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Flashcards in Pestana Orthopedics Deck (69)
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1

infant presents with uneven gluteal folds; hips can be easily dislocated posteriorly with a "jerk and click" and returned to normal position wiht "snapping"

next best step in management and treatment?

developmental dysplasia of the hip

get a sonogram (xrays will not work because the hip is not calcified)

Pavlik harness for 6 mo

2

6 year old with insidious development of limping, decreased hip motion, and hip/knee pain. 

Diagnosis, next best step in management, and treatment?

Legg-Calve-Perthes disease

(idiopathic disruption blood flow to femoral head -> avascular necrosis and cessation of growth -> collapse and deformity of the femoral head)

get AP and lateral hip X-rays

cast the femoral head within the acetabulum

(removes mechanical pressure from the joint until the disease has run its course and reduces risk of developing a severe degenerative arthritis as adult can be reduced)

3

chubby teenager boy limps and complains of groin pain; sits with legs dangling wtih the sole of the foot on the affected site

Diagnosis, next best step in management, and treatment?

Slipped capital femoral epiphysis (SCFE) - orthopedic emergency

X-ray

Surgery - pin femoral head back into place

4

toddler with a recent episode of fever refuses to move the hip and holds the leg with the hip flexed, in slight abduction, and external rotation. Gets very upset if anybody tries to move it passively

Diagnosis, next best step in management, and treatment?

Septic Hip

ESR + aspiration of hip under general anesthesia

Open drainage if pus is obtained during aspiration

5

5 year old with recent fever presents with severe, localized pain in a bone 

Diagnosis, next best step in management, and treatment?

Acute hematogenous osteomyelitis

MRI 

Antibiotics

6

Physical finding in a 2 year old

Diagnosis and treatment?

Genu Varum (bowlegs)

no treatment

7

physical finding in a 5 year old

Diagnosis, next best step in management, and treatment?

Blount disease - persistent varus beyond age 3; actually a growth disorder of the tibia (shin bone) that causes the lower leg to angle inward, resembling a bowleg

Surgery - may involve cutting the tibia to realign it and/or lengthen it 

8

physical finding in a 4-8 year old

Diagnosis and treatment?

Genu Valgus (knock knee)

No treatment

9

teenagers with persistent pain over the R tibial tubercle, aggravated by contraction of the quadriceps. No knee swelling

Diagnosis and treatment(3)?

Osgood-Schlatter Disease

RICE (rest, ice, compression, elevation); if it does not work, can use an extension or cylinder cast for 4-6 weeks

10

Physical finding in a newborn infant

Diagnosis and treatment (4)?

Club foot (talipes equinovarus)

serial plaster casts (started in the neonatal period to provide sequential correction), Achilles tenotomy, and Braces

Surgery if not responding to casting (usually 9-12 mo)

11

complications of scoliosis 

treatment? 2

deformity can progress until skeletal maturity is reached; severe cases can result in decreased pulmonary function

bracing to arrest progression, surgery for severe cases

12

two fractures that are the most concerning in children

supracondylar fracures of the humerus (shown in image)

fractures involving the growth plate

13

child trips and falls on the hand with the arm extended

Diagnosis and why is this of concern?

Next best step in management, and treatment?

think supracondylar fractures of the humerus

concerning b/c of vascular/nerve injuries that could result in Volkmann Contractures

casting w/ careful monitoring of vascular and nerve integrity, and development of compartment syndrome

14

How do you diagnose Fractures of the epiphyseal growth plate? (5)

Treatment(2)?

Diagnosis made based on SALTR classification

  • S: slipped (type I)
  • A: above (type II)
  • L: lower (type III)
  • T: through or transverse or together (type IV)
  • R: ruined or rammed (type V)

Treatment depends on the classification

  • If fracture does not cross the epiphysis or growth plate (type I) -> closed reduction
  • If fracture does cross the epiphysis or growth plate (type II-IV) -> open reduction and internal fixation (to precisely align the pieces)

15

teenager presents with low grade skeletal pain for the last several months. What should be your major concern?

malignant bone tumors (osteogenic sarcoma or ewing sarcoma)

16

teenager presents with dull but consistent pain in his knee for the last several months.

