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Pediatrics > ORTHO > Flashcards

ORTHO Flashcards

1
Q

If an infant baby was in a breech position, and has generalized hip laxity – what diagnosis? Who is it most common in?

A

Developmental dysplasia of the hip Most common in girls & the left hip!

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2
Q

When developmental dysplasia often present in children?

A

Decreased leg length, limp, asymmetry of skin folds, and loss of motion (abduction)

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3
Q

What tests do we do for DDH?

A

Barlow (dislocation) & Ortolani (relocation)

X-Rays & Ultrasound

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4
Q

What treatment can you do for DDH?

A

Brace/Pavlik Harness (under 6 months)

Casting (>6 months)

Surgical (>2 years)

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5
Q

If a child under 12 and is thin, wirey, and active and has pain with limping, and radiating groin pain that’s worse with activity and limits their ROM – what diagnosis?

A

Legg Clave Perthes Disease

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6
Q

If a child has hip pain, what must you always look at?

A

The entire leg

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7
Q

What’s occurring in Legg-Calve-Perthes Disease?

A

Osteonecrosis & femoral head collapses

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8
Q

What diagnostics would you do for Legg-Calve-Perthes Disease?


A

X-ray (look for crescent sign) MRI or CT

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9
Q

How would you treat legg-Calve-Perthes disease?

A

Observation (often re-vascularizes in 12-18 months), NSAIDS, NO activity, and crutches

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10
Q

If a 12 year old obese male presents with hip pain with a limp and decreased motion that presents suddenly or gradual – what diagnosis?

A

Slipped Capital Femoral Epiphysis

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11
Q

What diagnostics would you do for SCFE?

A

X-Ray – fuzzy irregularities (posterior slip with a hook sign)

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12
Q

How do you treat SCFE?

A

Surgical fixation – it WILL progress if left untreated

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13
Q

What is a sterile effusion of the hip known as?

A

Transient synovitis of the hip or Toxic Synovitis

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14
Q

How does a transient synovitis of the hip?

A

2-5-year-old boy who went to bed normally & won’t get out of bed the next morning.
acute onset, limp, pain in groin, and AFEBRILE

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15
Q

How do you diagnose transient synovitis of the hip?

A

Diagnosis of exclusion – x-ray, blood work, and joint aspiration

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16
Q

How do you treat transient synovitis of the hip?

A

Rest, monitor temp, reassurance

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17
Q

What would cause intoeing & outtoeing?

A

Femoral (anteversion/retroversion) or tibial (torsion) rotation

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18
Q

What are the sxs of intoeing & outtoeing?

A

Present by age 2 with walking – rarely painful

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19
Q

What are 4 diagnostic tests (rotational profile) that we can do for intoeing & outtoeing?

A

Foot progression angle, thigh-foot angle, femoral retro/anteversion, foot adductus

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20
Q

What type of diagnostic looks at the angle of the foot with walking, negative (intoeing) and positive (out-toeing)?

A

Foot progression angle

21
Q

What diagnostic test assesses the amount of tibial rotation with the patient prone and knees bent to 90 degrees (looking down on the foot) – looking for rotation of the foot compared to the femur?

A

Measurement of thigh-foot angle (20-30 degrees of external rotation is normal)

22
Q

What diagnostic test involves swing the lower legs towards/away from each other while prone?

A

Measure femoral ante/retroversion (40-50 degrees in both directions is normal)

23
Q

What diagnostic test looks at the midline of the foot and that it should bisect the 2nd & 3rd MT?

A

Assessment of foot adductus

24
Q

How do you treat intoeing or outtoeing?

A

monitor, reassurance, and referral if no change or improvement

25
Q

If a tall lanky kid presents with pain over the tibial tubercle that’s worse with jumping, running, and kneeling– what diagnosis?

A

Osgood Schlatter’s

26
Q

How do you treat Osgood Schlatter’s?

A

Ice, heat, NSAIDs, rest – may take several months

27
Q

What diagnosis involves a medially rotated very flexible forefoot?

A

Metatarsus Adductus

28
Q

How would you diagnose metatarsus adductus?

A

Serial weight-bearing photocopies (to measure the amount of deviation)

29
Q

How would you treat metatarsus adductus?

A

Most spontaneously resolve by 6 months

Serial casting (every 2 weeks) starts at 6 months (braces & splints are not helpful!)

30
Q

What are the 4 components of club foot (talipes equinovarus)?

A

Plantar flexion of ankle

Adduction of heel

High arch

Adduction of forefoot

31
Q

The deformity of club foot is obvious, what must we do on PE?

A

Assess muscle and nerve function – to r/o spinal etiology

NOT reducible

32
Q

How do you treat club foot in the neonate?

A

immediate casting – prior to leaving the hospital

Surgical indication if no results after 4 months

33
Q

At what degree of curvature would diagnose a child with scoliosis?

A

Lateral curvature >10 degrees

34
Q

What are some of the causes of scoliosis?

A

Idiopathic (MC), congenital, neuromuscular, and vertebral disease

35
Q

If a child has pain associated with their scoliosis what do you need to think?

A

Tumor or spinal cord problem – most scoliosis is asymptomatic

36
Q

How do you diagnose scoliosis?

A

X-rays (AP & LAT) to measure the cobb angle; Adam’s forward bend test

37
Q

At what degree to you brace a child with scoliosis? Surgery?

A

Brace at 20-40 degrees

Surgery at >50 degrees

38
Q

What muscle is involved in torticollis?

A

Sternocleidomastoid

39
Q

At what age do we see torticollis in? What do we need to r/o in torticollis?

A

4-6 weeks old

R/O a “tumor” in the muscle belly via x-ray and do a thorough neuro exam

40
Q

How do you treat torticollis?

A

Passive stretching exercises; usually resolves within a year

41
Q

Why should parents not swing their kids by their arms?

A

They can get a nursemaid’s elbow! AKA subluxation of radial head

42
Q

How would you treat nursemaid’s elbow?

A

Manipulate with pressure on the radial head and forcefully flex & supinate the forearm

43
Q

What is the name of the fracture that involves the growth plate? How many types?

A

Salter-Harris fracture & 5 types

44
Q

What type of fracture is through the physis?

A

Type 1

45
Q

What type of fracture is through the physis into the epiphysis?

A

Type 3

46
Q

What type of fracture is through the metaphysis, physis & epiphysis?

A

Type 4

47
Q

When would you do conservative treatment for a salter-harris fracture?

A

If fracture is non-displaced

48
Q

What type of orthopeadic disorder involves a defect in type 1 collagen and involved multiple reoccurring fractures?

A

Osteogenesis imperfecta

49
Q

How will the child with Osteogenesis imperfecta present?

A

Blue eyes, poor dentition, and decreased hearing

Pediatrics (12 decks)

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