Orthopedic Pediatrics Overview
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Since 1990, the speaker has not practiced as a clinical ______.

pediatrician

The percentage of the speaker's practice that involves pediatrics is approximately ______ percent.

20

The speaker focuses on ______ and knees in their practice.

shoulders

The speaker has been seeing pediatric patients as an orthopedic ______.

<p>surgeon</p> Signup and view all the answers

In the context of age, the speaker defines pediatrics as patients aged ______ and younger.

<p>18</p> Signup and view all the answers

A grade III OCD lesion on plain x-rays is minimally ______ in its early phase III.

<p>sclerotic</p> Signup and view all the answers

The cartilage cap can get ______ because it's irritated.

<p>hypertrophied</p> Signup and view all the answers

Cartilage doesn't have a ______ supply.

<p>blood</p> Signup and view all the answers

The bone may fragment or ______, but it won't get bigger.

<p>dissolve</p> Signup and view all the answers

If disconnected from its host bone, the lesion doesn't have a ______ supply anymore.

<p>blood</p> Signup and view all the answers

The lesion can't get bigger and should stay the same total overall ______ size.

<p>volumetric</p> Signup and view all the answers

The cartilage cap can get ______, which complicates late repairs.

<p>hypertrophic</p> Signup and view all the answers

The cartilage cap is often described as ______ and white.

<p>bleached</p> Signup and view all the answers

My focus is in ______, musculoskeletal ailments of the body, most of the extremities.

<p>orthopedics</p> Signup and view all the answers

I'm a sports medicine, fellowship-trained, ______ surgeon.

<p>orthopedic</p> Signup and view all the answers

Pediatrics is treating infants through about age ______, in general.

<p>18</p> Signup and view all the answers

You get some pediatric training during your ______.

<p>rotations</p> Signup and view all the answers

During my transitional internship, I did three months of ______ training.

<p>pediatrics</p> Signup and view all the answers

We specifically hone in on pediatric orthopedic ______ of the musculoskeletal system.

<p>ailments</p> Signup and view all the answers

I have just some pediatric orthopedics vis-a-vis my orthopedic ______.

<p>residency</p> Signup and view all the answers

Thomas DeBerardino, M.D. attended remotely from his location in ______, Texas.

<p>San Antonio</p> Signup and view all the answers

The oral deposition was conducted on December ______, 2021.

<p>16</p> Signup and view all the answers

Any and all medical, musculoskeletal included, ailments is kind of in their ______.

<p>wheelhouse</p> Signup and view all the answers

The deposition was taken at the instance of the ______.

<p>Defendants</p> Signup and view all the answers

The deposition was conducted via ______ videoconference.

<p>Zoom</p> Signup and view all the answers

Cicily John and Tony John are mentioned as plaintiffs and next friends of ______, a minor child.

<p>S.T.</p> Signup and view all the answers

The deposition was reported by Christi ______, CSR, RPR, CRR.

<p>Sanford</p> Signup and view all the answers

The court case is filed under cause number ______.

<p>DC-19-18636</p> Signup and view all the answers

This deposition took place in ______ County, Texas.

<p>Dallas</p> Signup and view all the answers

The radiographic hallmarks are used to check for subtle fractures of the tibial ______.

<p>tubercle</p> Signup and view all the answers

Fracture healing normally requires immobilization for about six to eight ______.

<p>weeks</p> Signup and view all the answers

Isolated, focal, anterior tubercle pain does not require x-rays to make a presumptive ______.

<p>diagnosis</p> Signup and view all the answers

In more advanced Osgood-Schlatter's, one can see the obvious Osgood ______.

<p>ossicle</p> Signup and view all the answers

The Osgood ossicle can be described as the size of a frozen ______.

<p>pea</p> Signup and view all the answers

The Osgood ossicle can be bipartite or tripartite, meaning it can have one, two, or three ______.

<p>parts</p> Signup and view all the answers

Findings that suggest Osgood-Schlatter's may include degrees of displacement from its ______ site.

<p>origination</p> Signup and view all the answers

These ossicles can form or break off from the tibial ______.

<p>tubercle</p> Signup and view all the answers

The ones that are in grade I, II and early IIIs that are fixed in situ, they jump right on the normal timeline of either not needing knee ______

<p>arthroplasty</p> Signup and view all the answers

Folks with the later-stage lesions have a higher propensity of progression of post-traumatic, post-injury ______

<p>arthritis</p> Signup and view all the answers

This necessitates an earlier likelihood of transition to knee ______

<p>arthroplasty</p> Signup and view all the answers

If we make the assumption that ten people without an OCD might need a total knee at age ______

<p>65</p> Signup and view all the answers

If ten people with OCDs happen to be late stage III or stage IV, they would need a total knee, but they'd need it ______ than those without OCDs.

