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DU PA Peds MS Dz

Duke PA Pediatric Musculoskeletal Disease

Sub-periosteal swelling contained in suture lines Cephalohematoma
Extra-periosteal swelling crosses suture lines, poorly defined Caput succedaneum
Cephalohematoma reabsorbs within ____ 2-12 weeks
Premature fusion of suture Craniosynostosis
Treatment for torticollis Active and passive stretching, botulinum injections in refractory cases.
When do you refer torticollis for surgical consult If not improved in 6 months
Annular ligament entrapment due to traction. Presents as flexed and internally rotated forearm Radial head subluxation (nursemaid’s elbow)
Treatment for nursemaid’s elbow Therapeutic x-ray, hyperpronation, flexion/supination/extension
Treatment for polydactyly/syndactyly Excision at 6-9 months
Stenosing tenosynovitis aka __ Trigger finger (painful thickened flexor tendon or nodule at the A-1 pulley
What is the classification of physeal fractures Salter-Harris
What does the mnemonic SALTR stand for when referring to Salter-Harris fractures S=straight (I), A=above (II), L=lower (III), T=through (IV), R=ram (V)
Treatment for greenstick fx Reduction if needed and short arm cast for 3-4 months
Buckle fracture with intact periosteum Torus fx
Treatment for torus fx 3-4 weeks immobilization in a short arm cast (young children need long arm cast)
__ fat pad sign is usually normal Anterior
__ fat pad sign is always pathologic and indicates supracondylar fx Posterior
What is the most common elbow fx in children Supracondylar fx
Which epicondyle is most commonly fractured Medial
What is the mnemonic for the ossification of the elbow CRITOL, C=capitellum, R=radius, I= internal epicondyle, T=trochlea, O=olecranon, L=lateral epicondyle
For scoliosis monitor curves less than __ 20 degrees
For scoliosis curves <__ are unlikely to progress 20; monitor (6-12 month xrays)
Scoliosis; for curves __ x-ray and bracing 25-45 degrees
Scoliosis; for curves >__ rod and grafting 45-50 degrees
When should you order an MRI for scoliosis Onset before 8 yo
Most common place for spondylolysis L5
Growing pains are more common in __ 2-5 year old boys, calves most common location
Osgood-schlatter is more common in __ 10-14 year old boys
What should be in your differential for a limp Transient synovitis, septic joint, Legg-Calve-Perthes, SCFE, fractures, contusion, malignancy
Septic joint and osteomyelitis frequently follows __ URI
SS of septic joint/osteomyelitis Fever, joint or bone pain, leukocytosis
Common etiologic organisms for septic joint and osteomyelitis Bone: GAS, S. aureus Joint: H. flu, GAS, E. coli, N. gonorrhea
Avascular necrosis of the femoral head, 2-11 yo, insidious groin and anterior thigh pain, limp. Loss of int and ext rotation. Mottled femoral head on x-ray Legg-Calve-Perthes disease
Femoral head displace from femoral neck through the physis. Obese, hypogonadic, adolescent boys, presents with limp and hip/thigh, or knee pain, loss of IR, flexion/abduction; 60% bilateral Slipped Capital Femoral Epiphysis (SCFE)
#1 bone tumor in children, pain free mass, rarely malignant Osteochondroma
Most common foot deformity of the newborn, caused by uterine packing, can be passively corrected, self correcting by 12-18 months Metatarsus adductus
Tibial torsion self corrects by __ 2-4 years
Bow legs Genu varum
Differential for genu varum Rickets, Blount’s disease
Knock knees Genu valgum
Gait appears clumsy, patellae and feet point inward, child may trip often and tends to sit in “W” position, spontaneous resolution by late childhood Femoral anteversion
Congenital deformity, fixed ankle plantar flexion, heel inversion, varus forefoot Talipes equinovarus “club foot”
Well localized posterior calcaneus pain along Achilles insertion, very common in 7-15 y/o calcaneal apophysitis (Sever’s disease)
Absent longitudinal arch of foot Pes planus
Spondylo imaging Spondylolysis oblique (Scottie dog); spondylolisthesis lateral (step-off sometimes seen)
Intoeing DDx Metatarsus adductus; Tibial torsion; increased femoral anteversion; Genu varum
Club foot epidemiology 1:1000, M>F slightly
Tx (Poseti) for club foot Serial casting; Surgical tendon release; Night brace 2 years
Created by: bwyche