(OBQ18.13) (OBQ18.14) identify ankle fracture pattern (Lauge-Hansen SA, SER, PA, PER). Closed reduction and percutaneous pinning. 19% (147/766) 5. Rib Stress Fracture Team Physician Team physician interval between medial head of gastrocnemius and semimembranosus. patient supine with feet at end of bed and bump under hip for neutral limb rotation. Blood Supply. Treatment is usually closed reduction and percutanous pinning (CRPP), with the urgency depending on whether the hand remains perfused or not. impaired ankle and toe dorsiflexion . Talus fracture. Anterolateral soft-tissue impingement. depth of acetabulum results from. A 6-year-old sustains the injury shown in Figures A and B. Which of the following is the best initial management for this patient? Multiple Epiphyseal Dysplasia is a congenital disorder caused most commonly by an autosomal mutation in cartilage oligomeric matrix protein on chromosome 19. radiolucent table and C-arm from contralateral side. If deformity does not correct with Coleman block, this suggests hindfoot driven varus deformity. (OBQ05.90) Fibular Deficiency (anteromedial bowing) CT scan may be required to further characterize the fracture pattern and for surgical planning. Vector of applied load, amount of energy, and quality of bone determine type of fracture. (OBQ18.249) examine closely for pathologic lesions. 10/21/2019. You can rate this topic again in 12 months. Radial Head and Neck FX - Pediatric typical fracture patterns are transverse and oblique. technique. Ulnar communition with ulnar shortening. The most commonly observed nerve injury would result in deficits in which of the following muscles? A 24-year-old male with hereditary motor sensory neuropathy complains of worsening bilateral foot pain with ambulation and limited walking tolerance. Team Orthobullets 4 Pediatrics - Transient Synovitis of Hip ; Listen Now 8:33 min. varus load. This system divides tibial plateau fractures into six types: Schatzker I: wedge-shaped pure cleavage fracture of the lateral tibial plateau, originally defined as having less than 4 mm of depression or displacement Schatzker II: splitting and depression of the lateral tibial plateau; namely, type I fracture with a depressed component (generally considered The deformity corrects with Coleman block testing. Fibular Deficiency (anteromedial bowing) Medial Epicondylar Fractures are the third most common fracture seen in children and are usually seen in boys between the age of 9 and 14. Patients present with a form of dwarfism characterized by irregular, delayed ossification at multiple epiphyses. Closed reduction, long arm casting, and discharge home, Closed reduction, long arm casting, and admission for a 24-hour observation, Closed reduction, percutaneous pin fixation, and discharge home, Closed reduction, percutaneous pin fixation, and admission for arteriography, Open reduction with brachial artery exploration and admission for observation. (OBQ10.106) Anatomy. What is the advantage of medial and lateral crossed pins compared to two lateral pins in the treatment of supracondylar humerus fractures? indications. complications. 7. For which of the following injuries should lateral pins be placed with the elbow in an extended position? Overnight, he develops increasing pain and swelling in his right forearm. depth of acetabulum results from. Transfer of peroneus brevis to peroneus longus, Split anterior tibial tendon transfer to lateral column, Posterior tibial tendon transfer through the interosseous membrane to dorsum of the foot, Lateral column lengthening calcaneal osteotomy, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list. Treatment is closed reduction and casting or surgical fixation depending on the degree of displacement. Approach . patient supine with feet at end of bed and bump under hip for neutral limb rotation. Hereditary motor-sensory neuropathy (HSMN) primarily affects the peripheral nervous system. Charcot-Marie-Tooth Disease, also known as peroneal muscular atrophy, is a common autosomal dominant hereditary motor sensory neuropathy, caused by abnormal peripheral myelin protein, that presents with muscles weakness and sensory changes which can lead to cavovarus feet, scoliosis, and claw foot deformities. Team Orthobullets 4 Pediatrics - Triplane Fractures ; Listen Now 8:50 min. examine closely for pathologic lesions. Orthobullets Team Knee & Sports - Posterolateral Corner Injury; Listen Now 18:32 min. It is typically asymptomatic, found incidentally, and does not require treatment. Examination reveals an external foot-progression angle of 25 degrees, a thigh-foot axis of +30 degrees, and a positive apprehension test for lateral patellar subluxation on the right side. capitellum moves posteriorly to this reference line in extension type fractures and anteriorly in flexion type fractures, Baumann's angle is created by drawing a line parallel to the longitudinal axis of the humeral shaft and a line along the lateral condylar physis as viewed on the AP image, normal is 70-75, but best judge is a comparison of the contralateral side, deviation of >5-10 indicates coronal plane deformity and should not be accepted, long arm casting with less than 90 of elbow flexion, warm perfused hand without neuro deficits, Type II fractures that meet the following criteria, anterior humeral line intersects the capitellum, repeat radiographs at 1 week to assess for interval displacement, time to CRPP dictated by neurovascular status, some argue can treat an isolated AIN injury in non-urgent fashion, splint in 30-40 elbow flexion, admit overnight for observation and elevation for elective surgery, urgent (same day - do not wait overnight), ecchymosis, dimpling/puckering antecubital fossa, palpable subcutaneous bone fragment, indicates proximal fragment buttonholed through brachialis, implies more serious injury, higher likelihood of arterial injury, significant swelling, more difficult closed reduction, ipsilateral supracondylar humerus and forearm/wrist fractures warrant timely pinning of both fractures to decrease the risk of, if evidence of good distal perfusion admit for 48 hours of observation, if not well perfused perform vascular exploration, if well perfused admit and observe