MCQs – Upper Extremity Peds

MCQs-UE peds
– the most common reason for supracondylar osteotomy following malunion and gunstock deformity is cosmetic.

– the best treatment for Monteggia fracture is to do a closed reduction of ulna, closed reduction of radial head, then cast.

– lateral condyle fracture missed and seen at 3 weeks – probably fix it.

– a child with open growth plates who sustains an anterior shoulder dislocation has a nearly 90% chance of having recurrent dislocations.

– for a proximal humerus fracture with greater than 25 degrees of angulation near skeletal maturity -should probably do something.

– most common site of osteochondritis dessicans in the elbow is the capitellum. X-ray changes are confined to the capitellum until joint becomes arthritic. Rarefaction, fragmentation, irregular ossification, and a localized crater defect can be seen. The articular surface may look irregular. Occasionally, the radial head looks abit bigger than the other side.

– fixation of a medial epicondyle fracture is indicated if displaced > 1 cm, if ulnar nerve symptoms present, if trapped within the joint, or if valgus instability is present.

– the most important radiographic aid in determining what is broken in elbow fractures is to line up the capitellum with the radial head.

– for the posterior dislocation of the radial head with ulna fracture (Bado II) – treat with reduction and then immobilization in EXTENSION and PRONATION. Most (Bado I) are treated in flexion and supination.

– if you flex a supracondylar fracture without first applying traction – you’ll kink the neurovascular structures anteriorly

– for the posteromedially displaced supracondylar fracture – assume that the lateral structures are totally torn. So when immobilizing, you want to pronate them to hinge on the intact medial side.

– for posterolateral displaced supracondylar fracture – assume the medial side is torn – immobilize in supination

– immobilization of a supracondylar fracture for more than 4 weeks is probably too much – they might get stiff if left in for 6 weeks.

– failure to correct cubitus varus with supracondylar osteotomy is most often due to inadequate correction of the medial rotation.

– for post-traumatic radioulnar synostosis, they are more common with open reduction, more likely with proximal fractures, and can be resected but only after waiting 1-2 years.

– mallet deformities in a 5 year old are caused by salter I or II injuries. In older children, they end up being salter III injuries.

– in epiphyseal separations of the distal phalanx of the finger, it is important to know that the flexor tendons insert into the metaphysis, and the extensor tendons into the epiphysis (hence Mallet fingers are salter I or II injuries)

– camptylodactyly of 30 degrees of the hand that is correctable with MCP flexion (indicating abnormal lumbrical insertion) should be treated initially with dynamic splinting. ???