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21
Q

How is a Nursemaid’s elbow presented?

A

Reduction by either:

  1. Hyperpronation with pressure over the radial head
  2. Supination, Flexion with pressure over radial head

Followed by Lollipop test to see if arm can reach out and grab lollipop successfully

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22
Q

How does a Capitellar Osteochondrosis present?

A
  • Rapid onset of pain
  • Deep, lateral pain
  • ROM: limited extension
  • No locking sensation
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23
Q

Who is a Capitellar Osteochondrosis typical in?

How do you treat them?

A
  • Males, 5-10 y/o
  • Dominant (throwing) arm
  • Baseball, gymnastics, handball

Conservative treatment:
-ice, nsaids, rest

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24
Q

What is seen on physical exam with Capitellar Osteochondrosis?

A
  • +/- swelling
  • May be difficult to elicit tenderness with palpation • Pain/guarding with passive extension
  • Lateral pain with valgus stress
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25
What is a Monteggia Fracture?
Ulnar (or radial and ulnar) shaft fracture with dislocation of radial head
26
Common cause of wrist fracture What is the most bone involved?
Direct Fall • FOOSH Distal radial head
27
How are wrist fractures treated?
Emergent with significant clinical deformity or neurovascular compromise * Splint and NSAIDS * Ortho: cast, +/- reduc8on vs surgery
28
What is the clinical presentation of a femur fracture?
* Pain in groin or buttock * Unable to bear weight/walk * Proximal femur fx pt will hold leg in slight adduction and external rotation. * May see shortening of limb.
29
What needs to be ruled out when assessing femur fractures
Child abuse, remember kids bones are gumpy
30
What is needed to diagnose a femur fracture?
Must x-ray entire length of Femur for | proper evaluation
31
How is a femur fracture treated?
Hip spica cast vs surgery
32
What are complication of femur fracture?
Shortening Lengthening --> growth of more bone in the fracture site Angulation
33
What is the most common patellar fracture in kids <13?
Patellar sleeve fracture
34
How are patellar sleeve fractures caused?
Caused by forced extension with knee in flexion | • Jumping, kicking, etc
35
How is a patellar sleeve fracture treated?
* Knee immobilizer, NWB, elevate * NSAIDs * Ortho: cast vs surgery
36
How is a Toddler's Fracture of the tibia caused?
Common cause is young child falling while running, twisting mechanism Causes them to non-weight bare on affected side
37
How is a Toddler's Fracture managed?
* Immobilize (splint/wee walker) * NWB, NSAIDs, elevate if possible * Ortho: Wee walker vs cast
38
What x-ray view should be used to assess ankle fractures vs sprain
AP, mortise, lateral, internal and external oblique
39
How is an ankle fracture managed?
* Posterior vs stirrup splint * Eleva8on, NWB, NSAIDs * Ortho consult PRN
40
What is the MOI of a Triplane Fracture?
Mechanism of injury is often external rotation
41
How is a Triplane Fracture diagnosed and treated?
Must get CT to asses displacement Ortho: surgical fixation vs closed reduction
42
What is a Jones Avulsion fracture?
Fracture to the base of the 5th MT * Apophysis runs parallel to MT shaa, fractures typically run perpendicular * Due to pull of peroneus brevis at its inser8on as well as plantar aponeurosis
43
What is Torticollis and how does it present?
Unilateral contraction of the sternocleidomastoid muscle with visible shortening Head tilt to shortened muscle and chin rotation to contralateral side
44
How is a Toticollis treated?
* Stretching/PT | * Positioning education
45
What physical exam test can be done to determine scoliosis?
Adam’s forward flexion exam
46
What are you looking for on x-ray with scoliosis?
Cobb Angle
47
How is scoliosis managed in kids?
TLSO Brace: Boston, Milwaukee, Charleston Bending
48
What is a Osteochondrits Dessecans (OCD)
Idiopathic osteonecrosis of subchondral bone
49
How is a Juvenile OCD caused?
• Idiopathic osteonecrosis of subchondral bone
50
What is the most common location for Osteochondritis Dessicans?
Knee-Lateral portion of medial femoral condyle
51
What causes OCD in the elbow?
Chronic valgus stress or micro trauma with compression attributed to overhead activities
52
How does Osteochondritis Dessecans presented?
Gradual onset of poorly localized deep pain (elbow: typically lateral) • Decreased ROM in elbow but not typically knee
53
How does OCD present on x-ray?
flattening of articular surface
54
Slide 68
slide 68
55
What is the Kochner criteria?
* WBC > 12,000 * ESR > 40 * Fever > 101.3 * Non weight bearing on the affected side • 2/4 criteria warrants joint aspiration
56
Slide 70
slide 70 treatment
57
What is Legg-Calve-Perthes Disease?
Idiopathic AVN of the femoral head
58
How does Legg-Calve-Perthes Ds. present?
* Limp: end of the day * Occasional pain (knee or hip region) * Limited internal rota8on and/or abduction of hip
59
Who is Legg-Calve-Perthes most present in
young boys Thin and active kids
60
How is Legg-Calve-Perthes diagnosed? How is it treated?
* Diagnostic: initially dx may be clinical but plain radiographs will confirm * Treatment: observation, PT to improve ROM, activity modifications, surgery for re-alignment if needed
61
What is a Slipped capital femoral epiphysis (SCFE) What is the biggest risk factor for these?
Slippage of the femoral physis: “Ice cream slipping off the cone" Risk Factor: Obesity is the BIGGEST RF
62
How does Slipped capital femoral epiphysis presented?
* Limp or NWB with c/o hip or knee pain (dull, achy) | * Restricted ROM: abduction and internal rotation
63
How is a Slipped Capiral Femoral Epiphysis treated?
* Requires urgent surgical consultation for in situ single screw fixation * NWB! Admit to hospital.
64
What are the biggest risk factors for Displasia of the hips
1st born Breech position, FHX
65
What two test are used to assess Dyplasia of the hips
Barlows Ortalani
66
How does the Galeazzi test done to test dyplasia of the hips?
Apparent limb length discrepancy while supine and knees flexed at 90 degrees
67
How is Dysplasia of the hips managed?
Pavlik Harness
68
What is an Osgood-Schlatter’s Disease?
Inflammation and irritation of patellar tendon insertion on tibial tubercle
69
How does Osgood-Schlatter's present?
* Focal tenderness to tibial tubercle | * Enlargement or bony protrusion of tibial tubercle
70
How osgood-schlatter's treated?
* Occasional rest, NSAIDs, ice * Quad exercises and hamstring stretches * Chopat strap

Disciplines II, Final Exam (4 decks)

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