Proximal femoral focal defect (C2311)
2 / M - 2 yo child with PFFD right leg and no femoral head and dysplastic acetabulum.
How would you classify this problem?
I would arthrodese the knee, perform a rotationplastynand account for final LLD.rotationplasty gives superior functional outcomes as opposed to other ampurations
A 12-year old boy fell sustaining a both bone forearm fracture. Which of the following is true regarding the radiographic assessment of anatomic forearm alignment after reduction?
The ulnar styloid and coronoid process are best seen on the AP radiograph
On the lateral radiograph the radial styloid and biceps tuberosity are oriented 90 degrees apart
On the AP radiograph, the ulnar styloid and the coronoid process are oriented 180 degrees apart
On the AP radiograph, the radial styloid and biceps tuberosity are oriented 180 degrees apart
On the AP radiograph the radial styloid and biceps tuberosity are oriented 90 degrees apart
rockwood says the angle to be around 135.. ??
Anterolateral tibial bowing is associated with which of the following lower extremity conditions in children?
Calcaneovalgus foot deformity
Congenital pseudoarthrosis of the tibia
Congenital talipes equinovarus
Congenital vertical talus
The answer for the question is "Congenital" pseudoarthrosis of the tibia....I thought its more "Developmental" as its not present at birth and occurs secondary to healing fractures.
type vii is autosomal recessive
A tibialis anterior transfer is appropriate for which of the following patients with clubfoot?
Newborn with forefoot adduction
3-year-old with a foot that supinates when he dorsiflexes
6-month-old residual equinus after casting
5-year-old boy with a fixed hindfoot varus
2-year-old with a foot that pronates when he plantarflexes
In the CAVE formula above we can add:E= Equinous at ANKLE (Tibio-Talar joint)
In postoperative complications , It states that they have higher risk of infections 10%, Is there any reasoning for this or this has just been noticed in literature? any comments please?
Radial Head and Neck Fractures - Pediatric
Radiograph technique image for Greenspan view shows forearm in supination, not neutral rotation as described. Which is correct?
A 10-year-old boy sustains an injury to his dominant elbow and presents with the injury shown in Figures A and B. What is the next best step in management?
Immobilization in full pronation
Closed reduction and percutaneous pinning
Open reduction and internal fixation
Dear Anonymous, I agree with you that the Metaizeau technique is worth trying. However the question is phrased as the next best step in management, and that would be to try closed reduction first.
J Am Acad Orthop Surg. 2015 Mar;23(3):202-5. Epub 2015 Feb 5.
Developmental Dysplasia of the Hip
The first step in managment is to perform an age appropriate history and physical. The hip examination can subsequently be classified as stable, Barlow positive, Ortolani positive, or dislocated and irreducible. The AAOS clinical practice guideline states that limited evidence supports either immediate or delayed (up to 9 weeks of age) brace treatment for hips with a positive instablity examation. However, superior results of Pavlik harness treatment when starting before 21 days of age has been reported.The AAOS clinical practice guideline states that limited evidence supports use of the von Rosen splint over the Pavlik and other splints for initial treatment of the unstable hip. My observation is that more providers have used the Pavlik harness. Whichever brace is used, it must be applied properly. For a nice video of Pavlik harness application, see hipdysplasia.org.One week after brace treatment, an ultrasound should be obtained to confirm reduction so that brace can be adjusted as needed. The brace should be stopped within 3 weeks if the hip is not reduced to prevent erosion of the acetabulum from the femoral head. Anb abduction orthosis can be initiated if the Pavlik has failed.Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants up to Six Months of Age.Mulpuri K, Song KM, Goldberg MJ, Sevarino KJ Am Acad Orthop Surg. 2015 Mar. pii: JAAOS-D-15-00006. doi: 10.5435/JAAOS-D-15-00006. 23. (3). :202-5PMID: 25656273 (Link to Abstract)Pitfalls in the use of the Pavlik harness for treatment of congenital dysplasia, subluxation, and dislocation of the hip.Mubarak S, Garfin S, Vance R, McKinnon B, Sutherland DJ Bone Joint Surg Am. 1981 Oct. 63. (8). :1239-48PMID: 7287794 (Link to Abstract)Use of an abduction brace for developmental dysplasia of the hip after failure of Pavlik harness use.Hedequist D, Kasser J, Emans JJ Pediatr Orthop. 2003 Mar-Apr. 23. (2). :175-7PMID: 12604946 (Link to Abstract)
PMSTR in Resistant Club Foot
PMSTR in Resistant Club Foot:
A 14-year-old boy presents with left groin and knee pain for 3 weeks. He is now unable to place weight on the left lower extremity, even with the assistance of crutches. AP pelvis radiograph is shown in Figure A. He is treated with surgical intervention and post-operative radiographs are shown in Figures B and C. What is the most common limb length and rotational profile found as a sequelae of this condition?
