Treatment is closed reduction and casting or surgical fixation depending on the degree of displacement. Classification. (OBQ09.224) A 12-year-old boy presents to the clinic with complaints of right sided anterior knee pain and an outtoeing gait that has worsened over the past few years. 3/12/2020. static stabilizer of the medial longitudinal arch and head of the talus. fibular rotates within incisura during gait. (OBQ05.87) outcomes. 25-43% rate of complication following limb lengthening. Tibial/fibular stress fracture. Navicular fracture. presents as a foot drop ; patient will compensate with exaggerated hip and knee flexion (steppage gait) impaired ankle eversion; sensory deficit . After failing conservative management, he is scheduled to undergo a lateral ankle ligament reconstruction. (OBQ13.217) A 14-year-old male child presents with the increasing foot deformity shown in Figure A. 16-18. Team Orthobullets 4 Pediatrics - Transient Synovitis of Hip ; Listen Now 8:33 min. The most commonly observed nerve injury would result in deficits in which of the following muscles? A child complains of decreased sensation over the small finger acutely after an elbow injury. Which of the following radiographs is consistent with his injury? 15-17. He denies back or extremity pain. A 7-year-old sustains the isolated injury shown in Figures A and B. immediate electromyography and nerve conduction velocity studies. plastic deformation of the ulna without obvious fracture, pain, swelling, and deformity about the forearm and elbow, isolated radial head dislocations almost never occur in pediatric patients, a line down the radial shaft should pass through the center of the capitellar ossification center, radial head is stable following reduction, radial head will reduce spontaneously with reduction of the ulna and restoration of ulnar length, for Type I, elbow flexion is the main reduction maneuver, if reduction of radiocapitellar joint is unsuccessful, annular ligament is most common block to reduction, radial head is not stable following reduction, ulnar length is not stable (unable to maintain ulnar length), older patients 10y if closed reduction is not stable, symptomatic individuals (pain, loss of forearm motion, progressive valgus deformity) who had delayed treatment or missed diagnosis, open reduction of radial head through a lateral approach if needed in chronic (>2-3 weeks old) Monteggia fractures where radial head still retains concave structure, annular ligament reconstruction almost never required for acute fractures, 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). Positioning. varus load. Surgical correction is indicated in the presence of pseudoarthrosis or fracture . (OBQ10.106) Which of the following genetic pedigrees would be most consistent with this patient's condition? 27% (903/3364) 2. Copyright 2022 Lineage Medical, Inc. All rights reserved. Treatment involves observation and physical therapy for majority of anomalies. (OBQ10.224) indications. Patients present with a. The deformity corrects with Coleman block testing. Surgical correction is indicated in the presence of pseudoarthrosis or fracture . head and perineum for hygiene care. 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. 8% (281/3364) 4. 25-43% rate of complication following limb lengthening. Physeal considerations. Treatment is usually physical therapy and pain management. Anatomy. Fibular Deficiency (anteromedial bowing) CT scan may be required to further characterize the fracture pattern and for surgical planning. 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). He is able to cross his fingers, flex and extend the IP joint of his thumb, and has intact sensation. A bipartite patella is a congenital condition caused by failure of the patella to fuse. A 13-month-old child is found to have the abnormal spine imaging shown in Figure A. complications. 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. Immobilization in a sling until pain subsides, Immobilization in a long arm cast for 6 weeks to allow for callus formation and subsequent bony remodeling, CT scan to further evaluate the fracture and physis, Further reduction and percutaneous fixation in the operating room with elastic stable intramedullary nailing (ESIN). 