Abos Day 34 B 1-3

Front 1

All of the following are findings associated with Ehlers-Danlos syndrome EXCEPT: (balloon chateristics)
1 Superior lens dislocation of the eye 2. Joint hypermobility 3. Skin hyperelasticity4. Pathologic defect of collagen;5. Poor wound healing

Back 1

Superior lens dislocation of the eye is associated with Marfan's syndrome, not Ehlers-Danlos. (Inferior lens dislocation is associated with homocystinuria)
sx: 1 generalized ligamentous laxity, 2 joint hypermobility, 3 poor wound healing, 4 pes planus, 5 vascular defects, 6 high palates, 7 gastroparesis, 8 mitral valve prolapse. The most common subtypes result from a mutation affecting collagen type V

Front 2

Physical exam for Ehlers-Danlos Syndrome; a score of 5 or more on 9-point Beighton scale defines joint hypermobility?

Back 2

-1 passive hyperextension of each small finger >90° 2-passive abduction of each thumb to the surface of forearm 3 hyperextension of each knee >10; 4 hyperextension of each elbow >10° ;5 forward flexion of trunk with palms on floor and knees fully extended

Front 3

Ehlers-Danlos Syndrome evaluation with _____ is mandatory in the workup, why?
Ehlers-Danlos Syndrome Diagnosed by?

Back 3

Echocardiogram- cardiac evaluation with echo is mandatory in the workup; up to 1/3 of patients have aortic root dilatation
Diagnosed by collagen typing of skin biopsy

Front 4

A 36-year-old male presents for left hand weakness. clnical photograph of his hand is shown. His medical history is significant for the elbow injury Current radiographic evaluation of the patients elbow will most likely reveal what deformity?

Back 4

Cubitus valgus (Lateral Condyle Fracture)
tardy ulnar nerve palsy -claw-hand deformity; Froment sign Wartneberg sign Interosseous and/or first web space atrophy is another common finding.

Front 5

Nonunion following a pediatric lateral condyle fracture has been associated with which of the following?

Back 5

Ulnar nerve palsy
The ulnar nerve palsy develops as the nerve becomes stretched from cubitus valgus deformity, pain, loss of motion

Front 6

The ulnar nerve palsy (traffic light)

Back 6

1 Ulnar claw consists of:hyper-extension of the MCP joints-index and ring fingers; 2 Froment sign (compensatory thump IPJ flexion 3 Wartneberg sign (persistent abduction and extension of the small digit during active adduction

Front 7

An 8-yo boy falls on his right elbow and presents to the ER with the x-rays He has exquisite tenderness to palpation along the lateral aspect of his elbow. What additional x-ray view will likely demonstrate the maximum degree of fracture displacement?

Back 7

Internal oblique radiograph
: Pediatric patients suspected of having a lateral condyle fracture should receive 3 view xrays of the involved elbow: AP, lat and int oblique.
Max displacement of the lateral condyle fracture internal oblique radiograph.
Classically, >2mm of displacement on any of the three views should be considered unstable and surgical fixation of the fracture warranted.

Front 8

Nonunion following a pediatric lateral condyle fracture has been associated with which of the following?
1 Ulnar nerve palsy 2. Radial nerve palsy 3. Heterotopic ossification 4. Parsonage Turner syndrome
5. Cubitus varus

Back 8

Ulnar nerve palsy
Displaced pediatric lateral condyle fractures should be treated with surgical reduction and fixation to avoid nonunion. Nonunion has been associated with cubitus valgus, pain, loss of motion, and tardy ulnar nerve palsy.

Front 9

A 7-year-old girl undergoes open reduction internal fixation of a displaced humeral lateral condyle fracture. Dissection around which portion of the fracture fragment should be avoided to protect its blood supply?

Back 9

posterior
The predominant blood supply to the lateral condyle of the distal humerus comes posteriorly. Nonunions occur because of these fractures are intra-articular and bathed in synovial fluid. When nonunions occur, the characteristic deformity is a cubitus valgus and subsequent ulnar nerve symptoms.

