Duke PA Pediatric Musculoskeletal Disease
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| Sub-periosteal swelling contained in suture lines | Cephalohematoma
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| Extra-periosteal swelling crosses suture lines, poorly defined | Caput succedaneum
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| Cephalohematoma reabsorbs within ____ | 2-12 weeks
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| Premature fusion of suture | Craniosynostosis
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| Treatment for torticollis | Active and passive stretching, botulinum injections in refractory cases.
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| When do you refer torticollis for surgical consult | If not improved in 6 months
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| Annular ligament entrapment due to traction. Presents as flexed and internally rotated forearm | Radial head subluxation (nursemaid’s elbow)
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| Treatment for nursemaid’s elbow | Therapeutic x-ray, hyperpronation, flexion/supination/extension
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| Treatment for polydactyly/syndactyly | Excision at 6-9 months
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| Stenosing tenosynovitis aka __ | Trigger finger (painful thickened flexor tendon or nodule at the A-1 pulley
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| What is the classification of physeal fractures | Salter-Harris
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| 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)
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| Treatment for greenstick fx | Reduction if needed and short arm cast for 3-4 months
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| Buckle fracture with intact periosteum | Torus fx
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| Treatment for torus fx | 3-4 weeks immobilization in a short arm cast (young children need long arm cast)
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| __ fat pad sign is usually normal | Anterior
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| __ fat pad sign is always pathologic and indicates supracondylar fx | Posterior
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| What is the most common elbow fx in children | Supracondylar fx
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| Which epicondyle is most commonly fractured | Medial
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| 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
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| For scoliosis monitor curves less than __ | 20 degrees
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| For scoliosis curves <__ are unlikely to progress | 20; monitor (6-12 month xrays)
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| Scoliosis; for curves __ x-ray and bracing | 25-45 degrees
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| Scoliosis; for curves >__ rod and grafting | 45-50 degrees
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| When should you order an MRI for scoliosis | Onset before 8 yo
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| Most common place for spondylolysis | L5
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| Growing pains are more common in __ | 2-5 year old boys, calves most common location
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| Osgood-schlatter is more common in __ | 10-14 year old boys
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| What should be in your differential for a limp | Transient synovitis, septic joint, Legg-Calve-Perthes, SCFE, fractures, contusion, malignancy
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| Septic joint and osteomyelitis frequently follows __ | URI
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| SS of septic joint/osteomyelitis | Fever, joint or bone pain, leukocytosis
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| Common etiologic organisms for septic joint and osteomyelitis | Bone: GAS, S. aureus Joint: H. flu, GAS, E. coli, N. gonorrhea
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| 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
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| 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)
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| #1 bone tumor in children, pain free mass, rarely malignant | Osteochondroma
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| Most common foot deformity of the newborn, caused by uterine packing, can be passively corrected, self correcting by 12-18 months | Metatarsus adductus
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| Tibial torsion self corrects by __ | 2-4 years
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| Bow legs | Genu varum
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| Differential for genu varum | Rickets, Blount’s disease
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| Knock knees | Genu valgum
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| 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
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| Congenital deformity, fixed ankle plantar flexion, heel inversion, varus forefoot | Talipes equinovarus “club foot”
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| Well localized posterior calcaneus pain along Achilles insertion, very common in 7-15 y/o | calcaneal apophysitis (Sever’s disease)
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| Absent longitudinal arch of foot | Pes planus
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| Spondylo imaging | Spondylolysis oblique (Scottie dog); spondylolisthesis lateral (step-off sometimes seen)
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| Intoeing DDx | Metatarsus adductus; Tibial torsion; increased femoral anteversion; Genu varum
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| Club foot epidemiology | 1:1000, M>F slightly
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| Tx (Poseti) for club foot | Serial casting; Surgical tendon release; Night brace 2 years
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