8) Pediatric Orthopedics Flashcards
Why does age matter?
Bc if a child is hit by a car, it will hit a different body part depending on their height
Priorities of pediatric trauma
- ABC’s
- Limb Ischemia
- Open Fx
Finish the phrase: Children are not _______.
Small adults
What does the fact that a kid’s head is larger than their trunk incr the tendency for?
Trunk flexion
What does post-fx bone remodeling potential depend on?
- Age
- Which growth plates are involved
- Proximity of injury to growth plate
- Plane of jt motion
What is a sleeve fx?
Periosteum gets ripped off the bone & then the bone fx’s in a certain location depending on the area
What causes compartment syndrome?
Build-up of pressure in a closed space in the body
What can compartment syndrome cause?
Compromised circulation, necrosis, or nerve damage
What are the 5 P’s of compartment syndrome?
Pulse, Pain, Parasthesia, Paresis, & Pressure
Describe the pain of compartment syndrome
Pain will be out of proportion to the injury
What can a fx at femoral growth plates cause?
Leg length discrepancy
What are the causes of leg length discrepancy?
- Fx at femoral growth plates
- Devo disorder
- Congenital disorder
- Infection
- Dysplasia
- Metabolic disorder
Pathological fx’s are the result of what?
Tumors
What do you need to know about in-toeing/out-toeing?
If its local & where the twist is coming from
Tx for club foot
Ponsetti stretching & percutaneous heel cord tendinotomy
What is miserable malalignment
Femur gets turned in, tibia turns out, & the patella tracks laterally causing patellar instability or dislocation
When are flat feet not a problem?
If they’re flexible but not painful
What can cause flat feet?
Pathological from tight achilles, tarsal coalition, neuromuscular, etc
By what age should a child have straight legs?
18 months
By what age should a kiddo have max valgus/varus?
Age 3 or 4
Ricketts
Whitening & cupping of growth plates
Is ricketts a systemic problem?
Yes
What are the pathological causes of malalignment?
- Trauma
- Metabolic
- Infection
- Tumor
- Developmental
- Bone Dysplasia
When is imaging needed?
For kiddies w/severe deformity, asymmetries, short stature, & dysmorphic features
Risk factors for hip dysplasia
- 1st born
- Female
- FHx
- Intrauterine crowding
- Breech delivery
- Torticollis
- Post-natal positioning
- Ethnicity
What happens if hip dysplasia is dx’ed after the child is 18mo?
Tx becomes more invasive
How is hip dysplasia dx’ed?
- Barlow Test
- Ortolani Test
- Asymmetric thigh creases
- Abduction deficits
Tx for hip dysplasia
- Closed reduction
- Anterior open reduction if CR fails
- Pelvic Osteotomy
- Femoral Shortening
- Capsulorraphy
- Adductor tendonotmy
- Arthrogram
- FU CT
- Pavlik harness/Abduction brace
- Positioning in 100° of flexion & 50° abduction
How many wks of tx for hip dysplasia does it take to achieve clinical stability?
6-12wks
Perthe’s Disease
Idiopathic necrosis of the femoral head
Tx for perthe’s disease
Containment & mobility
Who does perthe’s disease most commonly effect?
Males ages 4-10
For a pt w/perthe’s disease, what is prognosis based on?
Amount of femoral head involvement & age of onset
Cerebral Palsy
Group of permanent developmental & postural disorders as the result of non-progressive insult to UMN’s
What can CP effect?
Cognition, Behavior, & MSK system
Diplegia
LE’s are more involved than UE’s
What is the role of PT for CP?
Stretching, strengthening, gait training, positioning, pt ed, & emotional support
Types of Orthotics
- Standing Frame
- RGO
- HKAFO
- KAFO
- AFO
- SMO
- Inserts
Other modalities that can be good for CP
- Water therapy
- Hippotherapy
- Botox for spasticity
- Baclofen pumps
- Selective dorsal root rhizotomy
What is the management of leg length discrepancy based on?
- Predicted LLD
- Predicted height
- Jt Instability
- Foot/Ankle Form & Fxn
- Psychosocial
- Surgeon bias
Tx for LLD
Shoe lift & prosthetics
Describe the surgery done for LLD
Cut the bone, put in a fixation, distract, & then new bone will grow in the gap
What are the stages of LLD surgery?
1) Latency
2) Distraction
3) Consolidation
What will be the WB status of a pt who just had LLD surgery w/internal lengthening nails?
TTWB
What can LLD surgery cause?
Contractures
What are the disadvantages of LLD surgery?
- Compromises fxn for length
- Jt instability
- Psychological stress
- Misleading info
- Unrealistic goals
- Lack of planning
Blount’s Disease
Growth disorder of the tibia that causes pt to be bowleg
What is the tx for blount’s disease?
Tibial osteotomy
Congenital Radial Club Hand
Radius is missing
Chondrolysis
Degeneration of the acetabuluar labrum
Scoliosis
7° lateral curvature of the spine
What are the indications for an MRI for scoliosis?
- Atypical Sx’s
- Neurological findings
- Atypical curve pattern
- Rigid curve
- Rapid progression
Management of Scoliosis
- Observation
- Bracing
- Surgery
True or False: Stim, exercises, & manips have no substantial effect to pt’s w/scoliosis
True
When will they do bracing for pt’s w/scoliosis?
If the pt has a curve between 25°-40° & they still have growing to do
When will they do surgery on a pt w/scoliosis?
If the pt has a curve >45° or curve gets worse even w/bracing
Who is at risk for compartment syndrome?
Kids w/tibial or forearm fx