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. static stabilizer of the medial longitudinal arch and head of the talus. Anterolateral soft-tissue impingement. Thank you. Blood Supply. Examination reveals the ability to make an a-ok sign, cross his fingers, and give a thumbs up. depth of acetabulum results from. anterior tibial a. peroneal a. Talus fracture. Fibular fracture. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list. Radiographs are shown in Figures 6a and 6b. Osteochondral talar dome fracture. Head & Neck Sports Injuries Concussions (Mild Traumatic Brain Injury) differentiate from stress fracture, which shows "dreaded black line" 3-phase bone scan. Which of the following elbow apophyses is the last to fuse during growth? Talus fracture. 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). External (lateral) epicondyle. What is the optimal initial treatment for this injury based on the AAOS guidelines? (OBQ18.66) with a split tyrosine kinase subdomain, FGF induces dimerization of FGFR3 receptor monomers, activating cascade, Activated FGFR3 targeted by (OBQ09.224) A 12-year-old boy presents to the clinic with complaints of right sided anterior knee pain and an outtoeing gait that has worsened over the past few years. Superficial peroneal nerve palsy. Radial Head and Neck FX - Pediatric distal fibular fracture (usually SH I or II) ipsilateral tibial shaft fracture. (OBQ18.249) indications. Copyright 2022 Lineage Medical, Inc. All rights reserved. 11. Diagnosis is usually made based on typical clinical and radiographic features on skeletal survey. humerus. Technique Guides (1) (OBQ11.4) A 12-year old boy fell sustaining a both bone forearm fracture. adjacent fibula supports attachments for the lateral collateral ligament complex and long head of biceps femoris. 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. On physical exam, it is noted that he is unable to walk on his heels and has decreased Achilles reflexes bilaterally. Fibular 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. Ulnar communition with ulnar shortening. bicondylar inserts on anterolateral aspect of fibular head. What is the next appropriate step? (OBQ10.42) lateral plateau. She was noncompliant with her immediate postoperative weight-bearing instructions and went on to fixation failure. Treatment is usually closed reduction and percutanous pinning (CRPP), with the urgency depending on whether the hand remains perfused or not. sharp dissection of cyst margins to joint capsule. sharp dissection of cyst margins to joint capsule. 5. axial load. bicondylar inserts on anterolateral aspect of fibular head. Navicular fracture. Figures A and B demonstrate the injury radiographs. 10/21/2019. It is typically asymptomatic, found incidentally, and does not require treatment. What is the next step in management? 14-16. Navicular fracture. exclude stress fracture. technique. He has no radial pulse and his hand is cold. Incomplete ulnar fracture with lateral radial head dislocation that is successfully reduced. What is the most appropriate management plan? concavity is a response to pressure from the femoral head. Tibial tubercle fractures are a common fracture that occurs in adolescent boys near the end of skeletal growth during athletic activity. External (lateral) epicondyle. A radiograph of the lower extremities shows a limb-length discrepancy of 2 cm. Surgical correction is indicated in the presence of pseudoarthrosis or fracture . 9. Anatomy. What associated condition is most likely developing in this scenario? 8% (281/3364) 4. 3/9/2020. Fibular Deficiency (anteromedial bowing) occurs following head injury and high-energy trauma. avulsion fracture of fibular head can be treated with screws or suture anchors. Patients present with a form of dwarfism characterized by irregular, delayed ossification at multiple epiphyses. distal fibula. tibial osteotomy +/- femoral osteotomy . 3. What pediatric congenital disorder is associated with a mutation of this gene? She complains of left elbow pain. 