1The main way the bone is growing in a growing child is by replacing the ________ & growing in both ________ & _________
- Hyaline cartilage
- Length & width
2During childhood, the bone's not only dev. from the ___________, which creates the _______ or ______ of the bone; your also getting secondary ossification centers called the _______ that eventually become the _______
- Primary ossification center
- Diathesis or shaft
- Epiphyseal centers
- Long bone
3The cartilage in between these ossification centers is the _____ or ________ doesn't fuse until _____ length is obtained
- Physis or growth plate
- Adult
4The highest trajectory of growth occurs in 2 periods; The 1st is between _____ to _____ years and the 2nd is during ______
- Birth to 3
- Adolescents
5Hueter-Volkmann Principle: Compression forces ______ growth & Tensile forces ______ growth
- Inhibit
- Stimulate
6Wolff’s Law: Healthy bones will ____ to the ______ it experiences; meaning, When a bone experiences stress, the body _____ the bone and makes it _____
- Adapt
- Loads
- Ossifies
- Stronger
7According to Wolff's Law, weight bearing injured limbs actually _______
- Improves bone remodeling
8When getting an Xray, at least obtain an ____ and a ______ view because _______
- AP
- Lateral
- Fractures can hide other fractures
9CT: detects ________ but has significantly higher _________; Reserve this for when you can't make a proper diagnosis
- Fine bony detail
- Radiation exposure
10MRI: evaluates ________ & _______ issues, detect __________ fractures, no radiation but long exam in a tight space
- Soft-tissue and bone marrow
- Radiographic occult
11US: Evaluate ___________ ; great for _____ injuries; Keep in mind, theres a much higher component of __________
- Tendon and ligamentous
- Joint
- Operator technique/error
12Compartment Syndrome is a medical emergency d/t Increase in _______ pressure -> ↓ _______ leading to _____, _____, & _____ damage
- Osteofascial Compartment
- Perfusion
- Muscle, nerve, & tissue
13Compartment syndrome occurs anywhere ________ is surrounded by ______ b/c fascia is not _____
- Skeletal muscle
- Fascia
- Flexible
14Most commonly we see compartment syndrome in the __________, the _______, ______, and the __________ muscles
- Upper and lower extremities
- Buttock
- Shoulder
- Paraspinal
15Compartment syndrome presentation: 5 P's= Pain w______, Pain _______ to injury, ________, _________, & __________
- Passive stretch
- Out of proportion
- Paresthesia
- Paralysis
- Pulselessness
16Compartment syndrome in younger pediatric patients may present with the 3 A's:
- Anxiety, agitation and analgesic requirement
17We diagnose compartment syndrome by making a _______ & insert a wick or needle to measure the compartment pressure. Pressure >_____ = surgical intervention
- Slit in the skin
- 35mmHg
18After fasciotomy pt will need _______ that cover skin pathogens including a broad spectrum _______ like _______; may also need MRSA coverage with _______ or _______
- Prophylactic antibiotics
- Cephalosporin
- Cefazolin
- Vancomycin
- Linezolid
19Hip Dysplasia is a gait disturbance as a result of ________ of the _________ leading to _______
- Subluxation
- Femoral head within the joint
- Avascular necrosis
20Barlow Maneuver used to eval. __________; w/ pt on their back, _____ their hips by holding their knees and pushing _______
- Hip Dysplasia
- Adduct
- Outward
21_____ & _____ are used to diagnose hip dysplasia. US in children <______ old have a much higher risk of giving you a ______
- Xray & US
- 6 w.o
- False positive
22Pavlik Harness is used to Tx ________ in children < ______
- Hip Dysplasia
- 6 m.o
23Closed reduction is used to Tx _______ in pts > _______
- Hip Dysplasia
- 6 m.o
24Open reduction with internal fixation may be required to tx _________ in children > _____ . This pt. will need a _____ post op
- Hip Dysplasia
- 2 y.o
- Spica cast
