Bone and Joint Flashcards
malialignment of calcaneotalar-navicular complex
Talipes equinovarus (clubfoot)
normal foot that has been held in deformed position in utero and found to be flexible on examination
positional clubfoot
clubfoot is extremely common in patients with myelodysplasia and arthrogryphosis
Clubfoot
examination findings in infants with clubfoot
forefoot cavus and adductus
hindfoot varus and equinus
common radiographic finding in clubfoot
“parallelism” between lines drawn through axis of the talus and calcaneus on the lateral radiograph indicating hindfoot varus
pain over tibial tubercle in a growing child
Osgood-Schlatter disease
- traction of the tibial tubercle growth plate and adjacent patellar tendon
- self-limited in most patients and resolves with skeletal maturity
two groups of Developmental Dysplasia of Hip
typical
teratologic
occurs in otherwise normal patients or those with defined syndromes or genetic conditions
Typical DDH
have identifiable cause such as arthrogryposis or genetic syndrome and occur before birth
Teratologic DDH
what is Barlow maneuver
assess the potential dislocation of a nondisplaced hip in a neonate
- examiner adducts the flexed hip and gently pushes the thigh posteriorly
- (+) test: hip is felt to slide out of acetabulum
What is Ortolani maneuver?
examiner attempts to reduce a dislocated hip
- examiner grasps the child’s thigh between thumb and index finger and with 4th and 5th fingers lifts the greater trochanter while simultaneously abducting the hip
- (+) test: femoral head will slip into the socket with delicate chunk that is palpable not audible
shortening of the thigh is best appreciated by placing both hips in 90 degrees of flexion and comparing height of knees, looking for asymmetry in infants
Galeazzi sign
what is the modality of choice in DDH?
Ultrasonography
- before appearance of femoral head ossific nucleus
- early newborn period (0-4 weeks): PE preferred over UTZ
- radiographs once femoral epiphysis ossifies
management of patients Barlow and Ortolani positive
Pavlik harness
most important complication of DDH
avascular necrosis of femoral epiphysis
hip disorder of unknown etiology that results from temporary interruption of the blood supply to the proximal femoral epiphysis –> osteronecrosis and femoral head deformity
Legg-Calve-Perthes Disease
Stages of Legg-Calve-Perthes Disease
- initial: lasts months; synovitis, joint irritability and early necrosis of femoral head
2 fragmentation: lasts 8 months; femoral epiphysis begin to collapse usually laterally and begins to extrude from acetabulum - healing stage: lasts 4 years begins with new bone formation in the subchondral region
- residual stage: begins when entire head has reossified
most common presenting sign of Legg-Calve-Perthes Disease
limp
*routine plain radiograph
management of Legg-Calve-Perthes Disease
activity limitation, protected weight bearing, NSAIDs and physical therapy
*most common surgical containment procedure is varus osteotomy of proximal femur
tilting head to the right or left side in combination of head to the opposite side
Torticollis
most common etiology of Torticollis
congenital muscular torticollis
treatment for congenital muscular torticollis
stretching, stimulation and positioning measures
torticollis associated with GER
Sandifer syndrome
result from strabismus (weakness of 4th cranial nerve) or superior oblique muscle palsy
Ocular torticollis
most common infecting organism in Osteomyelitis
Staphylococcus aureus
frequently affected bones in osteomyelitis
femur and tibia equally affected
imaging of choice in osteomyelitis
MRI is more sensitive than CT
*Brodie abscess
In neonates with osteomyelitis, what is the treatment of choice?
Nafcillin or Oxacillin and broad spectrum cephalosporin such as Cefotaxime
gold standard agent for treating invasive MRSA infections of osteomyelitis
Vancomycin
parenteral treatment of osteomyelitis caused by Methicilin sensitive S. aureus
Cefazolin
minimal duration of antibiotics for osteomyelitis
21-28 days
most common cause of septic arthritis
Staphylococcus aureus
important cause of septic arthritis in neonates
Group B streptococcus
In neonates with septic arthritis, what is the treatment?
Nafcillin or oxacillin and broad spectrum cephalosporin Cefotaxime
most common genetic cause of osteoporosis
Osteogenesis imperfecta
triad of Osteogenesis imperfecta
fragile bones
blue sclerae
early deafness
most severe nonlethal form of Osteogenesis imperfecta
Osteogenesis imperfecta type III
*results in significant physical disability
morbidity and mortality of Osteogenesis imperfecta
cardipulmonary
treatment for Osteogenesis imperfecta
Bisphosphonates decreases bone resorption by osteoclast
limit treatment duration to 2-3 years
