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Peds and other
Ortho
| Question | Answer |
|---|---|
| What might subdural or retinal hemorrhaging suggest in a child? | possible abuse from shaking |
| What fractures indicate possible abuse? (5) | posterior rib, scapula, posterior process of spine, sternum, corner fractures of long bone metaphysis |
| Pt (child) presents w/ posterior heel pain and a limp. Pain inc w/ activity. | clacanel apophysitis aka Sever's dz |
| what age/gender is assoc w/ sever's dz | male 8-11 y/o |
| tx for calcaneal apophysitis (sever's dz) | activity restriction, heel lift, achilles tendon stretching, casting 4-6 wks, NO SURGERY OR INJECTION |
| associated w/ ligamentous laxity in hip and detectable at birth. assymptomatic in neonates and sometimes picked up when child starts to walk. | Developmental dysplasia of the hip |
| Dx Develop. Dysplasia of the hip | PE. Barlow test. Ortolani maneuver for relocatability. hip limiter abduction. US. Geleazzi sign for leg length |
| What are the adverse outcomes of Dev. Dysplasia of the hip | longer the hip is dislocated the harder to reduce AND possible early DJD |
| Tx Develop. dysplasia of the hip | <3 mos - PAVLIK HARNESS3-9 mos try harnesslater - closed or open reduction |
| congenital deformity, autosomal dominant, mild scoliosis, moderate limb deformity, mild limb shortening. BLUE SCLERAE | osteogenesis imperfecta |
| adverse outcomes of growth plate damage? | limb length discrepancy or angulation |
| congenital dislocaton of the radial head | subluxation of radial head |
| what is the most common childhood dislocation? | elbow dislocation |
| Are most elbow dislocations anterior or posterior? | 80% posterior |
| tibia becomes laterally deviated from midline as it progresses distally | Valgum |
| "knock knees" | valgum |
| "bow legged" | varus |
| how do you dx valgum | measure height and plot on nomogram; measure tibiofemoral angle or intermalleolar dist |
| tx for valgum | None: usually corrects itself |
| deformity w/ tibia medially deviated more as it progresses distally | genu varum |
| tx varum | ITV-bracing; tibial osteotomy 30-60 mos |
| what can cause mild intoeing? | mild CP |
| after what age is an osteotomy used to treat in toeing/out toeing | 7-8 yrs |
| What age should is in/out toeing considered severe at? | severe beyond age 4 and watch until age 8 |
| what age is metatarsus adductus severe beyond | 6 mos |
| idiopathic osteonecrosis of femoral head in children 2-12 y/o | legg-calve-perthes dz |
| is legg-calve-perthes dz more common in males or females | males 4:1 |
| what leads to a worse prognosis for legg-calve-perthes dz | advanced age and involvement; also bone death w/ collapse may lead to deformity and DJD |
| pt presents w/ limping x 3-6 weeks, pain increasing w/ activity and aching in groin or thigh | legg-calve-perthes dz |
| dx legg-calve-perthes dz | limited abduciton; AP and frog-lateral views of hips; inc density of FH, CRESCENT SIGN of shear fracture in subchondral bone; poss MRI |
| CRESENT SIGN on and xray indicates... | legg-calve-perthes dz |
| tx legg-calve-perthes dz | observation for children w/mild involvement:bracing in abduction (marginally effective), bed rest and traction, osteotomy for older pts |
| displacement of femoral head through an immature physis typically during adolescent growth spurt | slipped capital femaoral epiphysis |
| what directions does SCFE usually slip | posterior and medial |
| what factore predispose SCFE | obesity, male, sports activities |
| What age range for female and males w/ SCFE | F: 12y/o M: 13y/o |
| pt w/ proximal anterior thigh or groin pian possibly radiating to distal thigh. pain inc w/ activity. loss of hip internal rotation w/flexion. abduction and extension dec. shortening of affected extremity | SCFE |
| Dx SCFE | AP and frog-lateral pelvic films |
| "ice cream slipping off ice cream cone" | SCFE |
| Adverse outcomes of SCFE | progressive arthritis, chondrolysis, osteonecrosis, DJD |
| tx SCFE | in situ stabilization, reduction and emergent stabilization, realignment osteotomy, PINNING IN SITU IS STANDARD OF CARE |
| After what age do you worry about toe walking? | 18 mos |
| antibiotic used to treat animal bites | Augmentin |
| organism involved in cat/dog bites | pasturella multocida |
| when do you close a cat bite? | NEVER!!!! |
| swelling or stenosis of the tendon sheath, pain swelling, triggering at base of thumb. Swelling and tenderness over first dorsal compartment | DeQuervain's tenosynovitis |
| + finkelstein test | DeQuervain's tenosynovitis |
| tx DeQuervain's tenosynovitis | thumb spica splint, NSAID, injection surgery |
| nodular thickening and contracture of the palmar fascia. usually men >50 | Dupuytren contracture |
Created by:
mczarko
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