Trauma llama
The Little Foot Club
Slippery hips
Bugs everywhere
Genes, Screens, and NAT
100
95% of supracondylar humerus fractures are of this type.
What are extension type?
Example of flexion type:
100
These are the four deformities that make up a clubfoot.
What are cavus, adductus, varus, and equinus?
100
(A) What is the most common reason for this complication in SCFE and (B) what is an iatrogenic cause of this complication?
What is (A) unstable slip and (B) closed reduction of a SCFE?
100
A child presenting with a septic hip holds the affected hip in this position.
What is FABER (flexion, abduction, external rotation)?
Because this position of comfort maximized hip capsular volume
100
The alpha angle on hip ultrasound measures the angle between (1) these two structures, and is (2) considered normal in this range.
What are (1) lines of the acetabulum and the ilium, and (2) greater than 60 degrees?
200
This is the (1) name of this physical exam sign and indicates urgent management because of (2) these possible issues.
What is the (1) brachialis sign, and what are (2) possible arterial injury, significant swelling and skin compromise, difficult closed reduction because of proximal fragment buttonholed through brachialis muscle?
200
This is the most common cause of late failure after correction with the Ponseti method.
What is poor compliance with bracing?
200
Patients with SCFE present with this exam finding on supine hip exam.
What is a obligatory external rotation?
200
An aspiration of the hip that reveals the Gram stain in the picture is due to this organism.
What is staph aureus?
200
What is the appropriate work up for a 1 year old child with a femur fracture?
What is a nonaccidental trauma workup?
300
This is the nerve most likely injured in the fracture type shown.
What is the ulnar nerve?
300
In the Ponseti method, premature correction of this deformity can result in a rocker-bottom foot.
What is equinus?
300
This is the difference between a stable and an unstable SCFE.
What is the ability to bear weight?
(Unable = unstable)
300
(1) These are the 4 components of the original Kocher criteria.
(2) This is the probability of septic arthritis for having 1/4 Kocher criteria, 2/4 criteria, and 3/4 criteria.
What are (1) WBC >12K, inability to bear weight, Fever, ESR >40mm/h,
and (2) 1/4 criteria = 3%, 2/4 criteria = 40%, 3/4 criteria = 93%, 4/4 criteria = 99.6%.
300
This is the (1) most common and (2) second most common presentation of child abuse.
What are (1) skin lesions, and (2) fractures?
400
Risk to the ulnar nerve is highest when medial pins are placed with the elbow in this position.
What is hyperflexion?
400
During tibialis anterior transfer, the tendon should be transferred to this bone.
What is lateral cuneiform (B)?
400
This is the artery that provides the most blood to the hip in a patient older than age 4 years.
What is the medial femoral circumflex artery (3)?
400
The best medicine for septic arthritis.
What is the knife? (I&D = surgery!)
"Never let the sun set on pus"
400
This gene is associated with Charcot-Marie Tooth Disease.
What is PMP-22 (peripheral myelin protein 22)?
500
In a patient with a SCH fx, this is the (1) name of the line that should be assessed on every lateral elbow XR and should cross (2) this bone.
What is the (1) anterior humeral line, and (2) capitellum?
500
This common positioning error during Ponseti casting accentuates cavus rather than correcting it.
What is pronation?
500
SCFE affects this zone of the physis.
What is the hypertrophic zone?
500
These joints have intraarticular metaphyses and therefore are at higher risk for septic arthritis secondary to metaphyseal osteomyelitis.
What are the shoulder, hip, elbow and ankle?
500
What is this fracture athognomonic for?
What is non-accidental trauma?
600
This is the (1) latest-appearing ossification center of the elbow and can be seen on XR at (2) this age.
What is (1) lateral epicondyle at (2) 12 years of age?
Mnemonic to remember: CRITOE
600
Clubfoot is commonly associated with hypoplasia or absence of this structure.
What is the anterior tibial artery?
600
Placement of a screw in this quadrant of the femoral head has a high risk of violating the hip joint and subsequent chondrolysis.
What is anterior/superior quadrant?
600
This diagnosis of exclusion is characterized by episodic fever, multiple sites of osteomyelitis, negative cultures, no response to antibiotics, but can be treated symptomatically with NSAIDs and may resolve in 3-5 years.
What is CRMO (chronic recurrent multifocal osteomyelitis)?
600
This gene is associated with hypoplastic clavicles and other cleidocranial deformities.
What is Runx2 gene mutation?
700
Volkmann ischemic contracture following a type II SCH fx is likely due to this.
What is compression of the brachial artery with casting in flexion >90 deg (hyperflexion)?
700
This key difference separates Kite from Ponseti casting
What is counterpressure at the calcaneocuboid joint versus pressure over the lateral head of the talus?
700
The X-ray depicts this angle for measuring SCFE severity.
What is the Southwick slip angle?
700
Arthrocentesis fluid should be grown in this culture medium in order to isolate Kingella kingae.
What is a blood culture bottle?
700
This is the structure labeled #4.
What is the labrum?
800
This is the most common malunion deformity after supracondylar humerus fracture.
Cubitus varus deformity (gunstock deformity)
800
In recurrent clubfoot deformity, the tibialis anterior causes this abnormality during gait. (*Bonus points for demonstrating this appropriately)
Dynamic supination
800
(1) This is the number of screw threads that should cross the physis with percutaneous in situ fixation of SCFE in order to prevent slip progression, and
(2) This is the technique to confirm that the screw did not violate the hip joint.
(1) What is 5 threads?
(2) What is the Approach-withdraw technique (max IR and max ER under live fluoro)?
800
In septic arthritis, inflammatory and synovial cells activate (1) this cell signaling pathway, and release (2) these mediators, which can destroy cartilage and damage the articular surface within 8 hours.
What is the (1) NFKB pathway, and (2) matrix metaloproteinases (MMPs) or proteolytic enzymes?
800
Some strains of MRSA have genes encoding for this cytotoxin that has been implicated in MRSA-associated DVTs.
What is PVL (Panton-Valentine leukocidin) cytotoxin?