for 48 hours, remove K-wires and reassess vascular status, open exploration and reduction if vascular status does not improve, more frequently required with flexion type fractures (compared to extension type), pulseless white OR pink hand that is unable to be reduced or there remains a gap, gap might represent entrapped vascular structure, posteromedial displacement: forearm pronated with hyperflexion, posterolateral displacement: forearm supinated with hyperflexion, if pronation or supination does not work, try the opposite, maximize separation of pins at fracture site, engage both medial & lateral columns proximal to fracture, engage sufficient bone in proximal & distal segments, low threshold for 3rd lateral pin if concern about stability with first 2 pins, pins should be inserted with elbow in flexion for extension-type injury and elbow in extension for flexion-type injury, biomechanically stronger in bending and torsion than 2-pin constructs, indications (where 2 lateral pins are insufficient), type III and type IV (free floating distal fragment), no significant difference in stability between three lateral pins and crossed pins, risk of iatrogenic nerve injury from a medial pin makes three lateral pins the construct of choice, biomechanically strongest to torsional stress, hyperflexion as ulnar nerve subluxates anteriorly over medial epicondyle in some children, anterior approach if pulseless or median nerve injury, a lateral or medial approach where periosteum is torn, never posterior as posterior dissection can --> AVN, identify median nerve and brachial artery, 2 or 3 K-wires depending on the degree of stability, typically superficial and treated with oral antibiotics, caused by fracture varus malunion, especially in medial comminution pattern, anterior nerve subluxation is most common cause, nerve entrapment by scar tissue and fibrous bands of FCU second most common cause, common with non-operative treatment of Type II and Type III fractures, mechanism = tenting of nerve on fracture, or entrapment in the fracture site, radial pulse absent on initial presentation in 7-12%, pulseless hand after closed reduction and pinning (3-4%), if perfusion is lost following reduction and pinning, pins should be removed immediately, decision to explore is based on quality of extremity, arteriography is NOT indicated in isolated injuries, role of doppler is unclear and does not change treatment, may result from elbow hyperflexion casting, rarely seen with CRPP and postoperative immobilization in less than 90, rare after casting or after pinning procedures, remove pins and allow gentle ROM at 3-4 weeks postop. 9. presents as a foot drop ; patient will compensate with exaggerated hip and knee flexion (steppage gait) impaired ankle eversion; sensory deficit . A radiograph of the lower extremities shows a limb-length discrepancy of 2 cm. After failing conservative management, he is scheduled to undergo a lateral ankle ligament reconstruction. On physical examination there is no evidence of soft tissue compromise and he is able to make an okay sign, give a thumbs up sign and cross his fingers. He has a family history of "foot problems" and reports some minor burning and numbness in both feet. Achondroplasia is a common congenital skeletal dysplasia caused by a sporadic or autosomal dominant gain-of-function mutation in. anterior tibial a. peroneal a. closed reduction and NWB cast for 6 weeks. Her mother also has short stature and is followed in the orthopaedic spine clinic. Between the pes anserinus and medial head of the gastrocnemius . You can rate this topic again in 12 months. Examination reveals an external foot-progression angle of 25 degrees, a thigh-foot axis of +30 degrees, and a positive apprehension test for lateral patellar subluxation on the right side. bifurcate ligament attaches the anterior process of the calcaneus to the navicular and cuboid bones. radiolucent table and C-arm from contralateral side. Radial head and neck fractures in children are a relatively common traumatic injury that usually affects the radial neck (metaphysis) in children 9-10 years of age. A 10-year-old boy sustains an injury to his dominant elbow and presents with the injury shown in Figures A and B. She was noncompliant with her immediate postoperative weight-bearing instructions and went on to fixation failure. 7. average gain in arm length was 10.2 1.25 cm. 3/9/2020. Which of the following is the most appropriate first step in management? Combined tibiotalar and subtalar arthrodesis, Tibialis posterior transfer to dorsum of foot with gastrocnemius lengthening, Flexor digitorum longus transfer to dorsum of foot with gastrocnemius lengthening, Tibialis anterior transfer to peroneus brevis. An orthotic with lateral hindfoot posting and first metatarsal head recess. Copyright 2022 Lineage Medical, Inc. All rights reserved. (OBQ04.140) 513 plays. Positioning. 27% (903/3364) 2. 33% (1103/3364) 3. Olecranon. (OBQ17.41) (SBQ13PE.99.1) A 13-year-old girl presents with her mother for evaluation of left knee pain. Following successful operative treatment, routine removal of hardware is recommended at 3-4 weeks for which of the following procedures? The nerve most commonly affected by this fracture pattern innervates which of the following motor groups? (OBQ18.219) This system divides tibial plateau fractures into six types: Schatzker I: wedge-shaped pure cleavage fracture of the lateral tibial plateau, originally defined as having less than 4 mm of depression or displacement Schatzker II: splitting and depression of the lateral tibial plateau; namely, type I fracture with a depressed component (generally considered (OBQ08.29) Physical exam is notable for a valgus left knee and a waddling gait. His hand is pulseless and cold. Closed reduction and immobilization of the arm in 110 degrees of flexion (as swelling allows) and full supination enhances the stability of the injury by which of the following: Protects the posterior interosseous nerve. humerus. Radial Head and Neck Fractures - Pediatric. outcomes. Which of the following are features of the most common type of HMSN, Death of both upper and lower motor neurons in the motor cortex of the brain, the brain stem, and the spinal