25The goal of treatment for hip dysplasia is preventing or stopping _______
Avascular Necrosis
26Legg-Calve-Perthes Disease is ______ & subsequent ____ of the bone as a r/o ____________ to the _________ or femoral head
- Necrosis
- Repair
- Temporary interruption in blood supply
- Proximal femoral epiphysis (growth plate)
27Highest incidence of Legg-Calve-Perthes Disease in ____ to ____ y.o
4 to 8 y.o
28There are 4 stages of Legg-Calve-Perthes Disease: ______, ______, ______, & ______
ossification, fragmentation, re-ossification, remodeling
29Legg-Calve-Perthes Disease pts will present w/ _______ on effected side & ________ bc the reduced blood supply ________ of the effected leg
- Persistent/chronic mild to moderate pain
- Leg discrepancy
- Slows down growth
30Legg-Calve-Perthes Disease is diagnosed by a _________
Frog leg X-ray
31The goal of tx for Legg-Calve-Perthes Disease is to keep the ______ seated in the ______
- Femur head
- Acetabulum
32Pts w/ Legg-Calve-Perthes Disease should avoid ______ & _____
- Contact sports
- Strenuous exercise
33Osteomyelitis is an ______ of the bone; Can occur in any bone but is most commonly seen in the ____ & _____
- Infection
- Femur
- Tibia
34The most common bugs seen in osteomyelitis: _______, _______, ________ (neonates), & _________ (puncture wounds)
- S. aureus
- Group A strep
- GBS (neonates)
- Pseudomonas (puncture wounds)
35In pts w/ Osteomyelitis, early X-rays are usually ________
Normal looking
36Our image of choice for osteomyelitis is ______
- MRI
37Labs for Osteomyelitis include ____, ____, & _____
- CRP
- ESR
- Blood cultures
38_____ is the lab value that _____& is the most sensitive to osteomyelitis, but the ____ will rise and decline _____ as the infection occurs and gets better
- CRP
- Rises 1st
- ESR
- Slower
39Abx of choice for non-operative osteomyelitis are a _________ +/- ______ or _____ for MRSA coverage. Will need IV abx for about ________. weeks
- 1st gen cephalosporin
- Vancomycin or Clindamycin
- 6-8
40Osteomyelitis pts are at higher risk for _____ & ______; esp. pts w/ ____ infections & ______
- DVT's & venous thrombus embolism
- MRSA
- Mod. to severe osteomyelitis
41Septic Arthritis is a _________ infection in the ______ in the joint causing _________. This is a ________
- Purulent bacterial
- Synovial fluid
- Rapid destruction
- Medical emergency
42Peak incidence of septic arthritis is in pts < ____ y.o & ____ are 2x more likely than _____
- 3
- Males
- Females
43The most common areas seen w/ septic arthritis in kids are the ______, _____, _____ &, _____
- Hip, knee, elbow, and ankle
44The most common bugs we see in septic arthritis are _____, _____, & ______
- S. aureus, moraxella, & GBS
45Toxic synovitis is inflammation of the _____
synovium
46Highest prevalence for toxic synovitis is seen in ______ y.o
3 to 8
47Slipped Capital Femoral Epiphysis is the separation of the _______ in the proximal femoral head w/epiphysis slipping _________, causing potential complete dislocation
- growth plate
- posteriorly
48Highest incidences of Slipped Capital Femoral Epiphysis occur in _____, ______, ______, ______, _____, _______
Adolescence, obesity, African American, Hispanic, Males > females, ages 12-15yrs
49Osgood-Schlatter Disease is a common form of _______ or _______ of the ______ tuberosity in early adolescence
- Growing pains
- Stress overuse
- Tibial
50Osgood-Schlatter Disease Red Flags include _______, ______ y.o, and ______
- Athlete
- 10-15
- Localized pain
51______ of the femoral head is a common complication in unstable slipped capital femoral epiphysis
- Osteonecrosis
52Pts with _______ disease are prone to osteomyelitis due to vaso-occlusive infarcts of the bone
- Sickle cell
53ESR is used in combo w/ CRP to determine....
When we can switch from IV to PO abx
54Serial evaluation of _____ is the most expeditious method to determine the early success of treatment in osteomyelitis
CRP