Ch 44: Peds Musculoskeletal Flashcards
Developmental Dysplasia of the Hip
head of the femur is seated improperly in the acetabulum of the pelvis
Acetabular Dysplasia (preluxation) (DDoH)
mildest form
neither subluxation nor dislocation
delay in acetabular development occurs
femoral head remains in acetabulum
Subluxation (DDoH)
incomplete dislocation of the hip
femoral head remains in acetabulum
stretched capsule and ligamentum teres causes head of the femur to be partially displaced
dislocation (DDoH)
femoral head loses contact with acetabulum and is displaced posteriorly and superiorly over fibrocartilaginous rim
ligamentum teres is elongated and taut
Galeazzi’s sign, Allis’ sign
shortening of the limb on the affected side (DDoH)
Ortolani’s test (DDoH)
meaneuver is a test to assess for hip instability. examiner abducts the thigh and applies gentle pressureforward over the greater trochanter. a “clunking” sensation indicated a dislocated femoral head moving into the acetabulum.
Barlow’s test (DDoH)
examiner adducts the hips and applies gentle pressure down and back with the thumbs. in hip dysplasia, the examiner can feel the femoral head move out of the acetabulum.
Trendelenburg’s sign (DDoH)
child stands on one foot and then the other foot, holding onto a support and bearing weight on the affected hip; the pelvis tilts downward on the normal side instead of upward, as it would with normal stability.
Pavlik harness
DDoH: birth to 6 mo
worn continuously until ~3-6mo
hip spica cast
DDoH: 6-18 mo
following reduction under general anesthesia
worn for 2-4 mo until hip is stable
then flexion abduction brace for ~3mo
CF: talipes varus
inversion or bending inward
CF: talipes valgus
eversion or bending outward
CF: talipes equinus
plantar flexion in which the toes are lower than the heel
CF: talipes calcaneus
dorsiflexion in which the toes are higher than the heel
clubfoot treatment
manipulation an dcasting are performed weekly for about 8-12 wks
splint is then applied if casting and manipulation are succesful
surgical intervention may be necessary if normal alignment is not achieved by ~6-12 wks of age
Adam’s test
(scoliosis)
asymmetry of the ribs and flanks is noted when the child bends forward at the waist and hangs the arms down toward the feet
scoliosis post op
monitor for superior mesenteric artery syndrome:
caused by mechanical changes in the position of the child’s abdominal contents during surgery
superior mesenteric artery syndrome symptoms
emesis and abdominal distention similar to what occurs with intestinal obstruction or paralytic ileus
Marfan Syndrome
disorder of connective tissue that affects the skeletal system, CV system, eyes, and skin
Marfan Syndrome caused by -
defects in the fibrillin -1 gene, which serves as a building block for elastic tissue in the body.
disorder may be inherited.
no cure.
Marfan Syndrome symptoms
tall and thin body structure: slender fingers, long arms and legs, curvature of spine
visual problems
cardiac problems
Juvenile Idiopathic Arthritis meds
NSAIDS Methotrexate Corticosteroids Tumor Necrosis Factor Receptor Inhibitors Slower Acting Antirheumatic Drugs
(JIA meds) NSAIDS
first meds used
GI irritation and easy bruising
(JIA meds) Methotrexate
used is NSAIDS ineffective
CBC and LFTs monitored closely
