Ch. 17 Orthopedics Flashcards
Atlantoaxial instability
Unstable joint between occiput and first cervical vertebrae or between 1st and 2nd cervical vertebrae –> can compress spinal cord
(behavioral changes, torticollis, urinary incontinence, vertigo, diplopia)
Seen in 10-15% of pts with Down Syndrome
Mgmt: Fusion of C1 and C2 if instability is severe
Klippel-Feil syndrome
Failure of normal vertebral segmentation that results in relative fusion of involved vertebrae
Fusion occurs in cervical spine but can occur in lumbosacral vertebrae
Associated abnormalities: congenital torticollis, GU anomalies, congenital heart disease, hearing loss, and sprengel’s deformity (congenital abnormality of scapula in which scapula is rotated laterally leading to shoulder assymetry and diminished shoulder motion)
Most common cause of back pain in children
Back strain
Spondylolysis
Spondylolisthesis
Spondylolysis: Stress fracture in the pars interarticularis (i.e. bone that connects the superior and inferior articular facets of vertebral body) 2/2 repetitive hyperextension of the spine
Spondylolisthesis: Body of vertebra involved in the spondylolysis slips anterior (i.e., subluxation of the vertebra… palpable “step-off”)… the subluxed vertebra can impinge on nerve roots
Slowly developing back pain + neurologic impairment (i.e. bed wetting)
Diskitis
Infection (Staph aureus) or inflammation (idiopathic, trauma, rheumatic disease) of intervertebral disk
URI/minor trauma –> back pain with tenderness over involved disk
+/- fever
Children refuse to flex spine
ESR elevated
MRI to confirm
How does Developmental Dysplasia of Hip (DDH) occur?
Major risk factor?
How to dx? Treatment?
When acetabulum is abnormally flat, leading to easy dislocation of head of femur
Major risk factor: breech presentation
Dx made with U/S in young infants b/c femoral head does not ossify until 4-6 mo
Treatment: Pavlik harness
Differential Diagnosis for Painful Limp
Osgood-Schlatter disease
Inflammation or microfracture of the tibial tuberosity caused by overuse injury
Age of onset: 10-17 yrs
OSD usually occurs in children who participate in sports involving repetitive jumping, such as basketball or soccer. The disease is more common in boys.
What type of fractures are associated with child abuse?
Spiral fractures
Salter-Harris Classification of fractures
Treatment for club foot
Stretching, manipulation, followed by serial casting IMMEDIATELY
What is the most common cause of hip pain in children?
Transient synovitis
B/c characteristics of transient synovitis overlap with septic arthritis, lab studies should be sent to assess severity of inflammation… in contrast to septic arthritis, children with transient synovitis rarely have fever/lab abnormalities
If suspicion for septic arthritis, immediate arthrocentesis and IV abx
Idiopathic AVN that affects boys age 5-7 y/o
Legg-Calve-Perthes disease
What is the most common presentation of SCFE?
Knee pain (referred), not hip pain
Loss of abduction and internal rotation of hip / external rotation of thigh
Treatment: Surgical pinning of the slipped epiphysis where it lies to prevent AVN of femoral head and chondrolysis
Clinical features of serum sickness
Sx occur 1-2 weeks after exposure
Fever, skin rash, polyarthralgia
