OnlineMedEd - Surgery: Subspecialty: Ortho Peds Flashcards
Developmental dysplasia of the hip (DDH) presents in what age group?
Newborn
How is DDH diagnosed?
Newborns need to have their hips evaluated using the Ortolani and Barlow tests. If you feel clicking, then the baby needs to be reevaluated at four weeks. If there is persistent clicking, then you do an ultrasound to assess for dysplasia.
Describe the test used to evaluate newborns’ hips.
The newborn hip exam is done with the Ortolani and Barlow tests.
- In the Ortolani test, you abduct the legs when the hips are flexed (like the frog-leg position). With the legs in that position, you apply pressure from the backside of the femur (pressing anteriorly from the posterior femur). If the hips are dislocated, then you will feel a click.
- The Barlow test is done by flexing the hips and then pressing posteriorly on the femur (essentially trying to dislocate the hip). You then do the Ortolani test to feel for dislocation.
How is DDH treated?
Put the child in a harness to align the hip joint and strengthen the bond.
Define antalgic gait.
Antalgic gaits are abnormal gaits that are done to eliminate pain (antalgic = anti algia… get it?). Typically the swinging phase is shortened.
Legg-Calvé-Perthes disease typically presents around age _____________.
six
What is the typical presentation of LCP?
Insidious onset of pain with walking
You need to do a frog-leg x-ray to evaluate for _____________.
slipped capital femoral epiphysis (SCFE)
How can age be used to predict the diagnosis of hip problems in a child?
- Newborns: developmental dysplasia of the hip
- 6-year-olds (and around): Legg-Calvé-Perthes
- 12-year-olds: slipped capital femoral epiphysis
The wild card is septic joints –these can occur at any age.
How can you differentiate transient synovitis from septic arthritis?
The Kocher criteria help predict septic arthritis: the presence of fever, swelling, elevated WBC, and elevated ESR all suggest septic arthritis as opposed to viral transient synovitis.
Osgood-Schlatter is also known as ____________.
osteochondrosis
What’s the typical presentation of Osgood-Schlatter?
Knee pain and tibial swelling in a teenage athlete
What are the treatment options for Osgood-Schlatter?
Because Osgood-Schlatter is almost always found in teenage athletes –and is in fact caused by excessive activity –the main treatment is by resting it. If you don’t rest it, then the consequence is usually ongoing pain with activity with resultant tibial protuberance once the growth plate fuses.
Scoliosis most often presents with _______-leaning.
rightward
What physical exam evaluates for scoliosis?
The Adams test
You have the patient bend over while examining their back and shoulders. If one shoulder is higher than the other at the maximum bend, then that is a positive screen.
If the Adams test is positive, then an x-ray is indicated.
