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Own peds boards > Orthopedics > Flashcards

Orthopedics Flashcards

1
Q

Most likely demographics to have developmental dysplasia of hip and you should US them all

A

female breech

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2
Q

Are hip clicks benign or worrisome?

A

benign

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3
Q

What other abnormalities are associated with DDH?

A

Torticollis, metatarsus adductus

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4
Q

Work up for DDH in children <4 months?

A

US

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5
Q

Workup for DDH in children >4 months

A

Xray

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6
Q

What does DDP look like on Xray

A

Femor goes up and out, delayed ossification, acetabulum angle bigger

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7
Q

Rx for DDP <6m

A

Pavlik

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8
Q

Rx for DDP 6-18mo

A

Operate or cast

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9
Q

Rx for DDP 18m

A

Open reductin, acetabular osteotomy

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10
Q

What is complication of HHP

A

AVN of femoral head

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11
Q

What are the three causes of in-toeing and at what age?

A

Metatarus adductus <1yrs
Medial tibial torsion 1-3yr
Femoral torsion 3-9yr

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12
Q

Which cause of intoeing is seen more often in breech or twin

A

Metatarsus adductus

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13
Q

Which of the intoeing causes requires casting

A

Metatarsus adductus - if flexible, observe but cast if persist at 9-12 months. If rigid, will need to cast

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14
Q

What are associated anomalies with clubfoot?

A

DDH, myelodysplastia, arthrogyprosis, myotonic dystrophy

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15
Q

Rx for torticollis?

A

SCN release at 12-18 months

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16
Q

Age of benign paroxysmal torticollis

A

2-8 months

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17
Q

Age of resolution of benign paroxysal torticollis

A

2-3 yrs

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18
Q

Pattern: cervical spinal fusion with shortening of neck and neck stiffness

A

Klippel-Feil syndrome

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19
Q

What can be associated with Klippel-Feil?

A

Congenital scoliosis, renal/cardiac abnormalities, deafness, sprengel deformity, congenital elevation of scapula

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20
Q

What can be seen with Erb’s?

A

Unilateral diaphragmatic paralysis

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21
Q

What can be seen with Klumpke’s

A

Horner’s

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22
Q

Which has worse prognosis, Erbs or Klumpke’s

A

Klumpke’s

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23
Q

What are causes of bowlegs?

A

Poor bone mineralization, skeletal dysplasia, trauma, infection, abnormal diet, tibia vara

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24
Q

When does bowlegs usually resolve?

A

by 2 yrs

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25
Q

What are warning signs of casting?

A
  1. Not improving by 2 years
  2. Asymmetry or severe bowing.
  3. Short stature
    • rickets, skeletal dysplasia
  5. Abnormal diet
  6. Positive family history
  7. H/o trauma/infection
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26
Q

What do knock knees usually result from?

A

Exaggerated by hyperextension of knees

27
Q

When do knock knees resolve?

A

by 10 years

28
Q

What is the cause of tibia vara?

A

Abnormal growth of medial proximal growth plate

29
Q

Pattern: AA, obese, unilateral or bilateral bowing and painless

A

tibia vara

30
Q

Rx for tibia vara

A

Brace, osteotomy, kill growth plate on opposite side

31
Q

Pattern: Painful limp, refusal to walk in 3-6 yr old, low fever, leg internal rotation is decreased, mild/mod pain with hip movement worse in morning

A

Transient synovitis of hip

32
Q

Rx for transient synovitis of hip

A

Bed rest, NSAIDs

33
Q

If presumed diagnosis of transient synovitis of hip doesn’t improve, what should you think about?

A

LeggCalve-Perthes

34
Q

Pattern: child refused to bear weight, may crawl, with localized tenderness or swelling pain with gentle twisting of tibia in 9mo to 3yr

A

Toddler’s fracture - non displaced spiral fracture of distal tibial metaphysis

35
Q

What is the pathology of Legg-Calve-Perthes?

A

idiopathic ischemia and necrosis of femoral head

36
Q

Pattern: 3 to 12yr male, short stature, with decreased internal rotation, insidious onset, limp w/ or w/out pain, +/- pain with passive rotation, positive Trendelenburg, leg length discrrepancy

A

Legg-Calve Perthes

37
Q

What are the causes of Legg-Calve-Perthes disease

A

Trauma, steroids, hypoth, epiphyseal dysplasia, mucopolysaccharidosis, infection, sickle cell disease

38
Q

Picture of LCP on xray

A

widening of joint, patches and deformation

39
Q

Rx of LCP?

