Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pediatrics > Hip dysplasia and orthotics > Flashcards

Hip dysplasia and orthotics Flashcards

1
Q

At birth, the acetabulum covers about ___ of the femoral head

A

⅓

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When is ossification complete in the hip?

A

13 - 16 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When does the junction between the epiphysis and bone begin to interlock?

A

2nd year of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the risk factors for hip dysplasia?

A
  1. Mechanical (forces placed)
  2. Physiological (shallow acetabulum)
  3. Environmental
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Incongruency of the femoral head and the acetabulum leading to increased risk of subluxation and dislocation.

A

developmental hip dysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most reliable sign for hip dysplasia clinically?

A

hip abduction ROM
- Normal: 75-90
- Asymmetry of 5-10 degrees with hip abduction
Other indicators: uneven skin folds
Diagnostic tool: 0-6 months = ultrasound, >6 months = xray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Barlow’s Maneuver:

Start in abduction and move to adduction with pressure posteriorly. What is a positive sign?

A

hip subluxation

- move to ortolani’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Ortolani’s Sign

Start in adduction and move to abduction with slight traction-hip slides back into place. What is a positive sign?

A

Positive if one hip is less stable than the other, or if a hip is dislocated
- always start with Barlow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When is Barlow and ortolani tests relevant?

A

up to 2-3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

80% resolve without surgical intervention. What is the treatment of choice (ages 0-9 months, >9 months, 18-24 months, >2 years)?

A
  • 0-9 months = Pavlik Harness for treatment
  • > 9 months = Abduction Orthosis
  • 18-24 months = Traction, Closed reduction surgery with spica cast (hard cast)
  • Over two years = Open reduction surgery
  • if conservative therapy or closed reduction results in open reduction surgery
  • early dx and tx most effective (<7 weeks)
  • harness worn all the time, except for bathing every 3rd day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the proper position of pavlik harness?

A
  • Hip Flexion - Safe Zone: 100-110 degrees (prevent AVN)

- Hip Abduction - Safe Zone: 40-60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are risk factors of the pavlik harness?

A
  1. Avascular necrosis of the femoral head
  2. Femoral nerve palsy
  3. Inferior dislocation
  4. Erosion of the posterior rim of the acetabulum
    - worn 6 wks to 3 months, if not resolved my 3 months, other options considered
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Appliances for any part of the body that serve to support, align, prevent or correct deformities of a body part, or improve the function of moveable parts of the body

A

orthotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What should you consider when making a foot orthosis?

A
  1. Hindfoot - The Foundation
  2. Forefoot - The Partner
  3. Ankle - The Mover
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Where should the hind foot be positioned for AFOs?

A

subtalar neutral

- determine how much effort is needed to hold the calcaneus in neutral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

After the hind foot, what should you look for with the ankle?

A
  • after hind foot is positioned into subtalar neutral..
    1. How much ROM is available?
  • May want to attempt to achieve more ROM prior to casting
  • May need to post externally if DF ROM is not available
    2. How much voluntary control of the ankle is available?
  • This will determine the proximal trim lines of the DAFO
17
Q

Incorporate design features that are intended to inhibit hypertonia that has resulted from any of the following; Supports the Toes, Longitudinal, Peroneal,and Metatarsal Arch

A

tone reducing/ inhibitive footplates

- attempts to inhibit plantar grasp

18
Q

What are the indications for a PF stop, free DF AFO?

A
  1. Excessive Plantarflexion
  2. Consistent Toe Walking
  3. Little Voluntary Control of the Ankle
  4. Strong Hyperextension of the Knee
  5. **Can use a hinge
    - limitation = no active PF
19
Q

What are the indications for a resist PF AFO?

A
  1. Useful Voluntary Ankle Control
  2. Partial Control of plantarflexion
  3. Mild Resistance to Crouched Stance
    - Limitations - Does Not Control Strong Plantarflexion or Knee Hyperextension
    - need grade 2 strength
20
Q

What are the indications for a free PF/ DF AFO?

