Lower Orthopedic Pediatrics - Ferril

Question 1

growth centers begin

Answer 1

iliac crest - 11-14yo
ischial tuberosity - 13-15yo
femoral head - 4 months
greater trochanter - 4-6yo
femoral condyle - 39 weeks fetus
tibial plateau - birth

Question 2

growth centers complete

Answer 2

iliac crest - 20yo
ischial tuberosity - 16-18yo
femoral head - 16-18yo
greater trochanter - 16-17yo
femoral condyle - 16-19yo
tibial plateau - 16-19yo

Question 3

gait

Answer 3

heel strike
foot flat
mid stance
heel of
toe off

repeat

Question 4

genu varus

Answer 4

normal children

Question 5

flat feet

Answer 5

normal in children until 3yo

Question 6

intoeing

Answer 6

metatarsus adductus

Question 7

normal adult gait

Answer 7

not until 5-6yo

Question 8

developmental dysplasia of hip

Answer 8

decreased ROM hip
difficulty diaper change
delayed crawl, stand, walk
gait asymmetry

detection before 6mo best outcome

exam - ortalaniand barlow

Question 9

legg-calve perthes disease

Answer 9

avascular necrosis of femoral head

more in boys

aching groin or prox thigh

worse at end of day

antalgic gait

X-ray - narrowed/irregular epiphysis

Question 10

slipped capital femoral head

Answer 10

SCFE

more in overweight kid - age 10-16yo

pain and antalgic gait
-sudden onset

decreased physical activity

B/L 40-50%

Question 11

osgood schlatter disease

Answer 11

MC pediatric overuse injury

girl - 8-13yo
bot - 10-15yo

20% B/L

repeptive tensile force on developing tibial tubercle

Question 12

type 1 and 2 osgood

Answer 12

1 - soft tissue swelling only

2 - avulsion fraction

Question 13

functional flat foot

Answer 13

big toe passively extended - median arch lift up

Question 14

rigid flat foot

Answer 14

remain flattened with big toe extension

Question 15

innominate in osgood

Answer 15

posterior rotation and alteral flare

increase tensile force across patella

anterior rotation - alter tone knee flexors - influence knee rotation

Question 16

knee extension

Answer 16

tibia rotate laterally

Question 17

tibia cannot ext/int rotate with knee flexion/extension

Answer 17

tensile forces are increased

Question 18

hypertonic sartorius

Answer 18

external tibial rotation

Question 19

pes planus

Answer 19

compensatory internal rotation of tibia during loading

Question 20

keystone of median arch of foot

Answer 20

navicular

Question 21

transverse arch

Answer 21

3 cuneiforms and cuboid

Question 22

cuboid

Answer 22

lateral foot

Question 23

X-ray for hip issue in kid

Answer 23

frog leg - see femoral head in acetabulum

Question 24

associated with SCFE

Answer 24

endocrine disorder

hypothyroid and pituitary deficiency

Question 25

SCFE severity

Answer 25

mild - 0-1/3
moderate - 1/3-2/3
severe - 2/3-3/3

Question 26

tx of SCFE

Answer 26

goal - stabilize

good prognosis

Question 27

OMT goal for SCFE

Answer 27

improve vasc and lymph circulation

Question 28

loss of acetabulum cup on X-ray

Answer 28

with DDH - developmental dysplasia of hip

Question 29

OMT with osgood

Answer 29

tibial rotation
hip restriction
ice, NSAID when severe

Question 30

OMT with metatarsus adductus

Answer 30

only forefoot
hindfoot - flexible

tight medial fascia and adductors of foot

everted calcaneus

lateral long arch flat

posterior fibular head