Developmental & Congenital Orthopaedics -Dr. Hood

Question 1

*What is idiopathic scoliosis?

Answer 1

Fixed lateral curvature measuring > 10° in coronal plane

common right thoracic

more common and severe in females

*< 10 degrees=spinal asymmetry

Question 2

What are the 3 classifications of idiopathic scoliosis?

Answer 2

Infantile (0-3)
Juvenile (3-10)
Adolescent (>10)

based off age

Question 3

*What are the 3 types of scoliosis?

Answer 3

idiopathic

congenital: Abnormal Vertebrae (failure of formation or failure of segmentation)
neuromuscular: Accompanying Syndromes

Question 4

*What is peak growth velocity? When does this take place in females? When is it likely that pts will require surgery?

Answer 4

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

Question 5

What is the Cobb angle?

Answer 5

measure the curve based off the vertebrae that is most tilted on either end draw line out cobb angle

Question 6

What is the Risser staging a measurement of?

Answer 6

Ossification of iliac crest apophysis

Lateral to medial

Estimates skeletal maturity

maturity=5

Question 7

*When is surgery indicated for scoliosis ?

Answer 7

> 55 degree curvature

absolutely

Question 8

What is the goal of bracing of scoliosis?

Answer 8

doesn’t correct curve, but keep from progressing

Question 9

What is the goal of scoliosis surgery?

Answer 9

a well-balanced spine, not necessarily a straight spine

Question 10

*What is the genetic component for Achondroplasia?

Answer 10

FGFR-3 gene

Question 11

What is achondroplasia?

Answer 11

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

Question 12

*What are the ortho concerns for achondroplasia patients (2)?

Answer 12

spinal stenosis (especially lumbar) from short pedicles

and can have cervical foramen stenosis –> can present with apnea –> dissipates with growth

Question 13

What is the most important part of the PE for a kiddo with in-toeing?

Answer 13

rotational profile

Gait: determine foot progression angles

1. Assess hip rotation
2. Assess tibial rotation
3. Determine the alignment of the foot

Gait is controlled by CNS and affected by lower limb alignment

Question 14

What position will kids with femoral anteversion sit in? What are some other symptoms of femoral ante version?

Answer 14

“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

Question 15

*What is the best thing to do for most in-toeing?

Answer 15

observation and reassurance

most rotational issues will resolve on their own

Question 16

What is talipes equinovarus?

Answer 16

club foot

Question 17

how is idiopathic club foot treated? What about secondary?

Answer 17

idiopathic (CTEV) : serial casting

acquired: often needs surgery

Question 18

What are the 3 main principles with Congenital Talipes Equino-Varus (CTEV)?

Answer 18

Abnormal Intertarsal Relationships

Congenital Subluxations –>Talo Calcaneo Navicular Joint

Soft Tissue Contractures

–> early detection is key! and make sure to exclude other diagnoses

Question 19

What is the goal of treatment for CTEV?

Answer 19

functional, painless and stable foot –> want it to be plantigrade

cosmetics is a secondary goal

Question 20

*What is the gold standard treatment for club foot?

Answer 20

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)

Question 21

What is the most reliable exam finding for hip dysplasia in kids > 3 months?

Answer 21

limited hip abduction

Question 22

*What imaging study should be used on kids 1-2 months of age? > 3 months? Why?

Answer 22

US=1-2 months

xray=3+ months

femoral head not ossified in younger kids –> can’t see

Question 23

What is goal of treatment for DDH? How is it treated in babies 0-6 months

Answer 23

containment of the hip

0-6 months: pavlik harness
–> if unsuccessful–> spica cast

Question 24

What is the end stage treatment for kids with DDH over the age of 2?

Answer 24

pelvic or femoral osteotomy (cut and reposition the hip)