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Podopediatrics > 3) Pediatric Radiology and Osteochondroses > Flashcards

3) Pediatric Radiology and Osteochondroses Flashcards

1
Q

Podopediatric radiology considerations

A
  • Ossification
  • Alignment
  • Osteochondroses / apophysitis
  • Misc. physeal / epiphyseal abnormalities
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2
Q

Newborn primary ossification centers

A
  • 2 nd and 3 rd mets.: 9 th week IU
  • 4 th and 5 th mets.: 10 th week IU
  • 1 st metatarsal: 12 th week IU
  • Calcaneus: 3 mo. IU
  • Talus: 6 mo. IU
  • Cuboid: -/+ birth
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3
Q

Primary centers of ossification time of appearance

A
  • Lateral cuneiform: 1 st year
  • Medial cuneiform: 2 nd year
  • Intermediate cuneiform: 3 rd year
    (pneumonic 3-1-2)
  • Navicular: 2 – 4 years
  • Sesamoids: 8 – 14 years
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4
Q

Secondary ossification centers appearance

A
  • Calcaneus: 6-8 yrs.
  • Metatarsals: 6 mo. – 3 yrs.
  • Phalanges: 1 – 2 yrs.
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5
Q

Secondary ossification centers time of closure

A
  • Calcaneus: 8 – 12 years
  • Metatarsals / phalanges: 12 – 16 years
  • Tibia / fibula: 16 – 21 years
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6
Q

Biomechanical influences (Wolf’s Law, navicular)

A
  • Wolf’s law: Bone is a dynamic tissue which responds (increases / decreases) to the forces to which it is subjected
  • Navicular: excessive pronation may influence development
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7
Q

Radiographic alignment angles

A
  • Metatarsus adductus angle (AP)
  • Calcaneal inclination angle (Lat)
  • Talar declination angle (Lat)
  • Talo – calcaneal (Kite’s) angle (AP)
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8
Q

Metatarsus adductus angle

A
  • 30 degrees at birth
  • 20 degrees at onset of ambulation
  • 5 - 15 degrees by age 4 years
  • If it hasn’t reduced to 20 by the time they begin walking –> met adductus foot –> casting to reduce
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9
Q

Calcaneal inclination angle

A
  • 10 – 15 degrees at birth

- 15 – 25 degrees by age 6 years

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10
Q

Talar declination angle

A
  • 15 – 25 degrees at birth

- 10 – 15 degrees by age 6 years

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11
Q

Talo-calcaneal angle (Kite’s angle)

A
  • 30 – 50 degrees at birth

- 15 – 35 degrees by 4 years

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12
Q

Avascular necrosis

A
  • A circulatory abnormality involving a growth center
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13
Q

Osteochondroses etiologies

A
  • Trauma
  • Infection
  • Congenital
  • Endocrine (hypothyroidism)
  • Atavistic
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14
Q

Atavistic – never normal from the beginning, probably some kind of bone dysplasia or something there
Trauma usually top of the list for onset

A
  • Never normal from the beginning, probably some kind of bone dysplasia or something there
    Trauma usually top of the list for onset
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15
Q

Clinical features of osteochondroses

A
  • Pain
  • Edema
  • Erythema
  • Increased temperature
  • Antalgic gait
  • Age correlation
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16
Q

Osteochondroses radiographic features

A
  • Initial increase in density (sclerosis)
  • Fragmentation
  • Restitution (remodeling)
  • Diminished size
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17
Q

Three fractures that are among the most difficult to heal

A
  • Sesamoids
  • Jones
  • Navicular three fractures that are among the most difficult to heal
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18
Q

Osteochondroses differential diagnosis

A
  • Osteomyelitis
  • Cellulitis
  • Neoplasm
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19
Q

Legg-calves-perthes disease (coxa plana)

A
  • Avascular necrosis of the femoral capital epiphysis
  • Exact etiology unknown
  • Males > Females
  • Ages 4 – 8 years
  • Increased incidence in low birth weight children
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20
Q

Legg-calves-perthes disease (coxa plana) etiologies

A
  • Trauma is usually the cause

- Knee pain in a child or adolescent must be considered hip pathology until proven otherwise

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21
Q

Legg-calves-perthes disease clinical features

A
  • Hip / groin / thigh / knee pain
  • Antalgic gait
  • Pain with hip rotation, esp. internal
22
Q

Coxa plana management

A
  • Orthopaedic referral
  • Complete NWB rest
  • Casting / bracing
  • Occasionally surgery
23
Q

Kohler’s disease

A
  • Avascular necrosis of the navicular
  • AKA Panner’s disease
  • Males > females
  • Unilateral > bilateral
  • Ages 3 – 8 years
24
Q

Kohler’s disease clinical features

A
  • Midfoot pain
  • Antalgic gait
  • Edema / erythema
  • Excessive subtalar / midtarsal pronation
25
Q

