Developmental Orthopedics Flashcards
1
Q
Infant LE Alignment
A
- General kyphosis
- hips flexed, abducted, & ER
- knees flexed & varus
- ankles valgus & feet DF
2
Q
Development of Mature Alignment
A
- decreasing kyphosis, coxa valga, & reduction in femoral anteversion with extensor activation
- knee: increased compression on medial side facilitates medial epicondyle growth to decrease varum
- ankle: compression on lateral side directs shape & development of talus & calcaneus
3
Q
Osteogenesis Imperfecta (OI)
A
- brittle bone disease
- genetic disorder characterized by bones that break easily without specific cause
- 8 Types
4
Q
OI Type I
A
- most common
- mildest form
- collagen normal in quality but abnormal (low) quantity
- bones fracture easy; low muscle tone
- mostly occurs before puberty
- stature near normal or slightly shorter
- tendency toward spinal curvatures
5
Q
OI Type II
A
- most severe form
- collagen abnormal in both quality & quantity
- newborns severely affected
- few survive to adulthood
- severe bone deformity from fractures
- new gene mutation
- small stature with small chest & under-developed lungs
6
Q
OI Type III
A
- collagen is abnormal in quality but normal quantity
- bones fracture easy & cause deformity
- small stature
- birth fractures common
- loose joints
- barrel-shaped rib cage
- triangular face
- spinal curve
- possible respiratory problems
7
Q
OI Type IV
A
- between type I & III in severity
- fair quantity but moderate quality of collagen
- bones fracture easy, mostly before puberty
- teeth problems
- spinal curvatures
- possible hearing loss
8
Q
PT Role in OI
A
- parent education about positioning & handling
- fracture prevention
- acquisition of age-appropriate gross motor skills
- independence with ADL’s
- Adaptive equipment
9
Q
Developmental Dysplasia of the Hip
A
- congenital condition of hip joint
- acetabulum may be shallow (allows sublux) or femoral head may not have formed correctly
- Females > Males
10
Q
Risk Factors of DDH
A
- MULTIFACTORAL
- low amniotic fluid levels
- first child
- small uterus/large baby
- breech
11
Q
DDH Symptoms
A
- Newborn: may move less, leg appears turned out, shorter, folds in skin of thigh appear uneven, space between legs looks wider than normal
- Young Child: “waddle”, toe walk, limited abduction, leg appears shorter
- Assessed with ultrasound (<6 months) or Ortolani & Barlow maneuvers
12
Q
DDH Treatment
A
- Pavlik Harness: used on babies up to 6 months to hold hip in place while allowing legs to move
- worn full time 6+ weeks, then part time another 6 weeks
- may not be completely successful
- traction, casting, or surgery may be required if still dislocated
- surgery required if diagnosed after 2 years
13
Q
PT Role in DDH
A
- promote normal motor development
- preserve ROM/strength
- positioning & transfer training
- adaptive equipment
14
Q
Arthrogryposis Multiplex Congenita (AMC)
A
- group of diseases that involve joint contractures in 2+ areas
- Amyoplasia (impaired blood circulation to fetus in 1st 2 months of pregnancy, damaging anterior horn cells) is most common
- PT/OT, then orthotics, then surgery
15
Q
Treatment of AMC
A
- passive ROM/stretching
- serial casting
- splinting/orthotics
- strengthening
- adaptive equipment
- post-op rehab
- parent education
16
Q
Clubfoot
A
- congenital foot deformity affecting bones, muscles, tendons, & blood vessels
- Boys > Girls
- true clubfoot is rigid & stiff
17
Q
Treatment of Clubfoot
A
- Serial manipulation/casting, taping, splinting, PT
- Ponseti Method: casting 3-4 days/week for 3+ weeks
- corrected in 2-3 months
- recommended treatment at diagnosis, even at only 1 week old
- braces worn 23 hours/day for up to 3 months, then nightly for 2-4 years
18
Q
PT Role in Clubfoot
A
- manipulation/casting
- positioning/adapting activities
- facilitation of normal development & progression of motor milestones
19
Q
Congenital Limb Defects
A
- unknown cause
- Risk factors: conditions affecting baby in utero or pre-natal exposure to some chemicals, medications, or viruses
- Longitudinal: overgrowth or undergrowth
- Transverse: most commonly absence of limb
- Other: failure of portion of limb to separate or duplication
20
Q
PT Role in Congenital Limb Defects
A
- promote motor development
- accessibility, orthotics, adaptive equipment
- independence
21
Q
Leg Length Inequality
A
- congenital, traumatic, NM, or pathological
- causes compensatory MS impairments, gait deviations, inefficient gait, pain, etc.
22
Q
PT Role in Leg Length Inequality
A
- orthotics
- treatment of cause (if NM)
- treatment of gait deviations
- progression of gross motor milestones
23
Q
Genu Varum
A
- Bow Legs
- exaggerated outward bend of legs from knees down
- developmentally appropriate in infants
- 2+ years old or unilateral = red flags
- usually corrects itself if no other pathology present
24
Q
Genu Valgum
A
- Knock Kneed
- exaggerated outward flare of legs from knees down
- developmentally appropriate in kids under 3
- associated with obesity, anteversion, out-toeing, & pes planus
- surgical intervention may be needed beyond 2 years, unilateral, or nonsurgical treatment ineffective
25
Legg-Calve-Perthes Disease Phases
Phase 1: blood supply absent, hip becomes inflamed, stiff, & painful
- can last for several months to a year
Phase 2: body resorbs dead bone cells & replaces them with healthy bone cells
Phase 3: femoral head continues to remodel back into round shape with new bone
Phase 4: Femoral head fully reformed with permanent new bone cells
26
Slipped Capital Femoral Epiphysis (SCFE)
- condition where head of femoral bone slips off
- causes loss of ROM & pain
- boys > girls
- usually develops during growth spurts
- Mild: 1/3 femoral head slips off femur
- Moderate: 1/3 - 1/2 femoral head slips off femur
- Severe: more than 1/2 femoral head slips off femur
27
SCFE Risk Factors
- obesity
- medications (steroids)
- thyroid problems
- radiation treatment
- chemo
- bone problems related to kidney disease
28
SCFE Symptoms
- poorly localized pain in groin, hip, thigh, knee
- aggravated by PA & relieved with rest
- limited ROM
- chronic: walks with limp & leg is ER
- acute: immediate pain, limp, and/or unable to WB
29
PT Role in SCFE
- treat pain
- gait training
- ROM
- strength
- NM re-education to correct body mechanics
30
Legg-Calve-Perthes Disease
- transient condition in which femoral head temporarily loses blood supply
- damages femoral head & causes deterioration
- Males > Females (boys that are small for their age but active)
- 4-10 most common, 5-12 common as well
- typically unilateral
- gradual onset of limp
31
PT Role in Legg-Calve-Perthes Disease
- traction & rest for pain
- modalities as appropriate
- prevent deconditioning
- ensure proper mechanics
- taping/bracing/casting
- adaptive equipment
- ROM/strength
