A 9-year-old male is brought in for initial evaluation of persistent painless limping favoring the left leg. His symptoms began 6 months ago, and have been progressively worsening. He has nearly full abduction. Radiographs and an MRI are shown in Figures A, B, and C. What is the next most appropriate step in treatment?
Left hip aspiration and culture under fluoroscopic guidance
Continued activity limitation and bracing
Femoral or pelvic osteotomy
Core decompression of the femoral head
Work-up for underlying metabolic bone disease
crescent sign if positive indicate stage what
A 15-year-old Little League pitcher sustains an injury to his dominant elbow shown in Figure A. Radiographs demonstrate 7 mm of displacement. Which of the following treatments will result in the highest rate of bony union?
Long arm cast for 1 week, followed by passive and gentle active ROM
Placement in a hinged elbow brace with immediate active motion
Closed reduction followed by K-wire fixation
Open reduction and internal fixation
Fragment excision and flexor/pronator mass re-attachment
ORIF to get rigid fixation and early full ROM
Also, a retrospective review of 8 cases is level IV evidence. Here's a link to the newest JBJS level of evidence, for further review: http://jbjs.org/content/97/1/1
Dr. Anonymous - our policy at orthobullets is to include the referenced articles chosen by the OITE for each question. This ensures that we provide a link and summary of the articles that were felt to be testable at the time of the question. For this question, the original that this was based upon was a 2011 OITE question which included the reference by Case et al. The discussion section here allows for users and orthobullets staff to post additional feedback on the question or new references that may make the original question obsolete. When we discover new data that disagrees with the concept of our questions, we will remove our question or update it accordingly.
Lancet. 2016 Apr 16;387(10028):1657-71. Epub 2015 Nov 3.
Anonymous,Type I osteogenesis imperfecta is secondary to a quantitative defect while types II, III, and IV are secondary to qualitative defects. The text above will be edited.Forlino and Marini recently summarized the metabolic defects in osteogenesis imperfecta as well as treatment options.Osteogenesis imperfecta.Forlino A, Marini JCLancet. 2016 Apr 16. pii: S0140-6736(15)00728-X. doi: 10.1016/S0140-6736(15)00728-X. 387. (10028). :1657-71PMID: 26542481 (Link to Abstract)
A 12-year-old girl presents with a history of numerous long bone fractures in the past. Examination reveals normal-appearing sclera, and the dentin abnormality shown in Figure A. A radiograph of her lower extremities is shown in Figure B. The patient’s disorder is the result of which of the following?
Vitamin D deficiency
Abnormal osteoclast function
Qualitative defect of type I collagen synthesis
Mutated fibroblast growth factor receptor
Defective N-Ac-Gal-6 sulfate sulfatase enzyme
Hip Septic Arthritis - Pediatric
joints with intra-articular metaphysis include: hip shoulder elbow ankle (not the knee)Is this correct? For the ankle joint, the capusle attachment on the distal tibia side is very close to the joint surface (<8mm). For the knee joint, the capsule attachement on the femur is high on the anterior side (suprapatellar pouch), well cover the distal femur metaphyseal area; on the tibia side, the capsule attaches to the anterior half within 10mm from the joint surface, but 14mm to the posterior half. Due to this anatomy, when we place pins or wires for external fixator or skeletal traction, to avoid intracapsular penetration, it should be inserted >14mm below the tiba platea, but only 8mm above the the tibia plafond (on lateral views). Thus how come the ankle joint has intra-articular metaphysis, but not the knee joint (especially consider the supra-patellar pouch area)?
'Case et al reviewed 8 cases' - is that the best reference on medial epicondyle fractures?! 8 cases is hardly level one evidence
J Am Acad Orthop Surg. 2006 Oct;14(11):610-9.
HiType IV being a qualitative disorder hasnt been corrected in all sections of the review topic.'milder autosomal dominant forms (Types I and IV) associated with quantitative disorders of type I collagen'please updateThanks
A 16-year-old female complains of foot pain with ambulation. She previously underwent clubfoot soft tissue releases at 5 months of age. Each of the following are complications or late deformities associated with clubfoot surgery EXCEPT:
Osteonecrosis of the talus
Rigid pes planus
Tarsal tunnel syndrome
Why does over correction into a planovalgus deformity create a fixed deformity? Thank you
Spinal Muscular Atrophy
Regarding the placement of spinal muscular atrophy topic on the website: SMA is included in the neuromuscular section as the condition is distinct from the muscular dystrophies. Mesfin et al note that the pathology begins with selective destruction of the α motor neurons in the anterior horn of the spinal cord, which leads to manifestations of SMA.Spinal muscular atrophy: manifestations and management.Mesfin A, Sponseller PD, Leet AIJ Am Acad Orthop Surg. 2012 Jun. pii: 20/6/393. doi: 10.5435/JAAOS-20-06-393. 20. (6). :393-401PMID: 22661569 (Link to Abstract)
A 6-week-old boy presents with bilateral lower extremity deformities shown in Figure A. All of the following are true regarding the Ponseti technique for correction of this congenital deformity EXCEPT:
Weekly manipulation and application of long leg casts
Achilles tenotomy is indicated for residual equinus before final cast application
Pronation of the foot during initial cast correction
Abduction of the foot with counterpressure at the talus
Correction of adduction deformity prior to equinus
Maybe this is semantics, but shouldn't answer 4 read "abduction of the foot with lateral pressure on the talus" as opposed to "counterpressure". It seems counter pressure would be applied lateral border of the foot at the cuboid.
J Pediatr Orthop. 2013 Jun;33(4):353-60.
Oper Orthop Traumatol. 2009 Mar;21(1):97-111.
Developmental Coxa Vara
Dr. Elkhosousy,There are multiple osteotomy and fixation options for coxa vara. Carroll et al evaluated 37 coxa vara hips after Pauwel's, intertrochanteric, and subtrochanteric osteotomies. The recurrence rate was 50%, and no no one type of osteotomy or type of fixation impacted rate of recurrence.Gunter et al more recently reported results using end to side osteotomy. There were no cases of recurrence at mean follow-up of 6.2 (0.8 to 12.8) years. The technique is described in detail in the manuscript. Additional diagrams are found in Heimkes et al. The paper is in German but the figures are easy to understand.Coxa vara: surgical outcomes of valgus osteotomies.Carroll K, Coleman S, Stevens PMJ Pediatr Orthop. 1997 Mar-Apr. 17. (2). :220-4PMID: 9075100 (Link to Abstract)Midterm results after subtrochanteric end-to-side valgization osteotomy in severe infantile coxa vara.Günther CM, Komm M, Jansson V, Heimkes BJ Pediatr Orthop. 2013 Jun. doi: 10.1097/BPO.0b013e3182812194. pii: 01241398-201306000-00002. 33. (4). :353-60PMID: 23653021 (Link to Abstract)[Subtrochanteric end-to-side valgus osteotomy for severe infantile coxa vara].Heimkes B, Komm M, Melcher COper Orthop Traumatol. 2009 Mar. doi: 10.1007/s00064-009-1609-7. 21. (1). :97-111PMID: 19326071 (Link to Abstract)
Gower's sign is a physical exam finding found in children with Duchenne Muscular Dystrophy. It is a method by which children rise to their feet, first by walking hands up legs to compensate for gluteus maximus and quadricep weakness.Sussman M. Duchenne muscular dystrophy. J Am Acad Orthop Surg. 2002Mar-Apr;10(2):138-51. Review. Level of Evidence: 5 - Other. [PMID]11929208[/PMID]
typical of dystophy