VIVA

Pediatric - Perioperative
15 minutes
Case 1
Boy, 8 y.o with chief complaint pain and wound anteriorly above his elbow. Patient
with history of domestic accident, fell of 3 m height while climbing mango tree.
There is no palpable pulse but the CRT and pulse oximetry is normal. There is no
decrease in sensoric and motoric function
 Questions
1. What is the diagnosis of this patient
2. What is the appropriate treatment and explain preparation for the
treatment
EXAMINER’S GUIDE

Literature:
Tachdjian Pediatric
Pediatric VIVA - Perioperative
1. The patient with open fracture of supracondylar of the right humerus
type II Gartland type III extension type
2. In preparation the candidate should be aware of neurologic and
vascular condition in this patient
• Evaluate AIN, Median and Radial nerve
• Evaluate vascular by assessing pulse, assessing perfusion
3. Preparation of treatment :
• Operative with Close reduction and percutanous pinning (CRPP) with the
timing depends on neurovascular status
Pediatric VIVA - Perioperative

Case 2
Boy, 4 y.o with bowed leg. The bowing get worsen for the last 6
months, with no complaint of pain and the patient still able to walk
normally.
The patient already started to walk at the age of 10 months.
There is no history of trauma.
 Questions
1. What is the diagnosis of this patient
2. How to classify this conditions ?
3. What should you evaluate in the xray ?
EXAMINER’S GUIDE

Literature:
Tachdjian Pediatric
1. This patient with infantile blount disease Langenskiőld type II
2. The preparation in this patient to determine the classification based on
Langenskiőld to provide prognostic guidelines
• type I thru IV consist of increasing medial metaphyseal beaking and sloping
• type V and VI have an epiphyseal-metaphyseal bony bridge (congenital bar across
physis)
• provides prognostic guidelines
3. Xray Evaluation
• Measurements of metaphyseal-diaphyseal angle (Drennan)
• angle between line connecting metaphyseal beaks and a line
perpendicular to the longitudinal axis of the tibia
• >16 ° is considered abnormal and has a 95% chance of progression
• <10 ° has a 95% chance of natural resolution of the bowing

• Measurements of tibiofemoral angle

• tibiofemoral angle angle between the longitudinal axis of the femur and
tibia