Ortho Flashcards
erb’s palsy
upper brachial plexus inury C5,6.
P: flaccid arm asylum moro reflex. internally rated with elbow extended. fingers flexed= waiter’s tip
klumpke’s palsy
lower brachial plexus C7,8.
P: claw hand. unopposed finger flexion and decr ability to extend elbow and flex wrist. horner’s if SNS damaged
brachial plexus injury
erb’s palsy, klumpke’s palsy
dx: CMG.
tx: oberserve and RoM physical therapy to prevent contractors. improve in 48hr. surgery if it doesn’t
nursemaid’s elbow
subluxation of radial head. pulling toddler upward by hand.
P: sudden pain, hard to localize. elbow flexed. no swelling. don’t want to use arm though hand func is nl.
dx: P.
congenital torticollis
uterine constraint or birth trauma that cause contracture of SCM
P: head filtered toward affected site. chin pt away from contractor. stiff. mass in SCM may be bleeding into M. asm of head/ears if no tx
dx: PE.
tx: stretching exercise. helmet to correct shape
C: skull deformity.
acquired torticollis
cervical adenitis. peritonsillar or retropharyngeal abscess, cervical diskitis, osteomyelitis, neoplasm
atlantoaxial instability
unstbale J btw occiput and 1st cervical vertebrae
P: normal. asx. suspect in down’s, skeletal dysplasia. minor trauma can cause spine injury
dx: lateral flexion extension radiograph of C spine
tx: fuse C1/2
C: paralysis death
scoliosis
lateral curvature of spine.
80% idiopathic, due to leg length discrepancy, NMD, CTD
P: asxm shoulder ht, scapular position and wasitline. bend over- hump = posterior displacement of curved spine. no pain.
dx: PE, PA and lateral spine sray.
tx: bracing prevent progression during growth.
tx: surgery if cobb’s angle >50 post puberty, >40 prepuberty
spondylolysis
stress fracture in pars interarticularis. due to repetitive hyperextension of spine - gymnastics, tennis, diving. incr pain with hyperextension
dx: lumbar spine SCPECT or bone films
tx: analgesics. cast if persist
C: sponylolithesis- subluxation of vertebra- surgery if N impingement, pain, progression
diskitis
infection (aureus), or inflame of intervertebral disk.
P: sx of URI or minor trauma. then tenderness over disk. fever. decr mobility
dx: ESR incr. MRI
tx: bed. antistaylcoccal antibiotics
developmental dysplasia of hip
acetabulum is abnormally flat cause easy dislocation.
dx; barlow and ortolani, galeazzi. asx abduction of hips and thigh or buttock folds
dx: PE. US in infants bc femoral head doesn’t ossify until 4-6mo. AP radiograph if >6mo
tx: earlier= less likely need surgery. pavlik harness- stimulate formation of normal cup shape.
C: avascular necrosis, limb discrepancy, painful gait, osteroarthritis
limp dd
septic arthritis, transient synovitis, leg calve perches, SCFE
septic arthritis
orthopedic emergency
peak 1-3yo. hip in younger, knee in older. s aureus or strep progenies
P: fever, irritability, can’t walk, pain with mV, flexed, abducted, external rotation. erythema, swelling, asm soft tissue fold.
dx: high WBC, ESR CRP. blood culture psi in 1/2. US see fluid in J capsule.
tx: surgical decompression. emperic IV antibiotics to coger gram pos 4-6wks
C: avascular necrosis and cartilaginous damage
transient synovitis
toxic synovitis. self limtited post infectious response of hip J. URI or diarrhea prodrome. dx of exclusion.
EPi: most common cause of painful limp in toddler. peak 2-7yo.
P low grade fever, limp, appear well. hip pain acute of insidious.position ~ septic J.
Dx: Hx and PE, WBC and ESR nl or slightly high. effusion at hip- aspirate to r/o septic arthritis.
tx: NSAID.
legg calve perthes
idioapthic necrosis of femoral head.
