Bone and joints Flashcards
deformity involving malalignment of the calcaneotalar-navicular complex
Talipes equinovarus (Clubfoot)
Clubfoot extremely common in patients with
myelodysplasia and arthrogyposis
examination of infant clubfoot demonstrates
forefoot cavus and adductus
hindfoot varus and equinus
common radiographic finding in clubfoot
“parallelism” between lines drawn through the axis of the talus and the calcaneus on the lateral radiograph indicating hindfoot varus
management of clubfeet
surgical realignment
pain over tibial tubercle in a growing child
Osgood-Schlatter disease
*patellar tendon inserts into the tibia tubercle which is an extension of proximal tibial epiphysis
treatment for Osgood-Schlatter
self-limited in most patients and resolves with skeletal maturity
spectrum of pathology in the development of immature hip joint
Developmental dysplasia of the hip
2 major groups of DDH
typical and teratologic
- typical: occurs in otherwise normal patients or those without defined syndromes or genetic conditions
- teratologic: have identifiable causes such as arthrogryphosis or genetic syndrome and occur before birth
final common pathway in development of DDH
increased laxity of hip capsule which fails to maintain a stable femoroacetabular articulation
Barlow maneuver
provocative maneuver to assess the potential for dislocation of a nondisplaced hip in a neonate
- examiner adducts the flexed hip and gently pushes the thigh posteriorly in an effort to dislocate the femoral head
- In a positive test, hip is felt to slide out of the acetabulum
- as the examiner relaxes the proximal push, the hip can be felt to sip back into the acetabulum
Ortolani test
reverse of Barlow; examiner attempts to reduce a dislocated hip
- examiner grasps the child’s thigh between the thumb and index finger and with the 4th and 5th fingers, lifts the greater trochanter while simultaneously abducting the hip
- if positive: femoral head will slip into the socket with a delicate chunk that is palpable but not audible
Galeazzi sign
shortening of the thigh; appreciated by placing both hips in 90 degrees of flexion and comparing the height of the knees, looking for asymmetry in infants
diagnostic modality of choice for DDH before the appearance of femoral head ossific nucleus (4-6mo)
Ultrasonography
preferred examination during early newborn period (0-4 weeks)
physical examination
what is the treatment for newborn hips positive for Barlow or Ortolani
Pavlik harness as soon as diagnosis is made
most important complication of DDH
avascular necrosis of femoral epiphysis
hip disorder that results from temporary interruption of the blood supply to the proximal femoral epiphysis leading to osteronecrosis and femoral head deformity
Legg-Calve-Perthes Disease
stages of Legg-Calve-Perthes Disease
initial stage: often lasts for months, characterized by synovitis, joint irritability, early necrosis of the femoral head
fragmentation stage: lasts 8 months where femoral epiphysis begins to collapse usually laterally and begins to extrude from acetabulum
healing stage: lasts approximately 4 year begins with new bone formation in the subchondral region
Final stage (residual stage): begins after the entire head has reossified
most common presenting symptom of Legg-Calve-Perthes
limp of varying duration
primary diagnostic tool for LCPD
routine plain radiographs
most common surgical procedure for LCPD
varus osteotomy of the proximal femur
tilting of the head to the right or left side in combination with rotation of head to the opposite side
Torticollis
contracture of left sternocleidomastoid muscle results
in tilt of the head to the left and vice versa
