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Flashcards in Upper Extremity Peds Squirm Deck (39):

Growth Plate Zones

Germinal zone.


Name of fragment in a type II salter harris

Thursday holland is metaphyseal fragment


Skipped Ogden



Ossification of humeral head, greater and lesser tuberosity?

6 months
1-3 years
4 years


Classification of proximal humeral plate fracture

Neer Harowitz
Grade 1 is less than 5 mm displaced
Grade II is less than 1/3 width
Grade III is displaced 1-2 thirds
Grade IV is greater than 2/3 width


Acceptable alignment for Proximal humerus fracture in kids. Complication?

1-4 years old: any angulation
5-12 years old: up to 45 degrees angulation and one half displaced (near III)
12 is 20 degrees of angulation and displacement of less than 30% (neer horowitz II)

Can do osteotomy if its a problem, Axillary nerve needs exploration if out after 4 months (1% incidence and usually neuropraxia)


whats the disease with no clavicle?

cleidocranial dyostosis


Classification of AC disruption

Dameron and Rockwood (two favs) 1-3 is noon
1 is sprain
2 is partial tear with widening
3 is periosteal split with 25-100% displaced
4 posterior displacement buttonholed through trap
5 more than 100% displaced
6 is infracoracoid and into the conjoined tendon


Ossification of scapula shit?

Coracoid 1 year for base, upper fourth are 10 years

Acromion fuses late, 20 year

stopped writing it


Stryker notch view is for what?

Coracoid fracture or hill sachs



1a antioer, 1b posterior glenoid, 2 inferior exit 3 superior exit, 4 across the body, 5 is combo, six is comminuted


Acromion fracture

1 non displaced. 1 a is avulsion, 1b direct trauma

II is displaced without narrowing

III is subacromial narrowing


Shoulder suspensory complex

Clavicle AC, acromion, neck glneoid, coracoid and CC


What do you consider if luxatio?

Ehler's dances syndrome


Reduction of elbow first move?

How do you splint anterior dislocation?


Some extension


Bauman angle?

Humeral ulnar angle?

Metaphyseal diaphysial angle

11-20 degrees


40 degrees


Most common displacement and how it happens in supracondy? What type puts risk to brachial after and median nerve?

Posteromedial is more common! and happens when pronated (makes sense, its how you catch yourself)

IT IS LUCKY because posteriolateral puts brachial after and nerve at risk


Classification of supracondy's



Milch lateral condyle?

What are stages? Tx?

Note: crepitus suggests unstable

Through trochleaocapitellar groove. Two is through trochlea

Stage 1 is intact articular surface, less than 2 mm displace
Stage 2 is 2-4 mm displaced and articular surface disrupted
Stage 3 is displaced fragment, rotated

Stage 1 usually treat in slab with forearm NEUTRAL!!!!


Warning sign of medial condyle?

watch out for fat pad sign, because epicondyle is actually not in the capsule


Medial condyle staging?



Transphyseal imaging finding?


Posteriomedial displacement but radial and ulnar relationship maintained

DeLee: Based on ossification Lateral condyle
1 is prior to it being there (salter 1, before 1 year old)
2 is age 1-3. Can be 1 or II SH
3 is age 3-7, WATCH For smooth outline of distal metaphysics


T condylar fracture classification?

1 nondisplaced
2 Displaced but no metaphysical comminution
3 Displaced

Basically always need OR


Radial head/neck classification?

Obrien is based on angulation
Type 1 is less than 30 degrees
2 is 30-60
6 is more

Wilkins is based on fracture
A SH1 or 2
B is SH3 or 4
C is metaphseal completely


Treatment radial head?

Type 1 obrien (less than 30 degree is nonop)
Type 2 is isrealli or patterson method of reduction. Esmarch also
type 3 is OR or do OR for anything unstable


Problem with ORIF radial head?

Osteonecrosis, PIN, shit like that


Olecrenon fx tx?

In cast with 5-10 degrees flexion unless significantly displaced. THINK ABOUT OI

Unless shear, then hyper flex but worry about swelling


Montagia equivalent classification?

1 is isolated radial head dislocation
2 is ulna and proximal radius fracture
3 isolated radial neck
4 is elbow dislocation


Acceptable angulation in montagna?

10 degrees as long as radial head pops in


Galleazi classification and positions for treating?

Type 1 is apex volar. IT IS A SUPINATION injury. So pronate it (remember thumb follows apex)

Type 2 is opposite. Apex dorsal so supinate it


Distal radius physical injury acceptable range?

1 and 2 needs 50% apposition without rotational deformity.

SH III must be anatomic

IV and V need surgery if at all displaced (1 mm)

Also OR if carpal tunnel


Acceptable deformity for radius fracture?

15 degrees if less than 9 for girls 11 for boys
10 degrees for 9-13 for girls
10 degrees for 11-13 for boys
none after that


Scaphoid classification. Who gets surgery?

Type A is distal pol
a1 extraarticular. A2 intraartic
B is middle third (waist)
C is proximal pole

Displacement 1 mm or angulate more than 10 degrees


Capitate and scaphoid fx without dislocation is what?

Naviculocapigtate syndrome


Metacarpal classification

Type A epiphyseal/physeal
Type B metacarpal neck: 4th and 5th is peds version of peer fracture Acceptable angulation is 15 for 2nd and 3rd, 45 for 4th and 5th
C shaft and ten degrees for 2nd and 3rd and 20 for 4th and 5th

D is base. Unstable, usually operative


Thumb metacarpal classification

NOTE physis is proximal

A is distal to physis and 30 degrees acceptable
B is Salter harris two metaphseal medial. APL pulls laterally and proximally, adductor medial. THUMB SPICA
C is SH II and metaphysical laterally. Tends to buttonhole and need ORIF
D intraarticular III or IV and bennet equivalent


Gamekeeper classification

A sprain
B rupture of ligament
C avulsion (Salter harris 3)
D psuedogamekeeper: from SH 1 or II feracure


Phalanx classifciation

A physeal
B is shaft and tend to be APEX VOLAR in P1 due to lateral band and central slip
C Neck USUALLY operative b/c shit gets stuck in it like volar plate
D condylar intraairticular and needs wires to hold it


Phalanx fx operative when?

Unstable type C and D (neck and condyle)
Interposition of shit and won't reduce

Type B (shaft) and alignment angulated 30 degrees or 2- degrees if ten