Its Going Tibia Okay
I Hope You Find This Humerus
Talk to the Hand
Put Your Best Foot Forward
Whatever I Want
100
A 2 yo boy is brought in for limping after he jumped off his playset in the backyard. He is otherwise well and screams in pain when you dorsiflex his left ankle. You order an Xray. What is your diagnosis?
What is a toddler's fracture nondisplaced spiral or oblique fracture of tibial shaft only, common in children <3 yo
100
What is the most appropriate treatment for this fracture?
Sling and swath Up to 80% of humeral growth is from the proximal physeal region, so potential for remodeling of a proximal humeral fracture is great and sling is an adequate treatment.
100
When evaluating fractures of the metacarpals and phalanges, the exam is often more accurate than xrays when assessing _______ deformity, seen here:
What is rotational All fingers should point to the scaphoid bone and all nails should be parallel
100
Foot fractures are ______ common in children than they are in adults.
Less The pediatric foot is much more cartilaginous than the adult foot, making it more elastic and compressible than the adult foot. As a result, foot fractures are less common in children.
100
What is the most common Salter Harris fracture type?
What is SH II
200
A type of incomplete fracture seen in young, soft bones with a cortical and periosteal defect on the convex side of the bone; Seen here in the fibula:
What is a greenstick fracture
200
A patient with a supracondylar fracture has a weak "OK" sign. This branch of the median nerve has most likely been injured.
What is the anterior interosseous nerve. Children and adolescents with AION syndrome initially have proximal forearm pain followed by weakness in the hand with NO sensory deficits. They have either a weak "OK" sign, or more of a pincer grasp.
200
Your patient slammed her finger in the car door. In addition to a nailbed laceration, plain film shows a nondisplaced transverse fracture of the distal phalanx. In addition to nailbed repair, this patient's treatment plan should include ______.
What is antibiotics This injury is considered an open fracture and therefore should be treated with a course of oral antibiotics.
200
This bone of the hindfoot (seen here) is often seen fractured in snowboarders
What is the talus The lateral process of the talus is often fractured in snowboarders secondary to forced dorsiflexion and inversion. High clinical suspicion is essential as these fractures are often misdiagnosed as ankle sprains.
200
Typically caused by a fall onto the shoulder, clavicle fractures typically involve the _____ third of the clavicle.
What is middle third 90% of clavicle fractures occur in the middle third. These fractures are generally treated with immobilization in a sling or figure of 8 bandage until patient is asymptomatic with satisfactory shoulder function (~3-6 weeks in kids)
300
Name a type of ankle fracture that requires further imaging with CT of the ankle (There are 3 possible answers!)
Triplane fracture OR displaced SH III fracture/Tillaux fracture OR SH IV fracture For each of these cases, CT provides key information for operative repair
300
In patients with supracondylar fractures, this artery may be damaged with lateral displacement of the distal fragment
What is the brachial artery
300
Your patient ran through a glass door and cut his wrist. He is now having difficulty flexing his wrist and spreading his fingers. Which nerve is likely damaged?
The ulnar nerve. Its motor function includes wrist flexion, finger spreading and power grasping. It supplies sensory innervation to the entire 5th digit and to the ulnar aspect of the 4th finger.
300
Given the retrograde blood supply to the talus, ________ should be a particular concern with injury to this area.
What is avascular necrosis.
300
This fracture is considered highly specific for non accidental trauma
What is a classic metaphyseal fracture/lesion aka bucket handle fracture aka corner fracture
400
Seen here on xray and CT, this type of "transitional fracture" seen in children nearing skeletal maturity extends through the epiphysis, physis and metaphysis:
What is a Triplane fracture
400
When assessing sensory function in a child with a forearm fracture, you evaluate the dorsal web space between the thumb and index finger to evaluate this nerve.
What is the radial nerve In supracondylar fractures, lateral proximal fracture fragment displacement can impinge on the radial nerve see photo
400
A fracture of the 5th metacarpal neck, these fractures typically occur from hitting something with a clenched fist
What is a Boxer's fracture see image
400
The arrow in this xray denotes the "fleck sign", a bony fragment between the first and second metatarsals, suspicious for a fracture at the base of the second metatarsal. This is often seen in what unique foot fracture?
What is a Lisfranc fracture. The Lisfranc fracture occurs secondary to axial loading with forced plantar flexion (such as with bicycle or horseback riders whose foot gets caught in the pedal or stirrup) or with crush injury during motor vehicle accidents. This mechanism results in injury to the tarsometatarsal joint complex. AP radiograph of the foot shows widening of the space between the first and second metatarsals and cuneiforms (asterisk) - although this is often not recognized if the film is non-weight bearing, so high clinical suspicion must be maintained.
400
Name this fracture:
What is a Monteggia Fracture Proximal ulnar fracture + radial head dislocation Typically require closed reduction
500
Identify this "special" SH III ankle fracture as seen on CT:
What is Tillaux fracture Typically occurs in children between 12 and 14 years of age because they have a partially fused tibial physis. Inversion of the ankle with the foot pointed away from midline results in avulsion of the lateral tibial epiphysis
500
There are 6 ossification centers in the pediatric elbow: medial epicondyle, lateral epicondyle, radial head, capitellum, olecranon, and trochlea. Which is the last to appear?
What is the lateral epicondyle. MNEUMONIC: CRITOE age: 2-4-6-8-10-12 see image
500
Injury to this ligament - in what as commonly known as "skier's thumb" or "gamekeeper's thumb" - results in a painful, weak pincer grasp
What is the ulnar collateral ligament of the proximal phalanx of the thumb Characteristic signs include pain, swelling, and ecchymosis around the thenar eminence, and especially over the MCP joint of the thumb.
500
A Jones fracture occurs at the base of the _____ metatarsal.
What is the fifth see image The Jones fracture occurs at the base of the fifth metatarsal at the metaphyseal-diaphyseal junction. They are very common, comprising 40% of all metatarsal fractures, repre- senting up to 25% of all foot fractures in children.
500
Your 16 year old patient felt a "pop" in his hip when jumping up for a rebound during a basketball game. What type of fracture does the xray of his pelvis show?
An avulsion fracture of the anterior superior iliac spine These fractures can result when the muscular attachments are pulled during strong contractions
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