X-ray findings are shown. 

Diagnosis?

osteogenic sarcoma - typically affects 10-25 age group

X-ray usually shows "sunburst" pattern

17

child presents with dull but consistent pain in his thigh for the last several months.

Diagnosis?

What part of the body does this typically occur? (5)

Ewing Sarcoma - typically affects children 5-15

X-ray shows "onion-skinning" pattern

common areas: clavicle, humerus, ribs, pelvis, femur

18

type of bone pattern observed in metastatic bone canacer

blastic lesions

19

old man presents with fatigue, anemia, and localizable pain in several bones

Diagnosis, diagnostic tests 3, and treatment 2?

Multiple myeloma

Diagnostic tests

  • XRay - multiple punched out lesions
  • Urine - bence-jones protein
  • Serum Igs

Treatment

  • chemo
  • Thalidomide

20

How do soft tissue sarcomas present?

Diagnosis, diagnostic tests 2, and treatment 3?

relentless growth of a mass that is firm and fixed to surrounding structures.

Diagnosis with MRI and incisional biopsy

Treat with very wide local incision, radTx, and chemoRx

21

How do you determine if a fracture can be surgically treated with a closed reduction vs open reduction with internal fixation?

closed: broken bones that are not badly displaced or angulated or that can be aligned by external manipulation

open with internal fixation: broken bones that are severely displaced or angulated or that cannot be aligned easily

22

How are clavicular fractures managed?

SLING

23

patient presents with his arm close to his body and rotated outward.

What should you be worried about? 

What is another physical finding that is pathognomonic of this and why?

What imaging would you order to cinch the diagnosis?

Anterior dislocation of the shoulder

also presents wtih numbness over a small area of the deltoid, secondary to stretching of the axillary nerve

AP + Lateral XRays are diagnostic

24

patient with an epileptic seizure disorder presents with his arm held close to the body and internally rotated. 

What should you be worried about? 

Diagnostic imaging (2)? 

Posterior shoulder dislocation

Axillary vs. Scapular Lateral X-rays

25

little old lady falls on an outstretched hand

X-ray is as shown

Diagnosis? Treatment?

Colle's fractures - fracture of the distal radius

Note the dorsally displaced and dorsally angulated fracture of the distal radius seen on the X-ray

Trmt: closed reduction + long-arm cast

 

26

All time champion boxer comes in excrucating pain in his L arm

X ray is as follows

Diagnosis? treatment?

Monteggia Fracture - usually caused by direct blow to the ulna.

Note Xray shows a diaphyseal fracture of the proximal 1/3rd of ulna with dislocation of the head of the radius

given the extent of the displacement, open reduction with internal fixation is preferred over cosed reduction

27

Patient falls on an outstretched arm and complains of significant pain and swelling at the distal-third of his arm and hand.

Diagnsois? Treatment? 2

Galeazzi fracture - typically caused by direct blow to the distal third of the radius

Note Xray has an isolated fracture of the distal and middle 1/3rd of the radius with associated subluxation/dislocation of the distal radio-ulnar joint

open reduction and internal fixation of the broken and dislocated bones

28

Young adult falls on an outstretched hand and immediately complains of pain and swelling at the base of the thumb. Xray is as shown

Diagnosis? Treatment options?

Scaphoid fracture (carpal navicular)

in undisplaced fractures - thumb spica cast

in displaced and angulated fractures - open reduction and internal fixation

29

drunk person becomes belligerant and punches a wall and his hand becomes swollen and tender. 

X-rays are as shown.

daignosis? treatment?

metacarpal neck fracture

closed reduction with ulnar gutter split

30

old lady sustains a fall; paramedics is called and she is transported to the hospital in a stretcher  and you  notice her presentation.

diagnosis? management? treatment?

hip fracture

note her affected leg is shortened and externally rotated

treatment depends on the location, so get an x-ray!

treatment - open reduction and internal fixation with screws/plates