Ch 10 - Peds: Bone and Joint Diseases Flashcards
What are treatments for club foot?
Physical therapy
Bracing
Serial casting
50% require surgical correction
What is bowleg?
Genu varum
What is Blount’s disease?
Tibia Vara d/t ABN function of the medial portion of the proximal tibial growth plate and results in bowing in the proximal tibia
What is the MCC of bowing in young children?
Blount’s disease
Who is Blount’s disease MC seen in?
Obese children who walk at 9 to 10 months
African Americans
Suspected in children with bowing >2yo
What is the treatment of Blount’s disease?
Osteotomy of the proximal tibia and
fibula
Describe the Galeazzi (Allis) Test.
Flex hip and knees bilaterally, looking at the level of the knees and low knee indicates that hip dysplasia
What is the olive sign?
Soft, nontender enlargement of the SCM within the first 6 weeks and subsides within 4 to 6 months of age
What is seen on exam in Congenital Torticollis?
Flattening of the ipsilateral face
Contralateral occipital flattening
Orbital asymmetry (plagiocephaly)
Ipsilateral hip dysplasia
What is the MCC of Congenital Torticollis?
Fibrosis of the SCM
Describe right torticollis.
Head is tilted to the right shoulder with the chin rotated to the left.
What are treatments of congenital toricollis?
- Stretch SCM 15-29x/day
- Position head to encourage ipsilateral superior gaze to strengthen muscles
- Put mobile on right side of the crib in right torticolis
Describe Nursemaid’s elbow.
Radial head and neck are displaced distal to the annular ligament d/t longitudinal pull or sudden traction applied to the upper extremity
What is the treatment for Nursemaid’s elbow?
Reduction usually is achieved by supination and extension of the forearm
What is Little Leaguer’s elbow?
Repetitive traction stress on the apophysis of the medial epicondylar ossification center of the humerus from repetitive valgus stress
What is Osgood-Schlatter’s Disease (OSD)?
Traction apophysitis of the anterior tibial turbercle typically seen in active adolescent boys>girls
What is the most common cause of limping and pain in the hip of children?
Transient (toxic) synovitis of the hip
What is Legg-Calvé-Perthes disease?
AVN of the proximal femur d/t rapid growth in relation to blood supply
What is onset of Legg-Calvé-Perthes disease?
4-10yo
Boys> girls (4:1)
What is the clinical presentation of Legg-Calvé-Perthes disease?
Pain in groin and radiates anterior/medial thigh toward knee
Dec internal rotation, extension, and abduction
What is the treatment of Legg-Calvé-Perthes disease?
Abduction brace
Retain spherical shape of the femoral head
Continue WB with the femur in abducted position so that the head is well contained by the acetabulum
Surgical: varus osteotomy
What is Slipped capital femoral epiphysis (SCFE)?
Separation of proximal femoral epiphysis through the growth plate
What is the onset of Slipped capital femoral epiphysis (SCFE)?
9 to 15 years
Boys > girls
Blacks > whites
What is the clinical presentation of Slipped capital femoral epiphysis (SCFE)?
Dec internal rotation, abduction
Affected leg in external rotation
Endomorphic habitus
What is the treatment of Slipped capital femoral epiphysis (SCFE)?
Surgical pinning
What is the cause of 80% of scoliosis?
Idiopathic
What is the curve pattern in infantile scoliosis?
Left thoracolumbar
What is the curve pattern in juvenile scoliosis?
Right thoracic or double curve
What is the curve pattern in adolescent scoliosis?
Right thoracic 1
Right thoracic/left lumbar 2
What is the treatment of idiopathic scoliosis?
1–20°: Observation
20–40°: Brace
>40°: Surgery
What is the treatment of neuromuscular scoliosis?
1–20°: Observation
20–40°: Surgery
What is the treatment of scoliosis in CP?
1–20°: Observation
>40°: Surgery, may wait until 60° in some cases
What is Scheuermann’s disease?
≥3 consecutive thoracic vertebrae are wedged >5°
What is the MCC of Spondylolisthesis in children?
Dysplastic and isthmic types
Occur MC at L5–S1 and then at L4–L5
What is isthmic spondylolisthesis?
Vertebral body slippage d/t spondylolysis from fx of the pars interarticularis
What is dysplastic spondylolisthesis?
Congenital malformation of the facet joints at the lumbosacral junction with pars elongation or attenuation