<p>sooner</p> Signup and view all the answers

They'd need it maybe in their ______, their young 50s.

<p>50s</p> Signup and view all the answers

There's some quotations of at the age right around ______, those needing surgery might be younger.

<p>52</p> Signup and view all the answers

People needing surgery for knee issues might be in their mid to late ______ compared to those with more severe conditions.

<p>60s</p> Signup and view all the answers

Flashcards

Orthopedic surgeon's specialty

An orthopedic surgeon, trained to treat bones, joints, and muscles, who specializes in shoulder and knee problems.

Pediatric patient

A patient under 18 years old.

Surgical procedures

Procedures performed on joints, requiring incisions and manipulation of bones or ligaments.

Practice specialization percentage

The percentage of a doctor's practice dedicated to serving a specific patient group.

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Surgical target

The body part that is the focus of surgical intervention, e.g., shoulder, knee, hip.

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Orthopedics

A medical specialty focused on the musculoskeletal system, including bones, joints, ligaments, tendons, and muscles.

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Pediatric Orthopedics

A subspecialty of orthopedics that focuses on the musculoskeletal system of children and adolescents.

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Pediatrics

A medical field focused on the health and development of children from birth to adulthood.

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Residency

A formal training program in a specific medical specialty, lasting several years.

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Fellowship

Training specifically designed to enhance expertise in a particular area of a medical specialty.

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Internship

A period of supervised clinical training that follows medical school and prepares physicians for their chosen specialty.

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Rotation

A structured learning experience where medical students gain practical experience by observing and assisting with patient care in different medical specialties.

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Standard of Care

A set of established guidelines for medical treatments and procedures, considered the best and most appropriate care for a particular condition.

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Osteochondral Defect (OCD)

A condition affecting the knee joint, often due to injury, which can lead to cartilage damage and pain.

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Knee Arthroplasty

A type of knee surgery to replace the damaged joint surfaces with artificial components.

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Progression of Osteochondral Defect

The progression of joint damage over time, often leading to arthritis.

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Treatment Options for Different OCD Stages

Early stages of Osteochondral Defect are likely to be treated conservatively, while later stages often require surgery.

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OCD and Arthritis Progression

Patients with later-stage Osteochondral Defects often have higher rates of developing post-traumatic arthritis that may require earlier knee replacements.

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Age of Knee Arthroplasty for OCD

Patients with Osteochondral Defects may require knee replacements at a younger age compared to those without the condition.

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Rate of Knee Replacement for Late Stage OCD

The likelihood of requiring knee replacement for a patient with late-stage Osteochondral Defect (stage III or IV) is similar to that of patients without OCD, but they experience it at a younger age.

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Timeline for OCD Progression

The timeline of progression for Osteochondral Defects can vary widely, and the timing of knee arthroplasty depends on individual cases.

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What is the case about?

The legal case filed against Touchstone Medical Imaging, LLC and other defendants by Cicily John and Tony John, individually and as parents and next friends of their minor child, S.T.

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Where was the lawsuit filed?

The lawsuit was filed in the District Court of Dallas County, Texas.

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Who are the Plaintiffs?

The Plaintiffs in the case are Cicily John and Tony John, both acting individually and as parents and next friends of their minor child, S.T.

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Who are the Defendants?

The Defendants in the case are Touchstone Medical Imaging, LLC; Touchstone Medical Imaging, LLC, d/b/a Touchstone Imaging Richardson; Touchstone Imaging of Mesquite, LP, d/b/a Touchstone Imaging Richardson; BTDI JV, LLP, d/b/a Touchstone Imaging Richardson; Richardson Pediatric Associates; Gregory C. Downing, MD; GDX, PA; and Norah K. Randles, MD.

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How and when was the deposition taken?

The deposition was taken remotely via Zoom videoconference on December 16, 2021, from 3:33 p.m., with Thomas DeBerardino, MD, attending remotely from his location in San Antonio, Texas.

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Who requested the deposition?

The deposition of Thomas DeBerardino, MD, was conducted at the instance of the Defendants, meaning they requested it.

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Grade III OCD Lesion

A type of bone lesion characterized by progressive changes in its appearance on x-rays. It starts as a minimally sclerotic area, becomes more defined, and the host bone also becomes more defined over time. The lesion itself doesn't grow larger, but it can fragment.

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Cartilage Cap Hypertrophy

A condition where the cartilage cap covering a bone lesion becomes thicker and larger due to irritation. This thickening can change the shape of the cartilage cap, making it difficult to repair.

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What happened before the deposition?

Thomas DeBerardino, MD, was duly sworn before giving his deposition, making it a formal and legal statement.

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Who recorded and transcribed the deposition?

The deposition was reported by Christi Sanford, a certified court reporter, and transcribed by Corona Court Reporting, Inc.