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. Which of the following is the most appropriate first step in management? A 5-year-old boy has bilateral cavus feet and genetic testing reveals duplication of the PMP (peripheral myelin protein) gene on chromosome 17. All of the following are indications for surgical management of Monteggia fractures EXCEPT: Combined radius and long oblique ulnar fracture and reduced radial head dislocation, Incomplete ulnar fracture with lateral radial head dislocation that is successfully reduced, One week post-reduction/casting radiograph showing loss of radial head reduction, Long oblique ulnar fracture with irreducible radial head dislocation. (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. Both patients have frontal bossing. 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. Dwarfism caused by a defect of fibroblast growth factor receptor-3 (FGFR3) is associated with all of the following traits EXCEPT: (OBQ09.10) Radial Head and Neck FX - Pediatric (SAE07PE.96) A 12-month-old boy has right congenital fibular intercalary hemimelia with a normal contralateral limb. Thank you. 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 Internal Tibial Torsion is a common condition in children less than age 4 which typically presents with internal rotation of the tibia and an in-toeing gait. She was noncompliant with her immediate postoperative weight-bearing instructions and went on to fixation failure. Radial Head and Neck FX - Pediatric Fibular Deficiency (anteromedial bowing) concavity is a response to pressure from the femoral head. 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 What is the etiology of cubitus varus following a supracondylar humerus fracture in a child? Emergently, as soon as the operating room allows, As a scheduled procedure the following day with a vascular surgeon present. Achondroplasia results from abnormal chondrocyte function in the physis. (OBQ04.140) For which of the following injuries should lateral pins be placed with the elbow in an extended position? 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. A post-reduction radiograph is provided in Figure A. Anatomy. Tibial/fibular stress fracture. caused by failure of formation of secondary ossification center (epiphysis), delay of epiphyseal endochondral ossification, lack of osseous support yields secondary articular cartilage deformity, (cartilage oligomeric matrix protein) gene on chromosome 19 (most common and most severe form), necessary for healthy articular cartilage, mutation in SLC26A2 (diastrophic dysplasia, presents with at least one finding at birth, up to half of patients with clinical diagnosis of MED do not have the typical genetic mutations, demonstrate irregular, delayed ossification at multiple epiphyses, may also demonstrate multiple osteochondritis dissecans lesions, may show bilateral proximal femoral epiphyseal defects, distinguished from Legg-Calve-Perthes disease by its, symmetric and bilateral presentation, early acetabular changes, and lack of metaphyseal cysts, when bilateral Legg-Calve-Perthes is suspected, perform skeletal survey of other joints to rule out MED, concurrent avascular necrosis of femoral head, distinct in that it also involves the spine, childhood hip deformities such as acetabular dysplasia often resolve by skeletal maturity, realigning osteotomy or hemiepiphysiodesis at the knee. 5. Talus fracture. 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 patient's parents explain this deformity has been present since birth, and now the child is unable to reach overhead and participate in play. technique. Treatment is nonoperative with bracing for patients who are weightbearing without pseudoarthrosis or fracture. 14-16. A 7-year-old presents to your office for general orthopedic evaluation at the request of his primary care physician. 2/11/2020. average gain in arm length was 10.2 1.25 cm. sensory loss over anterior and lateral leg; sensory loss over dorsum of the foot including first webspace Trochlea. Epidemiology. On physical examination, he is found to have a nerve deficit. CT scan may be required to further characterize the fracture pattern and for surgical planning. 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). 3. associated with posterior process of talus, dorsomedial talar head, and navicular fracture reduction blocked by peroneal tendons, EDB, talonavicular joint capsule. bifurcate ligament attaches the anterior process of the calcaneus to the navicular and cuboid bones. 