Kohler’s disease radiographic findings

A
  • Silver dollar navicular –> clerotic/white pigmented deformity of bone
  • May need a talonavicular fusion, bone graft, etc.
26
Q

Kohler’s disease management

A
  • NWB immobilization 6 – 8 weeks

- Orthosis later

27
Q

Frieberg’s disease (infarction)

A
  • Avascular necrosis of a metatarsal head
  • Second metatarsal most common
  • Females > males; ages 13 – 20 years most common
  • Can be unilateral, bilateral or simultaneous multiple met. head involvement
28
Q

Frieberg’s infarction clinical features

A
  • Pain
  • Edema
  • Erythema
  • MTPJ crepitation
29
Q

Frieberg’s infarction management

A
  • NWB immobilization
  • Orthosis / metatarsal head accommodation
  • Rocker bar
  • Surgery
30
Q

Freiberg’s infarction surgical management

A
  • Resection
  • Implant
  • Fusion
  • Chondroplasty
31
Q

Other osteochondroses

A
  • Treve’s (Ilfeld’s) disease: hallucial sesamoids
  • Buschke’s disease: cuneiform
  • Diaz (Mouchet’s) disease: talus
  • Haglund’s disease: Os tibialis externum
  • Thicmann’s disease: phalanges
32
Q

Apophysitis

A
  • An epiphysis under traction

- Inflammatory disease

33
Q

Osgood-Schlatter’s disease

A
  • Inflammation of the proximal tibial tubercle (apophysitis / tendonitis)
  • Overuse anterior knee pain
  • Males > females
  • Ages 11 – 15 years
  • Unilateral > bilateral
34
Q

Osgood-Schlatter’s disease clinical features

A
  • Pain with palpation of proximal tibial tubercle
  • Edema
  • Tight quadriceps / hamstrings
  • Growth spurt
  • Prominence of tubercle
35
Q

Osgood-Schlatter’s disease management

A
  • Rest
  • Ice
  • Stretching
36
Q

Sever’s disease

A
  • Calcaneal apophysitis
  • Most common pediatric overuse injury
  • Males > females
  • Ages 7 – 13 years
  • Soccer cleats are most notorious ! (baseball #2)
37
Q

Sever’s disease clinical features

A
  • Posterior (postero-plantar) heel pain
  • Equinus
  • External angle of gait
  • Active child
38
Q

Sever’s disease management

A
  • Rest
  • Ice massage
  • Heel lift
  • Achilles stretching
  • Orthosis if indicated
  • Casting (3-4 weeks)
39
Q

Islen’s disease

A
  • Apophysitis of the fifth metatarsal base
  • Overuse lateral foot pain
  • Males > females
  • Ages 11- 14 years (“Bar Mitzvah bone”)
40
Q

Islen’s disease clinical features

A
  • Pain along styloid process
  • Edema
  • Overuse
  • Rearfoot varus
  • Tight, stiff shoes
41
Q

Islen’s disease management

A
  • Rest
  • Ice massage
  • Avoid stiff shoes
  • Orthoses if indicated
42
Q

Os vesilinium

A
  • Accessory ossicle at fifth metatarsal base
  • Incidence: 0.1 – 1 %
  • Probably represents an ununited apophysis
  • Become symptomatic via trauma
43
Q

Os vesilinium treatment

A
  • ORIF if Peroneus brevis involvement

- Excision

44
Q

Miscellaneous

A
  • Slipped capital femoral epiphysis

- Osteochondrosis deformans tibiales (Blount’s disease)

45
Q

Slipped capital femoral epiphysis

A
  • Displacement of the femoral capital epiphysis
  • Exact etiology unknown
  • Males > females
  • Ages 11 – 16 years
  • L > R; 25 % bilateral
  • Obese juvenile / adolescent
46
Q

Slipped capital femoral epiphysis clinical features

A
  • Hip / thigh / groin / knee pain
  • Pain with hip rotation (esp. internal)
  • Antalgic gait
  • Whitman’s sign: hip rotates externally when flexed
47
Q

Slipped capital femoral epiphysis (SCFE)

A
  • Pre-slip: widening

- Minimal slip: displacement < 1 cm

48
Q

Slipped capital femoral epiphysis management

A
  • Immediate NWB
  • Traction / splinting
  • ORIF
49
Q

Blount’s disease

A
  • Arrest of the medial proximal tibial growth plate
  • Exact etiology unknown. Abnormal pressure with ligamentous laxity ?
  • Obese children who are early walkers
  • Usually B / L
  • Infantile and adolescent forms
  • Males > females
50
Q

Blount’s disease clinical features

A
  • Prolonged (> 2-3 years) genu varum
  • Late onset genu varum (8 – 13 years)
  • Not generally painful
51
Q

Blount’s disease treatments

A
  • High top shoes
  • Orthoses / braces
  • Epiphysiodesis/tibial osteotomy

Podopediatrics (6 decks)

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