Upper Extremity Peds Squirm

Question 1

Growth Plate Zones

Answer 1

Germinal zone.
Proliferative
Hypertrophi
Endochondral

Question 2

Name of fragment in a type II salter harris

Answer 2

Thursday holland is metaphyseal fragment

Question 3

Skipped Ogden

Answer 3

ok

Question 4

Ossification of humeral head, greater and lesser tuberosity?

Answer 4

6 months
1-3 years
4 years

Question 5

Classification of proximal humeral plate fracture

Answer 5

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

Question 6

Acceptable alignment for Proximal humerus fracture in kids. Complication?

Answer 6

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)

Question 7

whats the disease with no clavicle?

Answer 7

cleidocranial dyostosis

Question 8

Classification of AC disruption

Answer 8

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

Question 9

Ossification of scapula shit?

Answer 9

Coracoid 1 year for base, upper fourth are 10 years

Acromion fuses late, 20 year

stopped writing it

Question 10

Stryker notch view is for what?

Answer 10

Coracoid fracture or hill sachs

Question 11

Ideberg:

Answer 11

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

Question 12

Acromion fracture

Answer 12

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

II is displaced without narrowing

III is subacromial narrowing

Question 13

Shoulder suspensory complex

Answer 13

Clavicle AC, acromion, neck glneoid, coracoid and CC

Question 14

What do you consider if luxatio?

Answer 14

Ehler’s dances syndrome

Question 15

Reduction of elbow first move?

How do you splint anterior dislocation?

Answer 15

HYPERSUPINATION

Some extension

Question 16

Bauman angle?

Humeral ulnar angle?

Metaphyseal diaphysial angle

Answer 16

11-20 degrees

5-15

40 degrees

Question 17

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

Answer 17

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

Question 18

Classification of supracondy’s

Answer 18

Gartland

Question 19

Milch lateral condyle?

What are stages? Tx?

Note: crepitus suggests unstable

Answer 19

Through trochleaocapitellar groove. Two is through trochlea

Jakob!
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!!!!

Question 20

Warning sign of medial condyle?

Answer 20

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

Question 21

Medial condyle staging?

Answer 21

Kilfoyle?

Question 22

Transphyseal imaging finding?

Classification

Answer 22

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

Question 23

T condylar fracture classification?

Answer 23

1 nondisplaced
2 Displaced but no metaphysical comminution
3 Displaced

Basically always need OR

Question 24

Radial head/neck classification?

Answer 24

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

Question 25

Treatment radial head?

Answer 25

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

Question 26

Problem with ORIF radial head?

Answer 26

Osteonecrosis, PIN, shit like that

Question 27

Olecrenon fx tx?

Answer 27

In cast with 5-10 degrees flexion unless significantly displaced. THINK ABOUT OI Unless shear, then hyper flex but worry about swelling

Question 28

Montagia equivalent classification?

Answer 28

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

Question 29

Acceptable angulation in montagna?

Answer 29

10 degrees as long as radial head pops in

Question 30

Galleazi classification and positions for treating?

Answer 30

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

Question 31

Distal radius physical injury acceptable range?

Answer 31

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

Question 32

Acceptable deformity for radius fracture?

Answer 32

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

Question 33

Scaphoid classification. Who gets surgery?

Answer 33

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

Question 34

Capitate and scaphoid fx without dislocation is what?

Answer 34

Naviculocapigtate syndrome

Question 35

Metacarpal classification

Answer 35

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

Question 36

Thumb metacarpal classification

Answer 36

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

Question 37

Gamekeeper classification

Answer 37

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

Question 38

Phalanx classifciation

Answer 38

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

Question 39

Phalanx fx operative when?

Answer 39

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