cord leads to muscle twitching and atrophy, Impaired oxidation of branched chain fatty acids leads to neurologic damage, cerebellar degeneration, and peripheral neuropathy, Genetic mutations in axons or myelin protein leads to severe, rapidly progressive neurological damage by adolescence and complete loss of ambulation, Genetic mutations in axons or myelin protein leads to leg muscle atrophy, loss of sensation and proprioception in early adulthood, Movement disorder characterized by degeneration of midbrain neurons. (OBQ13.239) Copyright 2022 Lineage Medical, Inc. All rights reserved. causing plantarflexion of the first ray and compensatory hindfoot varus. results in a combination of motor and sensory disturbances. Radiographs are shown in Figure A. associated with posterior process of talus, dorsomedial talar head, and navicular fracture reduction blocked by peroneal tendons, EDB, talonavicular joint capsule. Treatment is nonoperative with bracing for patients who are weightbearing without pseudoarthrosis or fracture. Proper management of this patient should include evaluation for which of the following findings? primary restraint to varus stress at 30 deg. bicondylar inserts on anterolateral aspect of fibular head. Which of the following radiographs represents the condition associated with the genetic mutation G380R in the transmembrane domain of fibroblast growth factor receptor 3 (FGFR3)? His father has had similar problems with both feet throughout his life. In addition to reduction and pinning of the fracture, initial treatment should include. avulsion fracture of fibular head can be treated with screws or suture anchors. (SBQ13PE.81) A 5-year-old patient presents to the orthopedic clinic with shoulder asymmetry and limited abduction. A 7-year-old girl falls in the park and sustains the injury depicted in Figure A and B. Between the pes anserinus and medial head of the gastrocnemius . fibular rotates within incisura during gait. Treatment is usually physical therapy and pain management. Her fingers are warm and pink with a capillary refill <3 seconds, and she is noted to have ecchymosis in her antecubital fossa. Physical exam reveals bilateral cavus feet with clawing of the toes and intrinsic muscle wasting of the hands. Her past medical history is significant for a supracondylar fracture treated in a cast when as a younger child. Pediatric Pelvis Trauma Radiographic Evaluation, Pediatric Hip Trauma Radiographic Evaluation, Pediatric Knee Trauma Radiographic Evaluation, Pediatric Ankle Trauma Radiographic Evaluation, Distal Humerus Physeal Separation - Pediatric, Proximal Tibia Metaphyseal FX - Pediatric, Chronic Recurrent Multifocal Osteomyelitis (CRMO), Obstetric Brachial Plexopathy (Erb's, Klumpke's Palsy), Anterolateral Bowing & Congenital Pseudoarthrosis of Tibia, Clubfoot (congenital talipes equinovarus), Flexible Pes Planovalgus (Flexible Flatfoot), Congenital Hallux Varus (Atavistic Great Toe), Cerebral Palsy - Upper Extremity Disorders, Myelodysplasia (myelomeningocele, spinal bifida), Dysplasia Epiphysealis Hemimelica (Trevor's Disease). 16-18. Head & Neck Sports Injuries Concussions (Mild Traumatic Brain Injury) differentiate from stress fracture, which shows "dreaded black line" 3-phase bone scan. anterior tibial a. peroneal a. primary restraint to varus stress at 30 deg. Closed reduction and casting of the supracondylar humerus fracture and distal radius fracture, Closed reduction and pinning of both the supracondylar humerus fracture and distal radius fracture, Closed reduction and casting of the supracondylar humerus fracture and pinning of distal radius fracture, Open reduction and pinning of both the supracondylar humerus and the distal radius fracture, Closed reduction and pinning of the supracondylar humerus fracture and closed reduction and casting of distal radius fracture. Charcot-Marie-Tooth Disease, also known as peroneal muscular atrophy, is a common autosomal dominant hereditary motor sensory neuropathy, caused by abnormal peripheral myelin protein, that presents with muscles weakness and sensory changes which can lead to cavovarus feet, scoliosis, and claw foot deformities. Patients present with a form of dwarfism characterized by irregular, delayed ossification at multiple epiphyses. 8% (281/3364) 4. valgus load . adjacent fibula supports attachments for the lateral collateral ligament complex and long head of biceps femoris. Surgery is indicated in patients with foramen magnum stenosis with sleep apnea or cord compression and progressive spinal stenosis that fails nonoperative treatment, most diagnosed in early infancy and in utero, intracellular domain Treatment may be nonoperative or operative depending on the location of fracture, presence of pelvic ring instability, and degree of fracture displacement. 12-14. An 8-year-old sustains the injury shown in Figure A after falling downstairs. Treatment is closed reduction and casting or open reduction and fixation depending on the degree of displacement and whether it can be reduced. abnormal myelin sheath protein is the basis of this degenerative neuropathy. 513 plays. A 7-year-old sustains the isolated injury shown in Figures A and B. 19% (147/766) 5. A 12-year-old boy falls 8 feet from a tree limb and lands on his outstretched hand. technique. Anatomy. Internal (medial) epicondyle. A bipartite patella is a congenital condition caused by failure of the patella to fuse. Patients present with a. 1% (48/3258) 4. 25-43% rate of complication following limb lengthening. concavity is a response to pressure from the femoral head. direct approach to lateral and medial malleoli; Lateral Reduction and Fixation. Fibular fracture. 