Flashbang!

Question 1

Flashbang!

Hindfoot valgus that doesn’t correct with toe standing.

Answer 1

Think tarsal coalition.

Question 2

Flashbang!

Pediatric conditions: Odontoid hypoplasia

Answer 2

Morquio’s syndrome and pseudoachondroplasia

Question 3

FlashBang!

pediatric distal femur fracture

Answer 3

Complication = Limb length discrepancy or angular deformity

• results from physeal arrest
• occurs in 30-50% of displaced fractures
• prevent with
• anatomic physeal alignment (critical)

Question 4

Flashbang

Bilateral sesamoiditis

Answer 4

Concern for:

Reiter’s disease

Psoriatic arthritis

Seronegative RA

Question 5

Flashbang!

Looks like perthes but is simultaneous and bilateral.

Answer 5

MED

Question 6

Flashbomb!

Markedly elevated CPK

Answer 6

Duchennes muscular dystrophy

Question 7

Flashbang!

SED

Answer 7

Involve:

1. ophthalmologist
   
   • obtain yearly eye examination
2. pulmonologist
   
   • monitor for declining lung function

Question 8

Flashbomb!

Pediatric Olecrenon Fracture

Answer 8

Association with OI

Question 9

Flashbang!

Intravascular Injection of Bupivicaine

Answer 9

Can cause arrythmia and asystole

Give intravascular lipid emulsion immediatly.

Question 10

FlashGong!

Pediatric patient: Distal tibial physeal fracture

Answer 10

Risk of unrecognized rotational deformity which can lead to increased external foot progression angle.

Question 11

Flashbang!

Recon with PAGETS

Answer 11

Increased bleeding - need cell-saver

Increased risk for intra-op fracture

Question 12

Flashbang!

JIA Workup

Answer 12

Examine C-Spine (AAS)

Opthamology consult (Uveitis)

Abdominal exam (splenomegaly)

Question 13

Flashbang!

Pediatric patient with irriducible (closed) injury.

Answer 13

Usually interposed soft tissue

PERIOSTEUM

Question 14

Flashbang

recurrent MT stress fractures

Answer 14

cavovarus foot

female athlete triad

Question 15

Flashbang!

Patient has spondylodiskitis.

Answer 15

MRI the ENTIRE spine.

high incidence of skip lesions.

Question 16

FlashNuke

Charcot Shoulder

Answer 16

Syrinx

Question 17

Flashbang!

Surgically treated tibial eminence fracture.

Answer 17

Risk of arthrofibrosis is high.

Early ROM is critical.

Question 18

Flashbang!

Nerve Injury post THR

Answer 18

1. Examine patient
2. Flex knee and extend hip
3. Release compressive bandages
4. Assess for hematoma - release in OR if present
5. EMG at 3 months
6. Involve nerve surgeon
7. Foot Drop Splint
8. Only 30% recover completely

Question 19

Flashbang!

Larsens Syndrome

Answer 19

Cervical spine imaging to rule out cervical kyphosis

Question 20

Flashbang!

OI patient with apnea, altered consciousness, ataxia, or myelopathy.

Answer 20

Basilar Invagination.

usually 3 or 4 decade of life.

Question 21

Flashbang!

BBFA fracture treated with CR and cast.

(Involving long term prognosis.)

Answer 21

5-10% chance of re-fracture

Question 22

FlashGrenade!

Hemihypertrophy

Answer 22

Association with malignant intra-abdominal tumours and genitourinary pathology

• malignant intra-abdominal tumors
  
  • Wilm’s tumor (most common)
    
    • perform serial abdominal ultrasounds (every 3 months) until age 7 to rule out Wilm’s tumor
    • then physical exam every 6 months until skeletal maturity
  • adrenal carcinoma
  • hepatoblastoma
• genitourinary abnormalities
  
  • medullary sponge kidneys
  • polycystic kidney
  • inguinal hernias

Question 23

Flashbang!

Ehlors Danlos w/u

Answer 23

Echocardiogram

(mitral valve and aortic root)

Question 24

Flashbang!

Bilateral sesamoiditis

Answer 24

Concern for:

1. reiter’s disease (urethritis, conjuctivitis / iritis, inflammatory bowel disease)
2. psoriatic arthritis
3. seronegative RA

Question 25

Flashbang! Pediatric proximal tibia fracture.

Answer 25

**_WARN FAMILY_**​ Cozen phenomenon * Risk of valgus deformity * Usually self correcting * Risk of LLD * Does not correct * Affected tibia usually LONGER (overgrowth)

Question 26

Flashbang! Hemophilia

Answer 26

HIV 90% prevalence

Question 27

Flashbang! Pediatric conditions: Spinal Stenosis

Answer 27

Achondroplasia

Question 28

Flashbang! Displaced distal ulnar physeal injury

Answer 28

Associated with DRUJ injury

Question 29

Flashbang! Patient is on Phenytoin.

Answer 29

Can cause osteoporosis and fracture.

Question 30

Flashbang! Myelodysplasia

Answer 30

Latex Allergy Anaphylactic (IgE mediated)

Question 31

FlashGang! Pediatric MRSA Osteomyelitis

Answer 31

High risk of DVT and septic emboli

Question 32

Flashbang ! Crouch walker - CP Gait

Answer 32

Don't do isolated heel cord lengthening because it will worsen the deformity.

Question 33

Flashbang! Pediatric carpal tunnel syndrome

Answer 33

Mucopolysaccharidoses Type 1 S (Sheie)

Question 34

Flashbang! Total knee in setting of patellectomy.

Answer 34

Have to use PS knee.