4-9yo. M>F. active thin boys small for age
P: painful limp decr internal rotation, abduction of hip. log rolling leg internally. pain refer to knee and groin
dx: AP and frog leg lateral radiograph. incr density in afferected femoral head or screaentic subchondral fracutre in femoral head= crescent sign
tx: containemnt, -faciliate molding and reossifying. physical therapy. surgery if >50% damage to femoral head
prog- better if young. resolve in 2y. older kids dev OA in hips as adults
SCFE
obese adolescent boy
P: painful limp in groin hip or knee, internal rotaiton, flexion and abduction. 30% b/l, higher in hypothyroid pt.
dx: AP and frog leg lateral film. klein line. - doesn’t cross epiphysis
tx: pinning epiphysis to prevent further slippage.
C: avascular necrosis, chondrolysis, limb dif, OA
osteomyelitis
onset
LE torsional abn
in toeing (most correct with growth): metatarsus adductus, talipes equinovarus, internal tibial torsion
out-toeing:
angulation of the knee: bowed legs, blond’s disease, know knee
metatarsus adductus
medial curvature of mid-ft. in
talipes equinovarus
aka club foot. fixed foot inversion with no flexibility. bl in 50%
genetic. associate with DDH, myotonic dystrophy
P: ankle in plantar flexion and inversion, little RoM
dx: PE
tx: casting or surgical
good prog
internal tibial torsion
medial rotation of tibia that cause ft to pt inward
epi: most common cause of intoning in u/l.
tx: observe be resolve by 5yo
femoral anteversion
medial femoral torsion. epi: most common cause of in toeing in >2yo. ft and patella pt medially. hips can internally rotate more than nl. sit in W position. observe bc resolve by 8yo
out-toeing
mostly due to calcaneovalgus foot. flexible ft held in lateral position. due to uterine constraint.
P flantar flexion restricted. tx: stretch foot. rare cast. self limited
Painful limp STARTSS HOTT
septic arthritis, transient synovitis, acute rheumatic fever, rheumatoid arthritis, trauma (fracture strain or sprain, Sickle cell disease, SCFE, Henoch schonlein purport, osteomyelitis, TB, tumor (osteosarcoma, leukemia)
bowed legs
genu varum. nl
blount’s disease
tibia vara. grogressive angulation at proximal tibia.
obese AA boys who are early walkers= overload injury to medial tibia growth plate causing only inhibited growth on medial side
P: bowed legs. lateral thrust with gait.
dx- bowing after 2yo.
tx: bracing, surgical osteotomy if >4yo or severe
OA common if not corrected
knock knees
menu valgum. idioapthic angulation toward midline
3-5yo. most due to overcorrection of gene vacuum
P: sep ankles when standing with knees together. swinging legs laterally when walking
tx: observe. surgery if >10yo or pain
can cause OA
aussogt schlatter disease
inflm or micro fracture of tibial tuberosity due to overuse
epi: apophysitis - inflm of tuberosity. onset 10-17yo
P: swelling of tibial tuberosity and knee with pt tenderness over tubercle. pain with extension against restistance. worse with running
dx: PE and hx
tx: rest, stretching, analgesics
patellofemoral syndrome
sligh alignment of patella causing knee pain.
worse with activity
sunrise view radiograph
tx: rest, stretching, stengthen medial quadriceps
supracondylar fracture
FOOSH. risk if
forearm fracture
colles- distal radius. monteggia- proximal ulna with dislocation of radial head. galeazzi- radius F with distal radioulnar J dislocation
dx: open or closed reduction + splinting. cast in 4-7d after swelling resolves. heal 6-8wks
femur fracture
dx: AP and lateral sray. look at J above and below injury. cast 8wks.
toddler’s fracture=
spiral fracture of tibia.
mild or no trauma. figural intact
9mo-3yo. trips and falls when playing.
P: can’t bear wt, erythema, swelling, mild pt tenderness.
oblique view of tibia show fracture line,
tx: long leg cast 3-4wks
child abuse fractures
metaphyseal fractures, 1st rib fracutres, somplex skull fracture, scapular, sternal and vertebral spinous process fracture