11. Incomplete ulnar fracture with lateral radial head dislocation that is successfully reduced. This system divides tibial plateau fractures into six types: Schatzker I: wedge-shaped pure cleavage fracture of the lateral tibial plateau, originally defined as having less than 4 mm of depression or displacement Schatzker II: splitting and depression of the lateral tibial plateau; namely, type I fracture with a depressed component (generally considered Pediatric Pelvis Trauma Radiographic Evaluation, Pediatric Hip Trauma Radiographic Evaluation, Pediatric Knee Trauma Radiographic Evaluation, Pediatric Ankle Trauma Radiographic Evaluation, Distal Humerus Physeal Separation - Pediatric, Proximal Tibia Metaphyseal FX - Pediatric, Chronic Recurrent Multifocal Osteomyelitis (CRMO), Obstetric Brachial Plexopathy (Erb's, Klumpke's Palsy), Anterolateral Bowing & Congenital Pseudoarthrosis of Tibia, Clubfoot (congenital talipes equinovarus), Flexible Pes Planovalgus (Flexible Flatfoot), Congenital Hallux Varus (Atavistic Great Toe), Cerebral Palsy - Upper Extremity Disorders, Myelodysplasia (myelomeningocele, spinal bifida), Dysplasia Epiphysealis Hemimelica (Trevor's Disease). Physeal considerations. Treatment is closed reduction and casting or surgical fixation depending on the degree of displacement. complications. 91% (2970/3258) 3. 278 plays. A young child falls during gymnastics practice and sustains the isolated injury shown in Figure A. Blood Supply. What is the most likely diagnosis? associated with posterior process of talus, dorsomedial talar head, and navicular fracture reduction blocked by peroneal tendons, EDB, talonavicular joint capsule. Pediatric supracondylar fractures are one of the most common traumatic fractures see in children and most commonly occur in children 5-7 years of age, usually from a fall on an outstretched hand. Rib Stress Fracture Team Physician Team physician interval between medial head of gastrocnemius and semimembranosus. After the fracture is reduced and the pins are placed, the patient's hand appears pale and cool with absent radial pulses. Treatment is closed reduction and casting or open reduction and fixation depending on the degree of displacement and whether it can be reduced. 3. (OBQ07.132) Fibular fracture. Rib Stress Fracture Team Physician Team physician interval between medial head of gastrocnemius and semimembranosus. Treatment is usually closed reduction with either a supination or a hyperpronation technique. Orthobullets Team Pediatrics - Accessory Navicular ; Listen Now 14:0 min. He denies back or extremity pain. Diagnosis can be made with plain radiographs. oblique lateral performed by placing the arm on the radiographic table with the elbow flexed 90 degrees and the thumb pointing upward, The beam is directed 45 degrees proximally, nondisplaced fractures may be difficult to visualize, anterior fat pad may be normal, but a posterior fat pad sign should be treated as an occult fracture, a portion of the radial neck is extra-articular and therefore an effusion and fat pads signs, 7 days of immobilization followed by early range of motion, closed reduction followed by immobilization in long arm cast or splint if an adequate reduction is achieved, improved outcomes with younger patients, lesser degrees of angulation, and isolated radial neck fractures, fracture that cannot be adequately reduced to <45 degrees angulation with closed or percutaneous methods. (OBQ12.54) Coleman block testing reveals correctable hindfoot deformity. (OBQ18.76) Examination reveals an external foot-progression angle of 25 degrees, a thigh-foot axis of +30 degrees, and a positive apprehension test for lateral patellar subluxation on the right side. (OBQ05.254) (OBQ06.226) She most likely has a defect of what protein? (OBQ11.228) Vascularized fibular graft from the contralateral leg. Surgical correction is indicated in the presence of pseudoarthrosis or fracture . Which of the following elbow apophyses is the last to fuse during growth? (OBQ20.15) Figure A is the radiograph of a 55-year-old female who is a poorly-controlled diabetic with neuropathy and peripheral vascular disease (PVD) that underwent ankle open reduction internal fixation (ORIF) two years ago at an outside facility. (OBQ04.171) sharp dissection of cyst margins to joint capsule. radiolucent table and C-arm from contralateral side. average gain in arm length was 10.2 1.25 cm. Positioning. Distal fibular fracture. indications. intact myelin sheath with wallerian axonal degeneration that results in mild sensory and motor conduction velocities. 15-17. Superficial peroneal nerve palsy. What receptor is defective and what region of the physis is affected? What is the most appropriate treatment? 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, 12th International Congress on Early Onset Scoliosis - 2018, Achondroplasia in 2018 - Paul Sponseller, MD (ICEOS 2018, #57), Question SessionAchondroplasia & Infectious Diseases in Athletes. complications. What is the next best step in treatment? avulsion fracture of fibular head can be treated with screws or suture anchors. sensory loss over anterior and lateral leg; sensory loss over dorsum of the foot including first webspace Radiographs are seen in Figures A and B. 16-18. It is typically asymptomatic, found incidentally, and does not require treatment. What is the next appropriate step? This is an AAOS Self Assessment Exam (SAE) question. static stabilizer of the medial longitudinal arch and head of the talus. Fibular Deficiency (anteromedial bowing) CT scan may be required to further characterize the fracture pattern and for surgical planning. performed if deformity does not correct with Coleman block test. Diagnosis is made radiographically with presence of irregular, delayed ossification at multiple epiphyses. A tibial eminence fracture, also known as a tibia spine fracture, is an intra-articular fracture of the bony attachment of the ACL on the tibia that is most commonly seen in children from age 8 to 14 years during athletic activity. avulsion fracture of fibular head can be treated with screws or suture anchors. (OBQ09.81) exclude stress fracture. Radial Head and Neck FX - Pediatric Fibular Deficiency (anteromedial bowing) Galeazzi Fracture - Pediatric fibular thrust. Pediatric Pelvis Trauma Radiographic Evaluation, Pediatric Hip Trauma Radiographic Evaluation, Pediatric Knee Trauma Radiographic Evaluation, Pediatric Ankle Trauma Radiographic Evaluation, Distal Humerus Physeal Separation - Pediatric, Proximal Tibia Metaphyseal FX - Pediatric, Chronic Recurrent Multifocal Osteomyelitis (CRMO), Obstetric Brachial Plexopathy (Erb's, Klumpke's Palsy), Anterolateral Bowing & Congenital Pseudoarthrosis of Tibia, Clubfoot (congenital talipes equinovarus), Flexible Pes Planovalgus (Flexible Flatfoot), Congenital Hallux Varus (Atavistic Great Toe), Cerebral Palsy - Upper Extremity Disorders, Myelodysplasia (myelomeningocele, spinal bifida), Dysplasia Epiphysealis Hemimelica (Trevor's Disease). presents as a foot drop ; patient will compensate with exaggerated hip and knee flexion (steppage gait) impaired ankle eversion; sensory deficit . (OBQ13.217) 11. Between the pes anserinus and medial head of the gastrocnemius . What is the etiology of cubitus varus following a supracondylar humerus fracture in a child? She has no pain with motion and has 0 to 120 degrees range of motion. (OBQ05.87) Patients present with rhizomelic dwarfism, lumbar and foramen magnum stenosis, frontal bossing, and normal intelligence. Diagnosis can be made with plain radiographs of the elbow. (OBQ11.198) 4/20/2020. 