ORTHO Flashcards
If an infant baby was in a breech position, and has generalized hip laxity – what diagnosis? Who is it most common in?
Developmental dysplasia of the hip Most common in girls & the left hip!
When developmental dysplasia often present in children?
Decreased leg length, limp, asymmetry of skin folds, and loss of motion (abduction)
What tests do we do for DDH?
Barlow (dislocation) & Ortolani (relocation)
X-Rays & Ultrasound
What treatment can you do for DDH?
Brace/Pavlik Harness (under 6 months)
Casting (>6 months)
Surgical (>2 years)
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?
Legg Clave Perthes Disease
If a child has hip pain, what must you always look at?
The entire leg
What’s occurring in Legg-Calve-Perthes Disease?
Osteonecrosis & femoral head collapses
What diagnostics would you do for Legg-Calve-Perthes Disease?
X-ray (look for crescent sign) MRI or CT
How would you treat legg-Calve-Perthes disease?
Observation (often re-vascularizes in 12-18 months), NSAIDS, NO activity, and crutches
If a 12 year old obese male presents with hip pain with a limp and decreased motion that presents suddenly or gradual – what diagnosis?
Slipped Capital Femoral Epiphysis
What diagnostics would you do for SCFE?
X-Ray – fuzzy irregularities (posterior slip with a hook sign)
How do you treat SCFE?
Surgical fixation – it WILL progress if left untreated
What is a sterile effusion of the hip known as?
Transient synovitis of the hip or Toxic Synovitis
How does a transient synovitis of the hip?
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
How do you diagnose transient synovitis of the hip?
Diagnosis of exclusion – x-ray, blood work, and joint aspiration
How do you treat transient synovitis of the hip?
Rest, monitor temp, reassurance
What would cause intoeing & outtoeing?
Femoral (anteversion/retroversion) or tibial (torsion) rotation
What are the sxs of intoeing & outtoeing?
Present by age 2 with walking – rarely painful
What are 4 diagnostic tests (rotational profile) that we can do for intoeing & outtoeing?
Foot progression angle, thigh-foot angle, femoral retro/anteversion, foot adductus
What type of diagnostic looks at the angle of the foot with walking, negative (intoeing) and positive (out-toeing)?
Foot progression angle
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?
Measurement of thigh-foot angle (20-30 degrees of external rotation is normal)
What diagnostic test involves swing the lower legs towards/away from each other while prone?
Measure femoral ante/retroversion (40-50 degrees in both directions is normal)
What diagnostic test looks at the midline of the foot and that it should bisect the 2nd & 3rd MT?
Assessment of foot adductus
How do you treat intoeing or outtoeing?
monitor, reassurance, and referral if no change or improvement
If a tall lanky kid presents with pain over the tibial tubercle that’s worse with jumping, running, and kneeling– what diagnosis?
Osgood Schlatter’s
How do you treat Osgood Schlatter’s?
Ice, heat, NSAIDs, rest – may take several months
What diagnosis involves a medially rotated very flexible forefoot?
Metatarsus Adductus
How would you diagnose metatarsus adductus?
Serial weight-bearing photocopies (to measure the amount of deviation)
How would you treat metatarsus adductus?
Most spontaneously resolve by 6 months
Serial casting (every 2 weeks) starts at 6 months (braces & splints are not helpful!)
What are the 4 components of club foot (talipes equinovarus)?
Plantar flexion of ankle
Adduction of heel
High arch
Adduction of forefoot
The deformity of club foot is obvious, what must we do on PE?
Assess muscle and nerve function – to r/o spinal etiology
NOT reducible
How do you treat club foot in the neonate?
immediate casting – prior to leaving the hospital
Surgical indication if no results after 4 months
At what degree of curvature would diagnose a child with scoliosis?
Lateral curvature >10 degrees
What are some of the causes of scoliosis?
Idiopathic (MC), congenital, neuromuscular, and vertebral disease
If a child has pain associated with their scoliosis what do you need to think?
Tumor or spinal cord problem – most scoliosis is asymptomatic
How do you diagnose scoliosis?
X-rays (AP & LAT) to measure the cobb angle; Adam’s forward bend test
At what degree to you brace a child with scoliosis? Surgery?
Brace at 20-40 degrees
Surgery at >50 degrees
What muscle is involved in torticollis?
Sternocleidomastoid
At what age do we see torticollis in? What do we need to r/o in torticollis?
4-6 weeks old
R/O a “tumor” in the muscle belly via x-ray and do a thorough neuro exam
How do you treat torticollis?
Passive stretching exercises; usually resolves within a year
Why should parents not swing their kids by their arms?
They can get a nursemaid’s elbow! AKA subluxation of radial head
How would you treat nursemaid’s elbow?
Manipulate with pressure on the radial head and forcefully flex & supinate the forearm
What is the name of the fracture that involves the growth plate? How many types?
Salter-Harris fracture & 5 types
What type of fracture is through the physis?
Type 1
What type of fracture is through the physis into the epiphysis?
Type 3
What type of fracture is through the metaphysis, physis & epiphysis?
Type 4
When would you do conservative treatment for a salter-harris fracture?
If fracture is non-displaced
What type of orthopeadic disorder involves a defect in type 1 collagen and involved multiple reoccurring fractures?
Osteogenesis imperfecta
How will the child with Osteogenesis imperfecta present?
Blue eyes, poor dentition, and decreased hearing
