Peds Ortho

A 12-year-old boy presents to the emergency department with his mother after a fall on his outstretched hand. Physical exam is notable for tenderness and swelling along the wrist. A representative diagram of the fracture is seen above. Which of the following is the correct type of fracture classification?

• 1

• 2

• 3

• 4

• 5

A 12-year-old girl presents with right hip pain after kicking a ball to score at her soccer game. She describes hearing a “pop” followed by immediate pain. The patient can limp and localizes pain to the anterior right hip. An X-ray is obtained as seen above. Which of the following is the most appropriate management?

• Immobilization with spica cast

• Muscle relaxant and heat

• Non weight bearing and pain control

• Surgical pinning

A 2-year-old boy presents with one day of not wanting to bear weight on his left leg. Prior to today the patient has been ambulating without assistance. He has not had a fever, but did have a recent viral upper respiratory tract infection. On physical examination, he has pain with any passive manipulation of the left hip. The left knee and ankle are normal. You are concerned about transient synovitis of the hip. Which patient preferred positioning of the hip is most suggestive of this diagnosis?

• Flexion, ABduction, external rotation

• Flexion, ABduction, internal rotation

• Flexion, ADduction, external rotation

• Flexion, ADduction, internal rotation

A 12-year-old boy presents with gradual worsening of left knee pain. He is on the track team at school and notes his pain is worse after long practices. On examination, he has mild soft tissue swelling over the tibial tuberosity and a thickened and tender patellar tendon. There is no joint effusion or laxity, but he has pain with extension of the knee against resistance. In addition to oral non-steroidal anti-inflammatory medications, which of the following is the most appropriate management of this patient’s condition?

• Continuation of normal activity

• Corticosteroid injection at patellar tendon insertion site

• Knee Immobilizer placement

• Orthopedic referral for surgical repair

A four-year-old boy is brought to the ED for right hip pain for the last three days. He has been walking with a slight limp. On examination, he has minimal pain with passive movement of the right hip. Which of the following is most consistent with a diagnosis of transient synovitis rather than septic arthritis?

• Abnormal radiographs of the hip

• ESR > 50mm/hr

• Oral temp 36.8C

• Serum WBC 20,000cells/uL

A 3-year-old boy was running full speed and tripped over his toy, falling on his right leg. An X-ray shows an isolated nondisplaced distal spiral fracture of the tibia. Which of the following is the next best step in the treatment?

• Orthopedic consult for casting and further treatment

• Observation at this fracture spontaneously heals in toddlers

• Obtain a skeletal survey

• Obtain work up for bone cancer

You examine a four-year-old boy for a limp. The parents note that the boy was gradually refusing to run, and later, there was the presence of a limp with walking that is especially prominent at the end of the day. Parents deny fever or rash. On exam, the boy appears well with an antalgic gait and limited hip rotation. Plain radiographs obtained were normal. Bone scan shows decreased perfusion at the left femoral head. Which of the following is the most likely diagnosis?

• Legg-Calve-Perthes Disease

• Osteomyelitis

• Slipped epiphysis

• Transient Tenosynovitis

A three-year-old girl refuses to use her left arm after her mother tugged on her arm to help her cross a street. She does not appear distressed but is holding her arm in pronation with the elbow slightly flexed. Which of the following is the most appropriate next step?

• Hyperpronate the forearm while applying pressure to radial head

• Obtain radiographs of forearm and elbow

• Perform arthrocentesis and send synovial fluid for analysis

• Place patient in splint