A
  • controls eversion/inversion
    1. Strong Fixing Patterns of Pronation and/or Supination but adequate control of plantarflexion and dorsiflexion
    2. Delayed Development with Low Tone
    3. High Level of Floor Activities Requiring Free Ankles - i.e. Infants
  • Limitations - Does not Control Plantarflexion/Dorsiflexion
  • used in Down’s syndrome population
21
Q

What are the indications for a floor reaction AFO?

A
  1. Sink into excessive dorsiflexion through weakness
  2. Lack Ankle Plantarflexion Strength
  3. Lack Knee Extension Strength
    - Limitations - Do not precisely control foot position; Does not Correct Crouch Due to Tight Hip Flexors or Hamstrings
    - contact with patellar tendon to activate quads (pt has weak quads)
    - HAVE to have full passive knee extension for this orthosis
22
Q

What are the indications for a UCB?

A
  1. Functional Ambulators with Moderate Pronation
  2. Excessive Foot Mobility but are Fully Correctable
  3. Pronation is Due to Low Tone, Delayed Development, Poor Proprioception
    - custom submalleolar
    - has active inv/ever
23
Q

What are the indications for a non custom shoe insert?

A
  1. Minimal Pronation in Weight bearing

2. Exhibit Delayed Foot Control Skill, but have Voluntary Control Initiated

24
Q

In kids with CP, orthoses [decreases/ increases] cost of energy expenditure in walking.

A

decreases

- improves gait energy efficiency for basic gait (not running or jumping)

25
Q

Why would you use an orthotic?

A
  1. Correcting the foot to the best possible position of function to provide appropriate stability
  2. Improving standing and walking abilities
  3. Preventing and/or correcting deformity
  4. Maintaining and/or increasing range of motion
  5. Facilitating the development of peripheral skills by diminishing the work and concentration required for standing and ambulation
  6. Protection of weak antigravity muscles
  7. Control of tone
26
Q

Anatomically designed to allow the 5 met heads to contact the ground throughout stance phase during pronation or supination

A

forefoot

- examine after hind foot is placed in subtalar neutral

27
Q

What are the arches named and how far from the ground are they at their hallmark landmarks?

A
  1. Medial Longitudinal Arch - 15 to 18 mm from the ground at the level of the navicular
  2. Lateral Longitudinal Arch - 3-5 mm from the ground at the level of the cuboid
  3. Transverse Arch (no measurement given)
28
Q

Whats the difference between a DAFO and an AFO?

A
  1. DAFOs wrap around the forefoot where AFOs do not

2. DAFOs generally have a footplate where AFOs do not

29
Q

The use of AFOs during gait, produced a statistically significant increase in _____ and ______, no significant difference in ______, and _______, compared to barefoot condition.

A

velocity; stride length; cadence; stride width

- DAFOs have similar effect of AFOs, so when getting orthoses individual factors need to be considered

30
Q

What are benefits of orthoses for kids with CP? DS?

A 
CP = lowers cost of walking
DS = improved postural stability
31
Q

How do you break in an orthotic?

A
  1. Wear breathable socks that cover the entire portion of the leg in contact with the orthotic
  2. First day wear the orthotic for 1-2 hours and increase wear time by 1 hour each day; Assess the skin after removing the orthotic
  3. If signs of Pressure/Breakdown Immediately Discontinue Wearing and Modify the Orthotic
32
Q

What are the signs of pressure/ breakdown from an orthotic?

A
  1. Redness that does not go away in 15 minutes
  2. Blisters
  3. Callouses
  4. Pain response by the Child
33
Q

What does a PT assess in fit and function of an orthoses?

A
  1. Overall fit
    - Heel position (statically and dynamically)
    - Is the heel in neutral (0-2 degrees of varus or valgus)
    - Is the medial, lateral and metatarsal arch supported
    - Is there any indication of redness or breakdown
  2. Is the child stable in standing?
  3. Can they do all functional activities that they were doing previously
    - What if the child cannot do what they were doing previously?

Pediatrics (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions