MSK-27 · Salter-Harris Fractures and Pediatric MSK

Salter-Harris Fractures and Pediatric MSK. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: The fractured bone and the dislocated joint always sit at opposite ends of the forearm. — Correct: The fractured bone and dislocated joint are in different bones, not opposite ends of the forearm. In Monteggia both the ulnar fracture and radial head dislocation are proximal; in Galeazzi both are distal. (2) In the audio: and an abnormal Klein line on a frog leg lateral view. — Correct: The Klein line (Trethowan sign) is drawn on the anteroposterior view, as the body of the episode says. The frog-leg lateral is the most sensitive view for detecting an early or subtle slip, not the view the Klein line is drawn on. (3) In the audio: Both the brachial artery and the anterior interosseous nerve sit directly anterior to the distal humerus, — Correct: The brachial artery and the median nerve trunk course directly anterior to the distal humerus. The anterior interosseous nerve is the branch most often injured, because the displaced fragment pinches the median nerve trunk where that branch arises; the anterior interosseous nerve itself does not run anteriorly at the elbow. (4) In the audio: carrying a 10 to 20% association with DDH. — Correct: Developmental dysplasia of the hip coexists with congenital muscular torticollis in roughly 5 to 20 percent of infants across series, depending on whether any sonographic dysplasia or only dysplasia needing treatment is counted. The screening rule is unchanged: examine the hips in every torticollis infant and keep a low threshold for ultrasound. (5) In the audio: if they have a 25 to 45 degree curve. — Correct: The bracing band in adolescent idiopathic scoliosis is about 25 to 40 degrees at Risser 0 to 2. Fusion is considered once the curve passes about 45 degrees in a still-growing spine and 50 degrees or more in a skeletally mature spine. (6) In the audio: is necessary in roughly 90% of cases — Correct: Percutaneous Achilles tenotomy is needed in roughly 70 to 90 percent of Ponseti-treated clubfeet, commonly quoted as about 80 percent, with the highest rates in the most severe feet. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-27-a.