Abos Day 35 Ahaa A 1-3

Front 1

An 11-year-old obese male presents with a slipped capital femoral epiphysis. Which of the following figures accurately represents the method used to determine the radiographic severity of the epiphyseal slip and help guide treatment?

Back 1

Southwick method slip severity, subtracting the epiphyseal-shaft angle on the uninvolved side from that on the side with SCFE on the frog leg lateral pelvis xray. classified mild (<30°); mod. (30° to 50°);sev. (>50°). slip angle -44°

Front 2

A 12-yo girl presents with groin pain 6 mths after treatment of a SCFE. Preoperative xrays are Fig A, xrays 6 mths after in situ fixation are Fig B. Which of the following is ass. with the x-ray abnormality seen in Fig. B?

Back 2

inability to bear weight; even with assistive devices, preoperatively unstable SCFE, which is ass. with sig incrd rates of AVN. The patient presents with femoral head AVN (Fig B), following in-situ screw fixation of a severe SCFE (Fig A).

Front 3

A 13-yo obese boy complains of a 3 mth hx of L knee, thigh & groin pain. His pain has sign worsened over the past wk. He denies pain in the R leg. Xrays Fig A&B. The hx & PE do not reveal any findings for an endocrine dis. tx?

Back 3

In situ 1 screw insertion across L proximal femoral physis only; Acute/acute on chronic (SCFE) stabz 1 percut screw fixation across prox femoral physis. Pin contralateral physis: boys< 12 & girls <10, opn triradiate cartilage, evid endocrinopathy.

Front 4

Southwick angle (epiphyseal-shaft angle) serves what purpose in the evaluation of a slipped capital femoral epiphysis (SCFE)?

Back 4

The epiphyseal-shaft angle, Southwick; is measured on the frog-leg lateral x-ray to determine the degree of the slip, which is calculated by subtraction of the angle on the normal side from the angle of the affected hip.is 44 degrees

Front 5

Which of the following treatment techniques decreases the risk of osteonecrosis in patients with unstable slipped femoral capital epiphysis (SCFE)?

Back 5

"Pinning in situ without reduction with a single cannulated screw is the method of choice for the treatment of a slipped capital femoral epiphysis."

Front 6

Hypothyroidism is MC associated with which pedi conditions?1 Legg Calve Perthes; 2 Slipped capital femoral epiphysis; 3 Toxic synovitis; 4 Achondroplasia 5. Rickets; which zone affected GP epiphysis, all ? direction of slippage?

Back 6

2 SCFE is a disorder of the proximal femoral epiphysis caused by weakness of the perichondral ring and slippage through the hypertrophic zone of the growth plate. The femoral neck displaces anteriorly and externally rotates.

Front 7

An 11-yo boy with hypothyroidism presents with groin pain and the inability to ambulate. His xray is shown in Fig A What is the most appropriate treatment?

Back 7

In situ pin b/l hips;Pts with endoc dz- hypothyroidism present with SCFE < age 10 & SCFE is usually detected 1st subsequent dx- hypothyroidism. Because prevalence b/l as high as 80%, prophylactic tx opposite hip considered.

Front 8

13-yo with L groin pain & inability to place wt on the L leg. xrays A&B. All true EXCEPT:1 Lhip is MC invol; 2 Forceful manip not indic bc it's ass. incr risk of complic; 3 Ass dec fem antevn & dec fem nck-shft angl; 4 Pain is loc knee >hip; 5 M>F

Back 8

4 Pain is localized to the knee more often than the hip on initial presentation. 77-85% presented with hip or groin pain. 15%- 23% of patients had complaints of knee pain or distal thigh pain, which can lead to unnecessary tests or misdiagnoses.

Front 9

14-yo boy presents- L groin and knee pain for 3 wks. He's unable to place wt LLE, even with crutches. AP pelvis XRAYs Fig A He is TXd surgery and po XRAY Fig B & C. What is the MC limb length & rotational profile found as a sequelae of this condition?

Back 9

Limb shortening, decreased hip flexion and dec. hip IR. Forceful manipulation is not indicated bc it is ass with an increased risk of AVN. SCFE can present with an out-toeing gait, limb shortening, dec. hip flex, dec hip abd, & dec hip IR.

Front 10

14yo fem presents with a hx of an un-dx L SCFE 3yo ago. 2 yrs of activity-related L hip pain & pain sitting. PE - restricted hip flex. motion, an ER deformity & obligatory ER upon hip flex manuevering. Xray Fig A&B. Which osteotomies is MOST approp?

Back 10

Flex, IR, & valgus-producing pro fem osteotomy (Imhauser osteotomy) is described to correct the deformity often seen in the late treatment of SCFE. The osteotomy produces flex., IR & valgus

Front 11

A right hip of an 8-year-old patient is modeled in Figure A. Which of the following vessels gives the greatest blood supply to the femoral head?

Back 11

Ans 3 depicts the med circumflex A, dominant blood supply of the fem. head in 8 yo med circumflex A dominant blood supply to the fem head in children >4 yo. lat. circumflex A & ligamentum teres supplies part ant fem head until 2 -4 yrs.

Front 12

14yo overweight boy complains of vague L knee pain worsens with activity. He has an antalgic gait & inc ER of his foot progress angle compared to the contralateral side. Knee Xrays, inc. stress views, are neg. What is the next step in management?

Back 12

In an adolescent boy with knee pain, always examine the hips and consider hip pathology, especially if the knee workup is negative. Matava et al discusses knee pain as the initial symptom of SCFE

Front 13

All of the following are characteristic findings in a patient with arthrogryposis EXCEPT:1. Normal cognition
2. IR contractures shoulder 3. Symmetrical extremity deformity 4. Progressive jnt contractures peak at skeletal maturity 5. b/l hip dislcn

Back 13

Progsve jnt contractures which peak at skeletal maturity-Athrogryposis is a cong. dz mult. jnt contractures & nor. cognition, jnt contractures non progrssve, etiology unkn. Cmn contractures;add & IR shds, hip flex & sublx/disloc, knee rigidity, club ft

Front 14

Physical exam-arthrogryposis: I/P-shoulders;
elbows, wrists, hands, hips, knees,feet, IQ,? facies? sensation? viscera? ROM?

Back 14

shoulders add & IR; elbows extended (no flexion creases); wrists flx &ulnarly deviated; hands-intrinsic + defomity & thumb adducted; hips flex, abd & ER sblux or teratologic dislocn common; knees ext;flexed clubfeet ROM; severely limited all four extre

Front 15

12 yo boy fell sustaining a both bone forearm fx. Which of the following is true re; x-ray assessment of anatomic forearm alignment after reduction? what is age cut off for accept, amount for: displ, angul, malrotaion; if prox vs distal?

Back 15

AP xray, radial styloid & biceps tuberosity -180 deg. apart. lateral, the coronoid proc & ulnar styloid -180 deg. apart. <10 yo- angula<15 deg, rotation <45
>10 yo- <10 deg, rotation <30 deg;<10 yo-bayonet apposition;> 13 both bone->ORIF

Front 16

10-yo boy falls off his bike sustaining inj Fig A&B. After initial unsucc. CR, he undergoes surg comparing ORIF vs (IMN), which is true? 1Non-union rates signf >IMN 2 Blood loss >IMN; 3 restor rad bow=both; 4. Surg. time>IMN 5 forearm rot > ORIF

Back 16

Restoration of radial bow is similar in both groups. Operative indications; open fx & fxs with unacceptable alignment after CR. The optimal fx patterns-midshaft pedc both bone forearm fx with minimal comminution & acute frx prior to fracture callus