Common Orthopedic Problems in Children (Week 4--Yazdani)

Question 1

Etiology of Developmental Hip Dysplasia

Answer 1

Usually due to mechanical factors: breech presentation, oligohydramnios, cerebral palsy, arthrogryposis

Increased estrogen and relaxin

Poorly formed acetabulum

Question 2

Screening for Developmental Hip Dysplasia

Answer 2

Girls:boys is 6:1

Screening use Barlow and Ortolani test: dislocation and relocation; Galeazzi sign: knee height discrepancy (shorter hip is bad/dislocated one)

Girls in breech position need to have ultrasound in 6 weeks and X-ray in 6 months

1 in 5,000 diagnosed after 15 months

Can get false acetabulum if don’t catch this early

Question 3

Toddler fracture

Answer 3

Spiral fracture of distal tibia (rotate, so because bone soft, fractures)

9 months to 3 years

Pathology

May not be obvious on x-ray

Resembles foot injury

Commonly mistaken for abuse

Question 4

Toxic synovitis

Answer 4

Presents with acute onset overnight

Patient refuses to walk or has a limp

Nearly full ROM if done slowly

Frog leg x-ray is helpful

Bed-rest and NSAID to treat but hospital traction for more severe cases

If recurs or does not resolve, do lab or radiographic studies

Question 5

Slipped capital femoral epiphysis

Answer 5

Etiology unclear but associated with obesity, abnormal shape of femoral head and neck and possibly endocrine factors and radiation

Presents with limp and knee pain

Pathognomonic sign: obligatory external rotation when hip flexed

Girls younger than boys

Usually slow gradual slip, but may be acute

A/P and frog leg x-ray to diagnose

Surgery promptly to treat

Can get avascular necrosis of the femoral head, achondrolysis

Question 6

Osgood Schlatter

Answer 6

Affects tibial tubercle

Boys: girls is 4:1

Treatment is rest, proper training, NSAIDs

Excellent prognosis

Question 7

Supracondylar fracture

Answer 7

Orthopedic emergency

Abnormal posterior fat pad

3-6 years old

Significant pain and swelling

Severe trauma to outstretched arm during fall

Closed reduction and percutaneous pinning to treat

Complications: proximity to brachial artery in distal arm; Volkman ischemic contracture (fascia swells up and compresses nerves and arteries); cubitus varus (decreased carrying angle)

Get Volkman contracture if got to it too late and swelling is bad or if cast too tight

Question 8

Torus (buckle) fracture

Answer 8

Distal radius fracture

Happens with very little pressure, is very common

Back cortex disrupted from compression injury while front cortex stretched but doesn’t break (bc kids have a good periosteum)

See a bump on the hand

Stable injury but treated with cast for short time

Question 9

Legg-Calve-Perthes Disease

Answer 9

Generalized constitutional disorder of growth (can’t predict who’s going to get it)

Compromised blood flow

Limping or pain in child that gets worse with activity

Epidemiology: shorter than normal, male with fair features, active

Treat with brace/surgery to keep femoral head in socket

(cannot revascularize)

Question 10

Nursemaid’s elbow

Answer 10

Due to pulling on hyperextended arm; sliding dislocation and trapping of annular ligament in radio-humeral joint

Toddler refuses to use arm and holds it in bent, internally rotated arm

Treat with rotation, supination and flexion of arm; if not improved function in 20 minutes, then x-ray the elbow

Question 11

Volkman ischemic contracture

Answer 11

Fascia swells up and compresses nerves and arteries

Happens with supracondylar fracture

Get Volkman contracture if got to injury too late and swelling is bad or if cast too tight