OSCE 8

1. a. Less common in young children than adolescents.

b. Salter-Harris type I or II fracture with dislocation.
c. Painful prominence of the distal ulna.
d. Requires immediate closed exam/reduction.
2. a. Salter-Harris type II.
3. a. Salter-Harris type IV.
b. Arrest of growth.
c. Types III and IV.
d. Types I and V.
e. Salter-Harris type V.
4. a. Ulnar fracture and dislocation of the radial head.
b. Hyperextension of the elbow.
c. Immediate orthopedic consult for reduction.
d. Branch of radial nerve.
e. Recurrent dislocation of radial head and limited range of motion at
elbow.
5. a. Fracture of radial metaphysis.
b. Occult fracture precautions, ice, immobilization,follow-up.
c. Prominent anterior fat pad.
6. a. No obvious lesions seen.
b. Splint, sling, ice, occult fracture precautions, and follow-up.
7. a. No pathology seen.
b. Repetitive microtrauma at insertion of Achilles tendon.
c. Foot eversion.
d. Limit playing soccer until the pain resolves, Foam heel pads to elevate
the heel, Short leg cast.
8.
a. Presumptive fracture of the scaphoid bone.
b. Thumb spica with radial gutter and wrap.
9.
a. Direct longitudinal force on metacarpals
b. Indicative of injury to scaphoid bone.
10. a. Slipped capital femoral epiphysis.
b. Obese inactive male children.
c. Inability to fully internally rotate hip.
d. Bed rest and orthopedic consult.
e. Same injury of contralateral hip.
11. a. Simple fracture.
b. Outpatient orthopedic follow-up.
12. a. Small linear fracture.

13.
14.
15.
16.

a. Lytic unicameral bone lesion. Pathological fracture.

a. Lytic unicameral bone lesion, Pathological fracture.
a. Osteogenesis imperfecta.
a. L2.
b. Compression fracture.
c. Chance fracture.
17. a. Loss of limb, Permanent neuropathy, Muscular infarct, Renal failure.
18. a. Plantar flexion/inversion.
b. Anterior talofibular ligament.
19. a. This patient has sustained a nondisplaced S-H type I fracture of the
distal fibula
b. immobilized in an appropriate splint and sent home
20. Corner fractures on both sides of the distal femur are barely visible at the
top, after 2 days the two corner fractures are more clear, and after 9 days the
fracture sites show some periosteal reaction. The pattern of healing shows a
bucket-handle appearance at the inferior border of the metaphysis.
21. a. This type of fracture is known in the orthopedic literature as a
transepiphyseal (transphyseal) fracture. This is not a true bucket-handle
fracture, although it resembles a bucket handle. radiographic findings indicating
child abuse include epiphysealmetaphyseal fractures,such as corner or
bucket-handle fractures, and subperiosteal hematoma bone formation
22. a. The white outlined arrow points to the lucency within the femoral neck.
The gray outlined arrow points to the thickened cortex along the calcar. The
vertical white lines measure the width of the hip joint space. The teardrop
distance measures the medial margin of the inferior aspect of the acetabulum to
the adjacent femoral head. This distance is wider in the left hip compared with
the right hip.
23. a. Transient synovitis, osteomyelitis, acute rheumatic fever.
b. Staphylococcus aureus, H. influenzae (more common in younger
patients), Streptococcus pyogenes. More common in young adults are
Pneumococcus, and Salmonella.