A

<5yrs restrict activity, NSAIDS, ROM exercise

>8yrs Abductor brace or surgery osteotomy, keep femoral head within acetabulum

40
Q

Pathology of slipped capital epiphyses

A

Displacement of femoral head secondary to abnormal growth plate

41
Q

What do you see with slipped capital epiphyses

A

ice cream slipping off cone, use AP and frog leg lateral (more sensitive)

42
Q

Rx SCE

A

to prevent further slipping not to put it back because of concern for avascular necrosis; use percutaneous screw into epiphysis

43
Q

Pattern: discrepancy when you stand, when you sit it goes away, no fracture, no scoliosis

A

leg length discrepancy

44
Q

Which pattern of scoliosis should you most worry about at thoracic and lumbar level?

A

Left thoracic, right lumbar

45
Q

At what degree do you observe, refer, and brace scoliosis?

A

<20 degrees
>20 degrees
>30 degrees or >20 and progresses over 5 over 6 to 8 months

46
Q

Pattern: fixed kyphosis in thoracic older adolescent and male, vertebral body narrowing of disc spaces, irregularity of vertebral and plates, wedging of anterior vertebral bodies, Schmorl’s nodules

A

Scheuermann’s disease

47
Q

For Scheuermann’s disease, what degree do you brace or do surgery

A

Brace >50 degrees

Surgery >70 degrees

48
Q

Best xray angle for spondylolysis and spondylolisthesis

A

Spondylolysis - oblique film (Scotty dog)

Spondylolisthesis - lateral film

49
Q

Pattern: tight hamstrings, tenderness L5-S1, limited straight leg raise, poorly defined lower back pain, pain with increased activity

A

Spondylolysis

50
Q

Pattern: gradual onset with symptoms for weeks, fever, refusal to walk in toddler, fever, limp or abdominal distress, back pain in adolescent stiffness of back and pain with motion, tenderness over different disc space, positive Gower’s sign

A

Discitis, staph aureus

51
Q

Warning signs of back pain

A

Age <4yrs, pain lasting >2 to 4 weeks, sever pain, pain that wakes from sleep, fever, weight loss, painful scoliosis, neuro abnormalities, focal abnormalities

52
Q

What are child abuse patterns?

A

Metaphyseal corner (chip) fractures, femoral fracture, scapular fracture

53
Q

Pattern: radial fracture on outstretch arm

A

torus or buckle

54
Q

Describe Salter-Harris classification

A 
Type 1 - through growth plate
Type 2 - above, physis and metaphysis
Type 3 - lower, physis and epiphysis
Type 4 - totally through all layers
Type 5 - compression with obliteration
55
Q

What are signs of benign bone tumors?

A

sharp or sclerotic border, small in size or multiple lesions, no cortical destruction or extension into soft tissue, do not extend across growth plate

56
Q

Nurse maid’s elbow

A

radial head subluxation

57
Q

Pattern: most common in 10-20 yr old, pedunculated cauliflower like lesion painless hard mass

A

solitary osteochondroma

58
Q

Pattern: 10-12 years, multiple osteochondrosis, if grows rapidly and painful can be malignant

A

hereditary multiple osteochondrosis

59
Q

What is the location for osteoid osteoma and unicameral bone cyst?

A

Osteoid osteoma, proximal or distal femur and tibia

Unicameral bone cyst - proximal humerus and femur

60
Q

Osteochondroma, hereditary multiple osteochondrosis, osteoid osteoma, unicameral bone cyst, aneurysmal bone cyst: which are painful which are not

A

Painful - multiple osteochondrosis, osteoid osteoma, aneursymal bone cyst
Not painful - solitary osteochondroma, unicameral bone cyst

61
Q

Pattern: poorly localized, wakes from sleep, pain comes and goes

A

growing pain

62
Q

Pattern: tibial tubercle - apoplysitis inflammation at growth place; fragmentation/bone pulled off of tuberosity

A

Osgood Schlatter’s

63
Q

Pattern: Calcaneus at insertion of Achilles tendon. Early adolence, pain increases with activity, pain over apoplhysis or if squeeze heel, decrease dorsiflexion secondary to concurrent tight heel cord

A

Sever’s

64
Q

Pattern: medial, femoral condyle of knee, bone fragment development and searption at distal femur

A

osteochondritis dessicans

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