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Cartilage's Avascular Nature

Cartilage does not have its own blood supply and relies on the joint fluid to receive nutrients. This makes cartilage more vulnerable to damage and difficult to heal.

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Progeny Fragment

A piece of bone that has become detached from the main bone structure. It no longer receives blood flow from the main bone.

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Bone's Vascularity

Bone is a vascular tissue, meaning it needs a blood supply to grow and heal. When a fragment of bone is detached, it loses its blood supply and can't grow.

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Cyclic Loading of Fragment

The cyclic loading of the detached bone fragment can lead to further fragmentation over time. This irregular loading is not supported by the host bone, causing stress and damage.

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Lesion Volume

The total volume of the OCD lesion remains relatively constant. It is the shape and integrity of the lesion that change over time.

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Orthopedic Observation

Orthopedists often notice the thickened cartilage cap when repairing OCD lesions. This can make the repair process more challenging.

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Osgood-Schlatter's Ossicle

A small, bony bump that forms on the tibial tubercle, the bony prominence below the kneecap. It is usually caused by repeated stress and inflammation due to overuse or powerful muscle contractions.

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Osgood-Schlatter's Disease

Inflammation and pain in the tibial tubercle (the bony prominence below the kneecap), usually in adolescents. It is caused by repetitive stress and inflammation at the site where the patellar tendon connects to the tibia.

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When are X-rays Necessary for Osgood-Schlatter's?

X-rays are not always necessary for diagnosing Osgood-Schlatter's disease. If the pain is isolated, focused on the anterior part of the tibial tubercle (the bony bump below the kneecap), and about the size of a quarter, it is likely Osgood-Schlatter's.

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What is the Tibial Tubercle?

The tibial tubercle is the bony prominence below the kneecap. It is where the patellar tendon, which connects the kneecap to the shinbone, attaches.

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What is the Apophysis?

The apophysis is the growth plate of a bone, where new bone is formed during childhood and adolescence. It can be injured by excessive force, such as from a strong pull on the patellar tendon.

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What Do X-rays Show in Osgood-Schlatter's?

X-rays can reveal an Osgood ossicle, a small, bony fragment that forms on the tibial tubercle. It can appear as one, two, or three separate pieces (bipartite or tripartite), and can be displaced from its original location.

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Can the Osgood Ossicle Break Off?

Osgood-Schlatter's disease can sometimes progress to a point where the Osgood ossicle, a small bony fragment, breaks off from the tibial tubercle.

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How Long Does Osgood-Schlatter's Take to Heal?

Osgood-Schlatter's disease typically requires rest, ice, compression, and elevation (RICE) to reduce inflammation and pain. It usually takes 6-8 weeks for the injury to heal fully.

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Study Notes

Case Information

  • Case no.: DC-19-18636
  • Court: District Court
  • County: Dallas County, Texas
  • Parties: Cicily John, Tony John (individually and as parents), S.T. (a minor child) vs. Touchstone Medical Imaging, LLC, Touchstone Medical Imaging, LLC d/b/a Touchstone Imaging Richardson, Touchstone Imaging of Mesquite, LP d/b/a Touchstone Imaging Richardson, BTDI JV, LLP d/b/a Touchstone Imaging Richardson, Richardson Pediatric Associates, Gregory C. Downing, MD, GDX, PA, and Norah K. Randles, MD.
  • Date: December 16, 2021
  • Reporter: Christi Sanford, CSR, RPR, CRR
  • Contact information: 214.528.7912

Deposition Information

  • Deponent: Thomas DeBerardino, M.D.
  • Location of deposition: San Antonio, Texas
  • Method of deposition: Remote oral deposition via Zoom videoconference
  • Duration of deposition: 3:33 p.m. to 8:44 p.m.
  • Reporter location: Taylor, Texas

Appearances

  • Attorneys for Plaintiffs: Russell Button, Ashley Washington (The Button Law Firm, Dallas, Texas 75209); Tobias A. Cole (The Cole Law Firm, Houston, Texas 77057); Heather Lynn Long (Heather Long Law, PC, Dallas, Texas 75206)
  • Attorneys for Defendants: Rikki L. Hirshman, Peter H. Anderson (Kershaw Anderson, PLLC, Dallas, Texas 75251); Reagan Boyce (Chamblee Ryan, PC, Dallas, Texas 75207)

Exhibits

  • Exhibit 1: Notice of Intention to Take the Oral Deposition of Thomas DeBerardino, MD, and Subpoena Duces Tecum
  • Exhibit 2: Video clip
  • Exhibit 3: Video clip

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Description

This quiz focuses on pediatric orthopedics, particularly the speaker's specific experiences and insights since 1990. Questions cover clinical practices, definitions of pediatrics, and details regarding cartilage and bone health in pediatric patients. Test your knowledge on these specialized topics within orthopedic medicine.

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