wk 7- radiology paeds

Question 1

important to note about the first proximal phalanx

Answer 1

the ossification centre is divided into two and can be misinterpreted as a fracture on radiographs

Question 2

os subfibulare

Answer 2

below the lateral mall

Question 3

os trigonum

Answer 3

posterior aspect of talus

Question 4

accessory navicular or os tibiale externum

Answer 4

dorsomedial aspect of navicular and lies within tibial tendon

affects 10-15% of children- most common accessory ossicle

Question 5

types of accessory navicular

Answer 5

type 1- 30%
5mm proximal to navicular tuberosity and 2-4mm in diameter

type 2- 50-60%
attached to navicular tuberosity by fibrocartilage synchondrosis (around 11mm diameter, triangle or heart shaped)

type 3- 10%
prominent navicular tuberosity- fused type 2
can be associated with PT dysfunction

Question 6

os peroneum

Answer 6

in tendon of peroneus longus and seen in the oblique view of the foot

associated with osseous frcition to cuboid and peroneus longus dysfunction

Question 7

what is clubfoot deformity

Answer 7

3 dimension deformity

rearfoot equinas- lateral talocalcaneal angle <35deg

rearfoot varus - talocalcaneal angle <20deg

forefoot metatarsal adductus- talus to first met angle is >15deg

also known as talipes equinovarus

Question 8

whats the difference between metatarsus adductus and clubfot

Answer 8

MA- the talus and calc are normal but there is medial deviation of forefoot

Question 9

whats the difference between skew foot and club foot

Answer 9

skew- ADDuction of forefoot, abduction of midfoot, valgus rearfoot

Question 10

how is coalitions best viewed on radiograph

Answer 10

45deg oblique view

Question 11

what findings would you have on a radiograph of canceonavicular coalition

Answer 11

osseous bar
eburnation or sclerosis
elongation of anterior calc process

Question 12

what is the most common coalition

Answer 12

calcaneonaviuclar

Question 13

what coalition has worse symptomology

Answer 13

talocalcaneal

Question 14

what is talocalcaneal coalition

Answer 14

bar of fibrous, cartilage or osseous tissue between the middle facet of the calc and talus

Question 15

radiographic findings of talocalcaneal coalition

Answer 15

-failure to visualise STJ
-talar beaking
-narrowing of posterior STJ
-concave undersurface of talar neck
-C sign, continuous c shaped arc on lateral ankle graph (however note that this can be seen in flat foot deformity with no coalition)

Question 16

juvenille hallux valgus what measurements are used to assess

Answer 16

3 measurements

1st met angle <20->40 (mild-sev)
line down 1st met and great toe

1-2 intermet angle <11 - >15 (mild-sev)
line down 1st met and 2nd met

seasamoid position/migration 50%0>75% (mild-sev)
across 1st met

Question 17

what do osteochondroses affect

Answer 17

epiphysis- end portion of long bone contributing to the joint
and
apophysis- part of the epiphysis and is the site of tendon or ligament attachment

Question 18

do osteochondroses include apophysitis/apophysitides

Answer 18

yes

Question 19

underlying pathogenesis of osteochondorses

Answer 19

disruption to vasuclar supply of involved area of epiphyseal cartilage
focal ischemia leads to failure in the ossification and abnormal epiphysis

Question 20

classifying osteochondroses through

Answer 20

non articular (tension)
articular (compression)
and physeal

Question 21

what classification is kohlers

Answer 21

articular/compression

Question 22

what classification is freibergs

Answer 22

articular, compression

met head collapse (typically the 2nd met)

Question 23

what classification is os goods schlatters

what is it and who is it common in

Answer 23

non articular, tension

traction apophysitis of tibial tubercle

common in jumping/high impact shorts for kids going through growth spurt

Question 24

what classification is legg calve perthes

Answer 24

articular, compression

lack of blood supply to head of femur

Question 25

what classification is slipped capital epiphysis what is it and who does it present in

Answer 25

articular, compression damage to growth plate which causes head of femor to slip can present as a limp in children

Question 26

diaz/ mouchets site is (OC)

Answer 26

talus/talar dome

Question 27

treves/ ilfleds site is (OC)

Answer 27

sesamoids

Question 28

thiemann's site is ( osteochondroses)

Answer 28

phallanges

Question 29

are osteochondroses self limiting

Answer 29

yes, immobilise to allow for healing

Question 30

kohler affects what bone, what age, symptoms, feature on x ray

Answer 30

navicular around age 5 symptoms:tenderness, swelling, decreased ROM, redness gait with limp or refusal to weight bear navicular is small on radiograph due to AVN

Question 31

treatment for kohlers

Answer 31

resolves over time usually NSAIDS to manage pain short period of non weight bearing cast or CAM walker immobilisation

Question 32

sever's disease is, what age range is it common in

Answer 32

calcaneal apophysis most common OC in children, presents typically in boys 8-14 years heel pain

Question 33

treatment for severes disease

Answer 33

linear heel raise to reduce tensile stress

Question 34

freiberg is

Answer 34

met head (2-4th)

Question 35

siffert, arkin is

Answer 35

distal tibial epiphysis

Question 36

lesson, weiner is

Answer 36

cuneiforms ossification

Question 37

what causes osteochondroses

Answer 37

multifactorial trauma hereditary diet / bone health growth plate timing anatomy of area biomechanical function vascular events

Question 38

what do u need to rule out with OC

Answer 38

stress fractures/reactions tumours infections

Question 39

iselins disease is what common in what age

Answer 39

traction of apophysitis at the base of the 5th met age 10-14 years x ray usually required to rule out accessory bones or frature/avulsion

Question 40

treatment for iselins disease

Answer 40

rest NSAIDS for pain relief at the start stretching of calf and lateral shin muscles heel raise to reduce stress if these dont work than immobilisation in CAM for short period until pain has decreased

Question 41

friebergs infarction

Answer 41

AVN due to trauma, compressive age 12-15 years

Question 42

radiography of friebergs infarction

Answer 42

flattening of articular head (most commonly 2nd)

Question 43

friebergs classification (bragard staging)

Answer 43

stage 1- met head flattening decreased bone density 2- met head sclerosis, fragmentation, deformation, cortical thickening 3- MTP OA with loose bodies

Question 44

treatment for friebergs infarction

Answer 44

rest NSAIDs immbolisation if hasnt decreased pain surgery may be considered in advanced stages

Question 45

vertical talus

Answer 45

talipes convex pas valgus rearfoot valgus and equinas, midfoot dorsiflexion and forefoot abduction due to fixed dorsal dislocation of the navicular on the talar head bulbous heel morphology looks similar to club foot

Question 46

treatment for vertical talus

Answer 46

stretching/manipulation bracing/ serial casting surgery of bones moved/pinned in correct place and tendons and ligaments lengthened where appropriate