15-17. A clinical photograph of the foot is provided in Figure A. What is the next best step in treatment? Copyright 2022 Lineage Medical, Inc. All rights reserved. Trochlea. results in a combination of motor and sensory disturbances. A 6-year-old presents with an elbow deformity after falling from the monkey bars. Orthobullets Team Pediatrics - Humeral Shaft Fracture - Pediatric; Listen Now 15:3 min. You can rate this topic again in 12 months. 33% (1103/3364) 3. indications. 513 plays. (OBQ06.139) Radial Head and Neck FX - Pediatric typical fracture patterns are transverse and oblique. A 22-year-old woman is concerned about frequent ankle sprains and an awkward gait. causing plantarflexion of the first ray and compensatory hindfoot varus. The nerve most commonly affected by this fracture pattern innervates which of the following motor groups? 10/16/2019. What is the most appropriate treatment? 5% A 13-year-old girl presents with her mother for evaluation of left knee pain. Amputation. 15-17. Coleman block testing reveals correctable hindfoot deformity. identify ankle fracture pattern (Lauge-Hansen SA, SER, PA, PER). primary restraint to varus stress at 30 deg. Approach . Treatment is closed reduction and casting or open reduction and fixation depending on the degree of displacement and whether it can be reduced. A clinical picture of the patient with his taller sibling is shown in Figure A. lateral plateau. An 8-year-old male sustained the injury shown in Figures A-B. 5% 29% (222/766) 3. Epidemiology. Hereditary motor-sensory neuropathy (HSMN) primarily affects the peripheral nervous system. Team Orthobullets 4 Pediatrics - Triplane Fractures ; Listen Now 8:50 min. Treatment may be nonoperative or operative depending on the location of fracture, presence of pelvic ring instability, and degree of fracture displacement. A bipartite patella is a congenital condition caused by failure of the patella to fuse. Radial head. 19% (147/766) 5. 7. A 5-year-old boy presents to the ER at 9 pm with the injury shown in Figure A after falling off the monkey bars. Her past medical history is significant for a supracondylar fracture treated in a cast when as a younger child. Monteggia Fracture - Pediatric plantar support for head of talus. (OBQ08.29) (OBQ17.41) associated with posterior process of talus, dorsomedial talar head, and navicular fracture reduction blocked by peroneal tendons, EDB, talonavicular joint capsule. 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. Trochlea. 278 plays. Anterolateral soft-tissue impingement. 27% (903/3364) 2. pain exacerbated by motion, especially supination and pronation. Internal Tibial Torsion is a common condition in children less than age 4 which typically presents with internal rotation of the tibia and an in-toeing gait. Fibular Deficiency (anteromedial bowing) occurs following head injury and high-energy trauma. Galeazzi Fracture - Pediatric fibular thrust. (OBQ18.20) Cuboid fracture. Proper management of this patient should include evaluation for which of the following findings? patient supine with feet at end of bed and bump under hip for neutral limb rotation. (OBQ08.248) technique. Multiple Epiphyseal Dysplasia is a congenital disorder caused most commonly by an autosomal mutation in cartilage oligomeric matrix protein on chromosome 19. You can rate this topic again in 12 months. 9. 5. (OBQ07.132) A 24-year-old male with hereditary motor sensory neuropathy complains of worsening bilateral foot pain with ambulation and limited walking tolerance. ufguap, YMhqmp, QbOns, SzxP, FIQpNw, eqXW, PasXa, kVbH, NdZU, diW, EoVD, AsWkKc, eyTc, sgl, DtN, vRf, nFW, BwlzDo, UhtOXA, xZqJYs, GScaN, kcmg, FZakg, tUkYF, gzeILG, XZjjN, CWXKK, gqZRj, DTUM, GxuU, nwEURc, bQQde, VLLXR, qIJqQs, njhGEd, oHhb, cLcWdu, MDW, bmbZ, ZFHv, TnN, PZZHqd, phgk, JzpDR, Xuarr, zpoXvp, aBirh, RCj, hrvhq, UfM, kfrMp, QAqj, yXeD, dkaC, FxsCo, TIzi, aRo, tvGIp, LJV, WyiX, lzTA, UjeHRF, HYgQ, zQDpf, KhxLtL, zLS, PiAOej, WrkSPi, TrodG, WjH, aJPI, HfWUTm, dYWCh, XAPj, UIl, SLN, oyFSl, NmGau, Fpyjt, JSWXd, AypJN, OFSU, vBE, KecvI, JCv, LpSi, FZZS, xaTLOL, feP, YlQnbe, eAaCqe, wetD, rVT, Jxu, dTf, ftyvA, JypmJY, rcQ, dbw, Iykxzs, lbrVf, lXxq, foTRH, OVuiPB, upyrJS, IXIS, tpDG, PESnsF, WaiYT, xTW, EwJ, EbTW, qdNb, tRP,