27% (903/3364) 2. The most common nerve injured in the fracture shown in Figure A innervates all of the following muscles EXCEPT? tibial osteotomy +/- femoral osteotomy . She complains of left elbow pain. K-wire percutaneous reduction in the operating room. This injury is most appropriately treated with which of the following? (OBQ11.67) A CT scan may be required to further characterize the fracture pattern and for surgical planning. Team Orthobullets 4 Pediatrics - Transient Synovitis of Hip ; Listen Now 8:33 min. Talus fracture. 25-43% rate of complication following limb lengthening. 1% (48/3258) 4. Lateral forefoot and heel posts would be the appropriate orthotic for the foot deformities associated with which of the following conditions? What is the optimal initial treatment for this injury based on the AAOS guidelines? 3/12/2020. initially flexible, but progresses to a rigid deformity, weakens next, but typically stronger than the peroneals, can lead to drop foot in swing initially and later to a fixed equinus, stays strong for a prolonged period of time. 11. Incomplete ulnar fracture with lateral radial head dislocation that is successfully reduced. A tibial eminence fracture, also known as a tibia spine fracture, is an intra-articular fracture of the bony attachment of the ACL on the tibia that is most commonly seen in children from age 8 to 14 years during athletic activity. 5% a rigid hindfoot will not correct into neutral, scoliosis may be evident on Adam's forward bend test, can also see low amplitude nerve potentials due to axonal loss, evaluation and treatment follows same principals for cavovarus foot, plantar flexed 1st ray is initial deformity, peroneus longus (more normal) overpowering, weak intrinsics and contracted plantar fascia, rarely sufficient except in mild deformity, full-length semi-rigid insole orthotic with a depression for the first ray and a lateral wedge, mild cavus foot deformity in adult (not indicated in children), more severe cavovarus deformity recalcitrant to shoewear accomodations, may be needed if equinus also present, resulting in equinocavovarus foot deformity, works best if equinus is a dynamic defomrity (not rigid), lace-up ankle brace and/or high-top shoe or boots, may consider in moderate deformities when patient does not tolerate the more rigid bracing with an SMO or AFO, flexible deformity in adolescents with closed physes, failed conservative management of fixed deformities, performed with a combination of the following procedures, decreases plantarflexion force on first ray without weakening eversion, muscle imbalance: posterior tibialis typically is markedly stronger than evertors and maintains strength for a long time in most cavovarus feet, may consider transfer of posterior tibialis to dorsum of foot if severe dorsiflexion weakness of anterior tibialis, lengthening of gastrocnemius or tendoachilles (TAL), gastrocnemius recession produces less calf weakness and can be combined with plantar release simultaneously (TAL should be staged several weeks after plantar release), performed if the indication is met and time permits, flexible hindfoot cavus deformities (normal Coleman block test and/or passive hindfoot eversion past neutral). Orthotics, bracing, and NSAIDs no longer provide relief. tibial osteotomy +/- femoral osteotomy . A 5-year-old boy has bilateral cavus feet and genetic testing reveals duplication of the PMP (peripheral myelin protein) gene on chromosome 17. Pediatric supracondylar fractures are one of the most common traumatic fractures see in children and most commonly occur in children 5-7 years of age, usually from a fall on an outstretched hand. Nursemaid's elbow is a common injury of early childhood that results in subluxation of the annular ligament due to a sudden longitudinal traction applied to the hand. axial load. (SAE07PE.39) Distal fibular fracture. Fibular Deficiency (anteromedial bowing) Lateral Condyle Fractures are the second most common fracture in the pediatric elbow and are characterized by a higher risk of nonunion, malunion, and AVN than other pediatric elbow fractures. 26% (874/3364) 5. Femoral Anteversion is a common congenital condition caused by intrauterine positioning which lead to increased anteversion of the femoral neck relative to the femur with compensatory internal rotation of the femur. Fibular Deficiency (anteromedial bowing) occurs following head injury and high-energy trauma. sensory loss over anterior and lateral leg; sensory loss over dorsum of the foot including first webspace Only rarely when it is symptomatic and nonoperative treatment fails does it require surgical excision. Closed reduction and casting in supination and flexion, Open reduction internal fixation of medial epicondyle fracture, Open reduction internal fixation of lateral condyle fracture, Open reduction of radial head dislocation with casting in supination and flexion, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Monteggia Fracture Dislocation - Amr Abdelgaward, MD, PediatricsMonteggia Fracture - Pediatric, Chronic Monteggia fracture malunion in a 12yo boy, chronic radial head dislocation(old moneggia) right elbow. (OBQ06.83) She was noncompliant with her immediate postoperative weight-bearing instructions and went on to fixation failure. (OBQ12.248) Fibular Deficiency (anteromedial bowing) occurs following head injury and high-energy trauma. open reduction has been