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Pediatrics > Lower Extremity Deformity/Deficiencies > Flashcards

Lower Extremity Deformity/Deficiencies Flashcards

1
Q

For LLD, which hip is less covered in the tab: the short or long leg?

A

Long leg - pelvis tilts towards the short side leaving the long side less covered

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2
Q

For LLD, which side is a resulting scoliosis more likely to develop on: the short or long leg?

A

Short leg

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3
Q

What age does growth stop for boys and girls

A

B: 16yo
G: 14yo

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4
Q

During the last 4 years of growth, what is the contribution of the physes in the femur and tibia (in order)?

A 
Prox fem: 3mm
Dist fem: 9mm
Prox tib: 6mm
Dist tib: 3mm
Use these + age left to skeletal maturity to calculate total LLD (remember to convert to cm!)
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5
Q

If a patient has LLD from hemihypertrophy, what other screening test should they have done until 6yo?

A

Abd US - screen for embryonal cancers (Wilms tumor, etc)

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6
Q

How do congenital LLD progress over time?

A

Absolute discrepancy increases

Percentage remains constant - short limb will be 70% of the long side at birth and at skeletal maturity

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7
Q

What is the amount of LLD you need to meet surgical threshold?

A

> 2cm

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8
Q

What is Blount’s disease? What are the 2 types?

A

Genu varum
Infantile: osteochondrosis of the prox tib physis + adjacent epiphysis -> physeal bar
Adolescent: varus force on knee inhibits medial physeal growth (Hueter Volkmann principle: compression decreases growth at physis)

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9
Q

RF infantile Blounts

A

Obese
Early walkers
African American
More often bilateral

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10
Q

What metaphyseal diaphyseal angle has a 95% chance of progressive bowing in Blounts?

A

16%

<10% - likely to self resolve

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11
Q

What is the normal progression of LE alignment as children grow?

A

Varus normal until 2yo
Max valgus 3-4yo (up to 20deg)
Should be straight by 7yo

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12
Q

Classification system for Blounts. What are the early vs late changes on imaging?

A

Langenskiold
Early: metaphyseal beaking/sloping
Late: medial physeal closure

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13
Q

What additional procedure should be considered during Blount’s osteotomy to prevent complications

A

Anterior fasciotomy

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14
Q

When is ideal surgery for infantile Blounts

A

If done <4yo, lower risk recurrence

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15
Q

Where should you modulate growth for Blounts

A

Proximal lateral tibia

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16
Q

Name causes of genu valgum

A

Rickets
Physeal injury
Cozen frx (prox tib metaphyseal)
Benign tumors (fibrous dysplasia, etc)

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17
Q

How much valgus is pathologic in kids >7yo

A

> 12deg

>10yo and the limb mechanical axis falls in outer quadrant of the plateau

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18
Q

Treat genu valgum

A

No bracing
Cozen frx self resolves
Skel immature: guided growth
Skel mature: osteotomy

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19
Q

What additional procedure is done during genu valgum osteotomy to prevent complication?

A

IT band release / peroneal nerve release

20
Q

Name 3 causes of intoeing + measurements

A

Babies: metatarsus adductus - heel bisector line
Toddlers: internal tibial torsion - TPA >10deg IR
Older (4+yo): femoral anteversion - IR>70, ER<20

21
Q

What does femoral anteversion mean?

A

Neck is anteverted relative to the transcondylar axis
Therefore, you IR femur to compensate and get the TCA to neutral
Most often presents as patellar medial maltracking/pain

22
Q

What are the physical exam parts for intoeing/rotational profile

A

Foot progression angle during gait
Thigh foot angle prone
Max hip IR/ER

23
Q

What is the trochanteric prominence angle test

A

How much hip IR needed to make GT most prominent laterally

Measure of fem AV

24
Q

What is threshold to treat fem AV surgically? How would you do this?

A

> 8yo (basically watch all intoers until this age for spont resolve)
Unacceptable gait/pain
<10deg hip ER
Derotational osteotomy @ subtroch level

25
Q

Diagnose internal tibial torsion (2)

A 
Transmalleolar axis (bilmal axis vs bicond axis) - normal = 20deg ER
TFA by 8yo 10deg ER
26
Q

What are the 3 most common tibia bows + associated conditions?

A

Antlat - cong tibial pseudoarthrosis, NF
Postmed - LLD, calcaneovalgus
Antmed - fib hemimelia

27
Q

Treat antlat tibial bowing

A
  1. Prevent pseudarthrosis/frx w/ clamshell total contact brace
  2. No osteotomies - high risk pseudoarthrosis
28
Q

Treat postmed bowing

A

Often self resolving

Watch for LLD

29
Q

What is the optimal age for amputation for limb deficiencies?

A

10mo-2yo

Don’t want to hold up walking in developmental cycle

30
Q

What are the Syme and Boyd amputations? Pros/cons?

A 
Syme = ankle disartic
- Tapered so may better fit prosthesis
Boyd = retain calc, fuse to distal tibia
- Prevents heel pad migration 
- Longer so may limit prosthesis options
31
Q

Classification for prox fem def

A

Aitken

  • Is the femoral head present
  • Is the tab present / normal
  • Is the femur normal or short
  • What is the relationship between the femur and tab at skeletal maturity
32
Q

Conditions associated with prox fem def

A

Knee laxity 2/2 cruciate absence
Fib hemi
Absent CENTRAL rays (vs lateral)

33
Q

What is the femoral deformity in PFD?

A

Short
ER
Retroverted neck
Thigh is short, flexed, aBducted, ER

34
Q

Treat PFD

A
  1. Treat prox fem and tab deformities before lengthening
    2:
    Lengthening: LLD< 20 cm, functional foot, stable hip
    Amp vs rotationoplasty otherwise
35
Q

Conditions associated with fib hemi

A 
Absent cruciates
Lateral tib plateau dysplasia -> lat fem condyle dysplasia -> genu valgum 
Ball + socket ankle
Tarsal coalition 
Missing central rays
36
Q

What does the ankle do in fib vs tib hemi

A

Fib hemi - valgus

Tib hemi - varus

37
Q

Which fib hemi classification guides treatment?

A

Birch - severity of LLD and functionality of the foot

38
Q

What inheritance pattern is most commonly seen with tib hemi?

A

AD

39
Q

What upper extremity condition should you check for with tib hemi?

A

Preaxial polydactyly

Lobster claw hand

40
Q

What knee exam finding guides treatment for tib hemi?

A

Presence/absence of active knee extension

No active extension -> amp

41
Q

Trt tib hemi

A

Tib-fib synostosis some success
Centralizing the fibular fails
Amp

42
Q

Conditions associated with congenital knee dislocation

A

DDH

Clubfeet

43
Q

Presentation/treat congenital knee dislocation

A

Knee stuck in extension - no flexion possible
+/- same side hip dislocation
Must treat the knee before the hip/ankle (both Pavlik and club foot cases require knee flexion)
Reduce the knee before flexing -> stretching + serial casing
Surg if needed for reduction/soft tissue releases

44
Q

What procedure should you do with a prox tibial epiphysiodesis if more than 2-3yrs of growth remain?

A

Prox fib epiphysiodesis

45
Q

How should the distal fragment be fixed in Blount’s to avoid under correction?

A

Slight valgus
Lateral translation
ER

46
Q

Can you treat in or out toeing with bracing?

A

No

47
Q

What is a good early radiographic sign that the proximal tibia is absent (worse outcome)?

A

Small, minimally ossified distal femoral epiphysis

Pediatrics (3 decks)

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