Diseases Week 6 Flashcards
Developmental Hip Dysplasia
Treatment - Pavlik haness –> holds hips flexed and abducted. 95% success rate. Contraindicated in spina bifida cases. Stop use if it isn’t working because it leads to more difficult future reduction.
Risk factors: Breech birth, torticollis, cultural factors (Onishinabe and Pima), swaddling, family history
Epidemiology: 9 in 1000
Diagnosis - Ortolani - not click reduction maneuver or Barlows dislocation maneuver. Galeazzi - apparent leg length discrepency.
Reduction difficulty increases with age.
Imaging - US (tech dependent) and X ray in 4-8 months.
Perthes Disease
Pathogenesis: Vascular insult to femoral epiphysis. Always heals back.
Clinical presentation- insidious limp, mild to moderate pain, hip thigh, or KNEE pain. (when you see a ped’s knee think hip!)
Treatment: Restore ROM (Rest, NSAID, PT, Casts, surgical muscle release)
Most common age 4-8, range 3-12.
Boy:Girls = 5:1
89% have delayed bone age/ shorter children
Slipped Capital Femoral Epiphysis
Etiology: Mechanical factors, renal osteodystrophy, radiation, hypothyroidism, and GH deficiency.
Clinical features: limp - external rotated gait, limited internal rotation and flexion, pain in thigh or knee
Types: Acute ( less than 3 weeks), Chronic, Stable (can walk), unstable (can’t walk)
Graded based on XR 1,2, or 3.
Treatment: surgery (prophylactic pinning of contralateral side w/ risk factors
Epidemiology: Males:Females = 2-1, obesity, ages boys 12-15 and girls 10-13
NEED HIGH INDEX OF SUSPICION - debilitating if missed Refer immediately.
Blounts Disease
Osteochondrosis. Deformity proximal medial tibia epiphysis. Fragmentation of tibial plateau.
Most common to black children.
Treatment: Brace when younger than 2.5 years old. Osteotomy when older.
Genu Valgum
Bowed legs. Usually physiologic, symmetric, and apparent after 2 years. Naturally remodels.
If increases over time may need treatment.
Patellar subluxation association.
Metatarsus Adductus
Medial deviation of forefoot on hind foot.
Spontaneous resolution with excellent resolution. Stretching, casting.
Talipes Equinovarus (Clubfoot)
Pathology = forefoot adductus, hindfoot equinus, varus, cavus, shortening of foot, atrophy of calf.
Treatment - series of casts after birth, 75% successful. Bracing to prevent recurrence. Often achilles tenotomy,
Refer all patients in first two weeks of life.
Rigid flatfoot
Congenital synostosis or failure of segmentation betwen 2 or more tarsal bones.
Types: Calcaneonavicular, talocalcaneal, talonavicular, calcaneocuboid, cubonavicular.
