Developmental & Congenital Orthopaedics -Dr. Hood Flashcards
*What is idiopathic scoliosis?
Fixed lateral curvature measuring > 10° in coronal plane
common right thoracic
more common and severe in females
*< 10 degrees=spinal asymmetry
What are the 3 classifications of idiopathic scoliosis?
Infantile (0-3)
Juvenile (3-10)
Adolescent (>10)
based off age
*What are the 3 types of scoliosis?
idiopathic
congenital: Abnormal Vertebrae (failure of formation or failure of segmentation)
neuromuscular: Accompanying Syndromes
*What is peak growth velocity? When does this take place in females? When is it likely that pts will require surgery?
Is the best predictor of curve progression
In females it occurs justbefore menarcheandbefore Risser 1 (girls usually reach skeletal maturity 1.5 yrs after menarche)–> when the curve progresses most rapidly
*If curve is >30° before peak height velocity there is a strong likelihood of the need for surgery because it will progress much worse
What is the Cobb angle?
measure the curve based off the vertebrae that is most tilted on either end draw line out cobb angle
What is the Risser staging a measurement of?
Ossification of iliac crest apophysis
Lateral to medial
Estimates skeletal maturity
maturity=5
*When is surgery indicated for scoliosis ?
> 55 degree curvature
absolutely
What is the goal of bracing of scoliosis?
doesn’t correct curve, but keep from progressing
What is the goal of scoliosis surgery?
a well-balanced spine, not necessarily a straight spine
*What is the genetic component for Achondroplasia?
FGFR-3 gene
What is achondroplasia?
Error in Endochondral Ossification (in long bones)
especially in the physis (growth plate) in the proliferative zone
trident hand –> cannot appose long and ring fingers
Flat bones are NOT affected –> normal head and trunk with dysmorphic limbs
excessive lumbar lordosis and shortened pedicles–> spinal stenosis
*What are the ortho concerns for achondroplasia patients (2)?
spinal stenosis (especially lumbar) from short pedicles
and can have cervical foramen stenosis –> can present with apnea –> dissipates with growth
What is the most important part of the PE for a kiddo with in-toeing?
rotational profile
Gait: determine foot progression angles
- Assess hip rotation
- Assess tibial rotation
- Determine the alignment of the foot
Gait is controlled by CNS and affected by lower limb alignment
What position will kids with femoral anteversion sit in? What are some other symptoms of femoral ante version?
“W”
Usually 3-5 yo girls Sits in the “W” “Kissing patellae” “Egg-beater” run Severe if > 90° Resolves with growth - no association with osteoarthritis
*What is the best thing to do for most in-toeing?
observation and reassurance
most rotational issues will resolve on their own
What is talipes equinovarus?
club foot
how is idiopathic club foot treated? What about secondary?
idiopathic (CTEV) : serial casting
acquired: often needs surgery
What are the 3 main principles with Congenital Talipes Equino-Varus (CTEV)?
Abnormal Intertarsal Relationships
Congenital Subluxations –>Talo Calcaneo Navicular Joint
Soft Tissue Contractures
–> early detection is key! and make sure to exclude other diagnoses
What is the goal of treatment for CTEV?
functional, painless and stable foot –> want it to be plantigrade
cosmetics is a secondary goal
*What is the gold standard treatment for club foot?
early detection and SERIAL CASTING (plaster casts)- –> then brace (2nd phase)
success rate is 85-90%
<1/3 require tendon transfer to maintain after casting
NOT surgery (2nd line treatment)
What is the most reliable exam finding for hip dysplasia in kids > 3 months?
limited hip abduction
*What imaging study should be used on kids 1-2 months of age? > 3 months? Why?
US=1-2 months
xray=3+ months
femoral head not ossified in younger kids –> can’t see
What is goal of treatment for DDH? How is it treated in babies 0-6 months
containment of the hip
0-6 months: pavlik harness
–> if unsuccessful–> spica cast
What is the end stage treatment for kids with DDH over the age of 2?
pelvic or femoral osteotomy (cut and reposition the hip)