Limb shortening, decreased hip flexion and decreased hip internal rotation
Limb lengthening, increased hip flexion, and increased hip internal rotation
Limb lengthening, decreased hip flexion, and decreased hip external rotation
Limb shortening, decreased hip flexion, and increased hip internal rotation
Limb shortening, increased hip flexion, and decreased hip internal rotation
So, fully threaded AO cancellous screws can be used as positional screws to avoid unnecessary compression at the physis and to avoid limb shortening?
One possible logic behind the decreases flexion and decreased internal rotation of the hip could be the pathology of SCFE ( epiphysis remains in place and the neck slips anteriorly and externally, naturally the hip should now face resistance of the bone or soft tissue to go more anterior and internally Compression screws to fix the physis could be one reason of decreased growth of femur ( limb shortening) considering Hueter-Volkmann Lawhttp://www.ismni.org/jmni/pdf/download.php?file=7/Stokes.pdf
6 weeks found-out head is out what would be the management?
J Pediatr Orthop. 2012 Jul-Aug;32(5):445-51.
While the capitellar starting point may be superior compared to the lateral starting point, crossed K wires still appear to be the strongest construct overall.Results of crossed versus lateral entry K-wire fixation of displaced pediatric supracondylar humeral fractures: A systematic review and meta-analysis.Dekker AE, Krijnen P, Schipper IBInjury. 2016 Nov. pii: S0020-1383(16)30422-3. doi: 10.1016/j.injury.2016.08.022. 47. (11). :2391-2398PMID: 27596688 (Link to Abstract)
Adolescent Blount's Disease
Dr. Mohamed, The normal tibiofemoral angle depend on whether the mechanical (joint center to joint center) or anatomic (two mid diaphyseal points) axes are used. The normal mechanical tibiofemoral angle is 1.3 varus +/- 2 while the normal anatomic tibiofemoral angle is 6 +/- 2 degrees valgus. A great description of the malalignment test and preoperatively planning is provided in the paper below from Drs. Paley and Tetsworth.Mechanical axis deviation of the lower limbs. Preoperative planning of uniapical angular deformities of the tibia or femur.Paley D, Tetsworth KClin Orthop Relat Res. 1992 Jul. (280). :48-64PMID: 1611764 (Link to Abstract)
what is the degree of tibiofemoral angle ?, thanks
J Pediatr Orthop. 2015 Apr-May;35(3):224-8.
A 22-year-old woman is concerned about frequent ankle sprains and an awkward gait. Lower extremity nerve conduction velocities show prolonged distal latencies in the peroneal nerves. DNA testing shows a duplication on chromosome 17. Which of the following images is most likely the radiograph of this patient?
Is toe clawing part of CMT or can it happen without it?
A 14 year-old girl has chronic foot pain which has failed to respond to previous surgical coalition resection and soft tissue interposition. A radiograph of her foot is shown in Figure A. A CT scan demonstrates a talocalcaneal coalition with almost complete involvement of the subtalar joint. What is the treatment of choice?
revision coalition resection and extensor digitorum brevis interposition
revision coalition resection and fat interposition
This is really a terrible question and does not reflect current pediatric orthopaedic expertise. Multiple studies out of San Diego, Toronto and Boston have shown quality outcomes data that does not support the somewhat arbitrary (and now historical) "50%" rule (or the 16 degree valgus "rule")Patient-reported Outcomes of Tarsal Coalitions Treated With Surgical Excision.Mahan ST, Spencer SA, Vezeridis PS, Kasser JR.J Pediatr Orthop. 2012 Apr-May;32(3):301-7. doi: 10.1097/BPO.0b013e318247c76e.Treatment of talocalcaneal coalitions.Gantsoudes GD, Roocroft JH, Mubarak SJ.Foot Ankle Int. 2013 Oct;34(10):1370-5. doi: 10.1177/1071100713489122. Epub 2013 May 12.Long-term functional outcomes of resected tarsal coalitions.Khoshbin A, Law PW, Caspi L, Wright JG.