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46 Cards in this Set

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  • Back
What is the treatment for a physeal fracture <10 days old?
Closed reduction
What is the treatment if irreducible?
Leave alone
How much deformity is acceptable in patients over 12 years of age?
<40 degrees
What is the radiographic appearance of nursemaid’s elbow?
Normal
What nerve is at risk with an extension type supracondylar fracture?
AIN (anterior interosseus nerve)
What nerve is at risk with an extension type and posteromedial displacement?
Radial nerve
What two nerves are at risk with an extension type and posterolateral displacement?
Median nerve
Brachial artery
What nerve is at risk with flexiotype?
Ulnar nerve
What two complications are associated with casting the elbow in hyperflexion?
Compartment syndrome
Volkmann’s contracture
ln what compartment are the highest pressures present (same as in adult)?
Deep volar compartment
Compare resistance to varus and valgus stress: lateral pins only versus medial and lateral pins?
Equivalent
What construct provides better resistance to axial load?
Medial and lateral pins better
How can the strength of lateral-only fixation be improved?
Cast also
What are the three long-term complications of varus malunion?
Poor cosmesis
Ulnar neuropathy
Posterolateral rotatory instability
What is the usual age of injury?
6 years
How much displacement is acceptable?
2 mm
What is the treatment if less than 2 mm displacement?
Cast
What is critical about nonoperative lateral condylar fracture treatment?
Must follow very closely
Like a supracondylar fracture, what is fracture stability dependent on?
Integrity of cartilaginous hinge
What is the treatment for lateral condylar fracture with 2 to 5 mm of displacement?
Closed reduction and percutaneous pinning
How long after surgery should the pins be removed?
4 weeks
At what time point is radiographic evidence of healing first seen?
6 weeks
What is the treatment for lateral condylar fracture with over 5-mm displacement?
ORIF
What is a key caveat?
Avoid posterior dissection to preserve blood supply
How is a nonunion with <1 cm displacement best treated?
Leave alone
What is the preferred treatment for a nonunion with 21 cm displacement?
ORIF
What are the two key caveats?
No soft tissue stripping
Anatomic reduction unnecessary
What is the usual age of medial epicondylar fracture?
9 to 14 years
How much displacement is considered acceptable?
10 mm
How is late-presenting Monteggia fracture with chronic radial head dislocation treated?
ORIF
May require ulnar osteotomy
How are radial head fractures with to <40 degrees of angulation treated?
Nonoperative
How are radial head fractures with to 60 degrees of angulation?
Closed reduction and percutaneous pinning
How are radial head fractures with over 60 degrees of angulation?
ORIF
What should be tried before ORIF?
Closed reduction (with Kirschner [K] wire hinge, for example) to improve angulation
What are the three recently reported risk factors for wrist and forearm fractures in children?
Decreased bone density
Poor balance
Increased body mass index
What two steps are proven to protect against wrist and forearm fractures in sports?
Wrist guards
Decreased ball size
How much rotation is acceptable in both-bone forearm (BBF) fractures in
patients <1O years of age?
45 degrees
What bone is at greater risk of developing growth disturbance:radius or ulna?
Ulna
What is the likely diagnosis for a child with healed BBF and inability tendons within the fracture callus to extend the fourth and fifth distal iriterphalangeals (DlPs)?
Tethering of the fourth and fifth FDP
What is the advantage to pinning a pediatric distal radius fracture?
Decreased rate of loss of reduction
How do outcomes of pinning and nonoperative treatment compare?
Equivalent
lf median nerve symptoms are present, how does this affect treatment?
Should be pinned
What are the two treatment options for phalangeal neck fracture?
Closed reduction percutaneous pinning
ORIF
What structures must be identified and protected in surgery?
Preserve collateral ligaments
What is Seymour’s fracture?
Distal phalanx fracture with associated nail-bed laceration Incarceration of germinal matrix in physis
How is it treated?
Requires exploration, nail-bed repair, fracture reduction