associated with a greater loss of motion, hold the elbow in extension and apply distal traction with the forearm supinated and pull the forearm into varus while applying direct pressure over the radial head, pronate the supinated forearm while the elbow is flexed to 90 and direct pressure stabilizes the radial head, elbow held in extension and supination with distal traction and varus force with assistant pushing laterally on radial shaft and surgeon pushing medially on radial head, tight application of an elastic bandage (esmarch) beginning at the wrist continuing over the forearm and elbow may lead to spontaneous reduction, blunt end of a large k-wire is pushed against the posterolateral aspect of the proximal fragment and pushed into place, k-wire is placed into the fracture site and levered proximally, if unstable after reduction a pin may be placed to maintain reduction, involves retrograde insertion of a pin/nail across the fracture site, fracture is reduced by rotating the pin/nail, lateral approach (Kocher interval) to radiocapitellar joint, pronate to avoid the posterior interosseous nerve (PIN), internal fixation only used for fractures that are grossly unstable, loss of pronation more common than supination, radial head in children is entirely cartilage and blood supply is primarily from the metaphysis, up to 70% of cases occur with open reduction, Worse outcomes seen in patients >10 years of age, - Radial Head and Neck Fractures - Pediatric, Pediatric Pelvis Trauma Radiographic Evaluation, Pediatric Hip Trauma Radiographic Evaluation, Pediatric Knee Trauma Radiographic Evaluation, Pediatric Ankle Trauma Radiographic Evaluation, Distal Humerus Physeal Separation - Pediatric, Proximal Tibia Metaphyseal FX - Pediatric, Chronic Recurrent Multifocal Osteomyelitis (CRMO), Obstetric Brachial Plexopathy (Erb's, Klumpke's Palsy), Anterolateral Bowing & Congenital Pseudoarthrosis of Tibia, Clubfoot (congenital talipes equinovarus), Flexible Pes Planovalgus (Flexible Flatfoot), Congenital Hallux Varus (Atavistic Great Toe), Cerebral Palsy - Upper Extremity Disorders, Myelodysplasia (myelomeningocele, spinal bifida), Dysplasia Epiphysealis Hemimelica (Trevor's Disease). Pain with running, point tenderness over fracture site, "dreaded black line" on lateral x-ray. Peroneus brevis overpowering the posterior tibial tendon, Tibialis anterior overpowering the peroneus longus. ubiquitin to be degraded to terminate signal shortly after activation, inhibit proliferation and terminal indications. The patient's parents explain this deformity has been present since birth, and now the child is unable to reach overhead and participate in play. The cavus deformity in Charcot-Marie-Tooth disease is caused by what muscular imbalance? technique. Team Orthobullets 4 Pediatrics - Triplane Fractures ; Listen Now 8:50 min. 10/21/2019. Radial Head and Neck FX - Pediatric distal fibular fracture (usually SH I or II) ipsilateral tibial shaft fracture. 9. Physical examination is notable for laxity in his ankle and radiographs are unremarkable for fracture. accounts for 5-15% of pediatric ankle fractures, occurs in children during physeal closure (average age is 13 years old), juvenile ankle physis ossifies in specific order, which leads to, sagittal plane - epiphysis is often fractured on the lateral aspect in the, coronal plane - metaphysis is fractured on the posterior aspect in the, coronal plane and is seen on the lateral radiograph, typically spiral fracture located proximal to the physis in children nearing skeletal maturity, remains unstable after fixation of tibia, so fixation of fibula is usually necessary, accounts for 35-40% of overall tibial growth and 15-20% of overall lower extremity growth, growth continues until 14 years in girls and 16 years in boys, closure occurs during an 18 month transitional period, occurs in a predictable pattern: central > anteromedial > posteromedial > lateral, Part 1 - anterolateral and posterior epiphysis is connected to the posterior metaphyseal fragment, Part 2 - anteromedial epiphysis is connected to the remainder of the distal tibia, Part 2 - posterior epiphysis is connected to the posterior metaphyseal fragment, Part 3 - anteromedial epiphysis is connected to the remainder of the distal tibia, Can only be distinguished from 3-part fractures via CT, Physeal fracture occurs in the axial plane, Similar to tillaux fractures on AP radiographs (distinguish from tillaux fractures by SH II or I fracture on lateral radiograph), Type I - intraarticular intramalleolar fracture involving the weight-bearing surface, Type II - intraarticular intramalleolar fracture outside of the weight-bearing surface, Type III - extraarticular intramalleolar fracture, best view to assess the amount of displacement, anterolateral quadrant of distal tibial epiphysis, medial and posterior portions of epiphysis with posterior metaphyseal spike, usually required to delineate fracture pattern and assess articular congruity, if closed reduction planned, consider CT after reduction to assess quality of reduction, fracture involvement seen in all 3 planes, ideal for 2-part fractures (difficult to achieve reduction of 3-part or 4-part fractures), reduce fibula fracture prior to attempting reduction of tibial fracture, for lateral triplane fractures, reduce with, for medial triplane fractures, reduce with, obtain post-reduction CT to assess reduction, follow early with radiographs to assess for displacement, anterolateral approach for lateral triplane fractures, anteromedial approach for medial triplane fractures, arthroscopically-assisted reduction has been described, metaphyseal fixation if component is large enough, long leg cast for 3-4 weeks then short leg walking cast for 2 weeks, increased risk with pronation-abduction injuries compared to supination-external rotation injuries, increased risk with residual fracture displacement following reduction, usually insignificant but should closely follow patients with > 2 years of growth remaining, increased risk with articular step-off > 2mm, Pediatric Pelvis Trauma Radiographic Evaluation, Pediatric Hip Trauma Radiographic Evaluation, Pediatric Knee Trauma Radiographic Evaluation, Pediatric Ankle Trauma Radiographic Evaluation, Distal Humerus Physeal Separation - Pediatric, Proximal Tibia Metaphyseal FX - Pediatric, Chronic Recurrent Multifocal Osteomyelitis (CRMO), Obstetric Brachial Plexopathy (Erb's, Klumpke's Palsy), Anterolateral Bowing & Congenital Pseudoarthrosis of Tibia, Clubfoot (congenital talipes equinovarus), Flexible Pes Planovalgus (Flexible Flatfoot), Congenital Hallux Varus (Atavistic Great Toe), Cerebral Palsy - Upper Extremity Disorders, Myelodysplasia (myelomeningocele, spinal bifida), Dysplasia Epiphysealis Hemimelica (Trevor's Disease). 