Front 10

A 7 yo girl undergoes open reduction internal fixation of a displaced humeral lateral condyle fracture. Dissection around which portion of the fracture fragment should be avoided to protect its blood supply?MT1/MT2-SH?

Back 10

blood supply to lateral condyle of the distal humerus comes posteriorly. Nonunions occur because of these fractures are intra-articular and bathed in synovial fluid, the characteristic deformity is a cubitus valgus & ulnar nerve sx.MT1-SH4; MT2-SH2

Front 11

Figure A shows the radiograph of a 6-year-old girl after a fall on the playground. What is the most appropriate course of action

Back 11

Open reduction internal fixation with k-wires
The radiograph demonstrates a laterally displaced and rotated intra-articular lateral condylar fracture, a Type III fracture. Type I fractures are non-displaced, stable fractures that may be treated with a long arm cast, but must be followed closely for possible displacement. Type II fractures are minimally displaced and may undergo attempted closed reduction with percutaneous pinning if the fracture is able to be anatomically reduced and found to be stable with stress arthrography. If anatomic reduction is not obtained, open reduction with internal fixation must be performed. Type III fractures are displaced, unstable fractures that require open reduction and fixation.

Front 12

Figure A shows the radiograph of a 6-year-old girl after a fall on the playground. What is the most appropriate course of action?

Back 12

Open reduction internal fixation with k-wires
laterally displaced and rotated intra-articular lateral condylar fracture, a Type III fracture.;Type I fx are non-displaced, stable fractures that may be treated with LAC , but must be followed closely for possible displacement; Type II fractures are minimally displaced and may undergo attempted closed reduction with percutaneous pinning if the fracture is able to be anatomically reduced and found to be stable with stress arthrography. If anatomic reduction is not obtained, open reduction with internal fixation must be performed; Type III fractures are displaced, unstable fractures that require open reduction and fixation

Front 13

A 32-mo male with severe infantile Blounts disease has been treated with full time bracing for the past year. At follow-up, the varus deformity of his bilateral legs has worsened despite compliance with bracing. What treatment is now recommended?

Back 13

: Infantile Blount’s disease is a pathologic type of tibia vara which develops in children 0-4 years of age. Bracing is indicated in patients < 3 years of age with Langenskiöld stage I-II disease, and is more effective in patients with unilateral disease. Surgery is indicated if varus secondary to Blount's disease persists at the age of 4 or if bracing fails in 2-3 year olds after 12 months (answer 3).

Front 14

In the treatement of Blount's disease, how do plates or staples help correct the genu varum deformity?

Back 14

Increasing compression forces across the physis in the form of plates or staples will slow longitudinal growth.

Blount’s disease, also called tibia vara, is the most common cause of genu varum that is not physiologic. The pathoanatomy is thought to involve excessive medial pressure (eg, heavy, early walkers who are in physiologic varus alignment) that produces an osteochondrosis of the physis and adjacent epiphysis that can progress to a complete physeal bar. The Hueter-Volkmann law states that increasing compression across a growth plate leads to decreasing growth and increasing tension stimulates growth.

Front 15

A 30-month-old boy has worsening bilateral bowleg deformities, and radiographs are shown in Figure A. The most appropriate initial management should consist of which of the following?

Back 15

Initial management of infantile Blount's disease in children less than 3 years old consists of full time bracing with a knee-ankle-foot orthosis.
Initial treatment is non-operative in children less than 3 years of age. Operative management in children older than 3 is considered if non-operative management has failed, or in Langenskiold classes V and VI, where there is a congenital bar across the physis. When osteotomy is required, overcorrection to at least 5 degrees of valgus should be done.

Front 16

Genu varum is a normal physiologic process in children at what ages? when abnormal?

Back 16

<2 yo- physiologic genu varum
(bowed legs) is normal in children, <10 ° has a 95% chance of natural resolution of the bowing
14 months-genu varum-migrates to a neutral
3 yo-continues on to a peak genu valgum (knocked knees) children < 3 years brace Tx KAFO
4 yo-genu valgum then migrates back to normal physiologic valgus proximal tibia/fibula valgus osteotomy children > 3 years
>16 ° is considered abnormal and has a 95% chance of progression