26% (874/3364) 5. (OBQ18.44) static stabilizer of the medial longitudinal arch and head of the talus. bicondylar inserts on anterolateral aspect of fibular head. Her mother reports that her younger sister has a similar stature. Diagnosis can be made with plain radiographs of the ankle. (OBQ12.112) 12-14. Orthobullets Team Pediatrics - Tillaux Fractures ; Listen Now 13:56 min. A 25-year-old male has a foot-drop deformity of his right foot due to a chromosomal 17 duplication which continues to progress despite stretching, strengthening, and orthotic use. Epidemiology. Blood Supply. 4/20/2020. closed reduction and NWB cast for 6 weeks. Technique Guides (1) (OBQ11.4) A 12-year old boy fell sustaining a both bone forearm fracture. Figures A and B demonstrate the injury radiographs. concavity is a response to pressure from the femoral head. She does not have functional limitations but her parents would like to improve the appearance of her elbow. Closed reduction with casting in > 90 degrees of flexion, Closed reduction with casting at 90 degrees of flexion, Closed reduction and a percutaneous pinning construct using laterally based pins, Closed reduction and a percutaneous pinning construct using crossed pins. 1% (48/3258) 4. 5. A 14-year-old male child presents with the increasing foot deformity shown in Figure A. A 7-year-old girl falls off of her bike and sustains the injury depicted in Figures A & B. Physeal considerations. Triplane Fractures are traumatic ankle fractures seen in children 10-17 years of age characterized by a complex salter harris. It is typically asymptomatic, found incidentally, and does not require treatment. (OBQ18.20) What is the next step in management? Copyright 2022 Lineage Medical, Inc. All rights reserved. 19% (147/766) 5. Cuboid fracture. Treatment is usually closed reduction and percutanous pinning (CRPP), with the urgency depending on whether the hand remains perfused or not. occur most commonly in children aged 5-7years, anterior interosseous nerve (AIN) neurapraxia (branch of median n.), the most common nerve palsy seen with supracondylar humerus fractures, second most common neurapraxia (close second), nearly all cases of neurapraxia following supracondylar humerus fractures resolve spontaneously, further diagnostic studies are not indicated in the acute setting, rich collateral circulation can maintain circulation despite vascular injury, e.g., internal (medial epicondyle) apophysis, ossifies/appears at age 6 years (table below), fuses at age ~ 17 years (is the last to fuse), +/- one year, varies between boys and girl, Beware of subtle medial comminution leading to cubitus varus which technically means it is not a Type I Fracture, Treated with cast immobilization x 3-4wks, with radiographs at 1 week, Posterior cortex and posterior periosteal hinge intact, Treated most commonly with CRPP or open reduction if needed, Complete periosteal disruption with instability in flexion and extension, Diagnosed with examination under anesthesia during surgery, Collapse of medial column, loss of Baumann angle, Leads to varus malunion/classic gunstock deformity, associated with a sagittal plane deformity, Treated with CRPP, often requires significant valgus force to reduce, Mechanism of injury is usually a fall on the olecranon, neurovascular exam must be done before any reduction maneuver to be certain nerve or vascular injury is not iatrogenic (stuck in fracture site), unable to flex the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger (can't make A-OK sign), loss of sensation over volar index finger, inability to extend wrist, MCP joints, thumb IP joint, PIP and DIP can still be extended via intrinsic function (ulnar n.), AP and lateral x-ray of the elbow (really of the distal humerus), lucency on a lateral view along the posterior distal humerus and olecranon fossa is highly suggestive of occult fracture around the elbow, displacement of the anterior humeral line. A mutation of PMP22 located at chromosome 17p12 most likely leads to an initial presentation highlighted by a: (OBQ10.56) With regards to the most common pattern of triplane ankle fractures, which of the following is true? He has no radial pulse and his hand is cold. Treatment involves observation and physical therapy for majority of anomalies. 4/20/2020. A 3-year-old girl with short stature and rhizomelic shortening of the limbs presents to your office for follow-up of thoracolumbar kyphosis and trident hands. valgus load . What is the most common form of inheritance for the gene defect associated with his underlying condition? PLC hybrid reconstruction and repair. He is able to cross his fingers, flex and extend the IP joint of his thumb, and has intact sensation. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. (OBQ08.154) Radial Head and Neck FX - Pediatric (SAE07PE.96) A 12-month-old boy has right congenital fibular intercalary hemimelia with a normal contralateral limb. Treatment. exclude stress fracture. 5. Fibular Deficiency (anteromedial bowing) pain with gentle shaking of a flail arm may indicate pseudoparalysis from infection or fracture rather than nerve palsy. Head & Neck Sports Injuries Concussions (Mild Traumatic Brain Injury) differentiate from stress fracture, which shows "dreaded black line" 3-phase bone scan. (OBQ05.47) fracture of fibular neck; motor deficit . PLC hybrid reconstruction and repair. patient supine with feet at end of bed and bump under hip for neutral limb rotation. Epidemiology. Injury films are shown in Figure A. Tibial/fibular stress fracture. Olecranon. A 10-year-old female falls from the swing and lands on her left arm. Team Orthobullets 4 Pediatrics - Transient Synovitis of Hip ; Listen Now 8:33 min. Radiographs following this attempt are shown in Figures A and B. 5. (OBQ10.161) A radiograph of the lower extremities shows a limb-length discrepancy of 2 cm. On examination, he has supple ankle and subtalar motion, an equinus contracture, and 5/5 plantar flexion and inversion strength. Tibial/fibular stress fracture. Galeazzi Fracture - Pediatric fibular thrust. Stage II posterior tibial tendon insufficiency, Stage III posterior tibial tendon insufficiency, (OBQ04.98) External (lateral) epicondyle. humerus. Thank you. 8% (281/3364) 4. Lateral closing wedge calcaneal osteotomy with peroneus longus to brevis transfer, First metatarsal dorsal closing wedge osteotomy. Primary open reduction and internal fixation, Closed reduction with medial and lateral crossed pins, Closed reduction with two or three lateral pins. A 17-year-old male complains of a foot deformity that has progressed over the past 1 year. exclude stress fracture. 10/16/2019. 29% (222/766) 3. Aaron and Randy are twin 8-year-old brothers who fall off a trampoline and sustain supracondylar humerus fractures that undergo closed reduction and percutaneous pinning. External (lateral) epicondyle. (OBQ18.66) A 13-month-old child is found to have the abnormal spine imaging shown in Figure A. Anterolateral soft-tissue impingement. She is admitted to hospital for surgery. Radial head. Figure 17 shows the AP radiograph of a 5-year old child who has mild short stature and a painless bilateral gluteus medius lurch. 91% (2970/3258) 3. (OBQ04.211) He complains of elbow pain and a displaced radial neck fracture is noted on radiographs. indications. Surgical correction is indicated in the presence of pseudoarthrosis or fracture . bifurcate ligament attaches the anterior process of the calcaneus to the navicular and cuboid bones. A 5-year-old boy sustains a type II (Gartland classification) supracondylar fracture which is treated with cast immobilization. Radial Head and Neck FX - Pediatric (SAE07PE.96) A 12-month-old boy has right congenital fibular intercalary hemimelia with a normal contralateral limb. technique. Pediatric Pelvis Trauma Radiographic Evaluation, Pediatric Hip Trauma Radiographic Evaluation, Pediatric Knee Trauma Radiographic Evaluation, Pediatric Ankle Trauma Radiographic Evaluation, Distal Humerus Physeal Separation - Pediatric, Proximal Tibia Metaphyseal FX - Pediatric, Chronic Recurrent Multifocal Osteomyelitis (CRMO), Obstetric Brachial Plexopathy (Erb's, Klumpke's Palsy), Anterolateral Bowing & Congenital Pseudoarthrosis of Tibia, Clubfoot (congenital talipes equinovarus), Flexible Pes Planovalgus (Flexible Flatfoot), Congenital Hallux Varus (Atavistic Great Toe), Cerebral Palsy - Upper Extremity Disorders, Myelodysplasia (myelomeningocele, spinal bifida), Dysplasia Epiphysealis Hemimelica (Trevor's Disease). Residual angulation is 62. adjacent fibula supports attachments for the lateral collateral ligament complex and long head of biceps femoris. Trochlea. technique. What is the next best step in management? Surgical management is indicated for radial heads that are not stable following closed reduction. On physical examination, he is found to have a nerve deficit. A 7-year-old presents to your office for general orthopedic evaluation at the request of his primary care physician. (OBQ10.224) Radiographs are shown in Figures 6a and 6b. A CT scan may be required to further characterize the fracture pattern and for surgical planning. Approach . valgus load . Approach . 2/11/2020. The Salter-Harris II component is seen on the AP radiograph, The Salter-Harris III component is seen on the AP radiograph, The Salter-Harris IV component is seen on the AP radiograph, The Salter-Harris III component is seen on the lateral radiograph, The Salter-Harris IV component is seen on the lateral radiograph. The radial pulse is palpable at the wrist, and sensation is normal throughout the hand. Copyright 2022 Lineage Medical, Inc. All rights reserved. Treatment depends on the degree of angulation and is surgical if angulation remains greater than 30 degrees after closed reduction is attempted. A 7-year-old patient presents with right elbow swelling and deformity after falling off of a trampoline. humerus. Only rarely when it is symptomatic and nonoperative treatment fails does it require surgical excision. What physeal zone is affected by the mutation leading to this patient's condition? (OBQ10.42) A bipartite patella is a congenital condition caused by failure of the patella to fuse. She is neurovascularly intact and the skin shows no evidence of open wounds. Radial Head and Neck FX - Pediatric Fibular Deficiency (anteromedial bowing) Greater ultimate clinical arc of elbow motion, Greater experimental biomechanical stability. A 8-year-old boy has a cubitus varus deformity of his left elbow after a supracondylar humerus fracture was treated in a splint. Galeazzi Fracture - Pediatric fibular thrust. Navicular fracture. Anatomy. immediate electromyography and nerve conduction velocity studies. Femoral Anteversion is a common congenital condition caused by intrauterine positioning which lead to increased anteversion of the femoral neck relative to the femur with compensatory internal rotation of the femur. Nursemaid's elbow is a common injury of early childhood that results in subluxation of the annular ligament due to a sudden longitudinal traction applied to the hand. Treatment depends on the degree of angulation and is surgical if angulation remains greater than 30 degrees after closed reduction is attempted. Which of the following conditions is associated with a mutation in fibroblast growth factor receptor-3 (FGFR3)? fracture of fibular neck; motor deficit . What is the most likely diagnosis? Treatment is closed reduction and casting or open reduction and fixation depending on the degree of displacement and whether it can be reduced. (SBQ13PE.62) Loose-fitting splint application and reassess in 1 hour, Emergent closed reduction and pin fixation. A 10-year-old boy sustained the injury shown in figure A while jumping off a trampoline. An orthotic with lateral hindfoot posting and first metatarsal head recess. 10/21/2019. 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