Ortho Flashcards
1
Q
Common ortho congenital defects?
A
- clubfoot (most common)
- developmental dysplasia of the hip (DDH)
- legg-calve-perthes disease (hip osteonecrosis)
- spine deformities (scoliosis and kyphosis)
- muscular dystrophy
- limb defects
2
Q
What is clubfoot? How common? Tx?
A
- Talipes equinovarus
- 1/1000 births, 50% bilateral
- anatomic changes: talus plantar flexed, heel cord tight, fore foot adducted/supinated
tx: - most can be tx conservatively
- Ponseti method: casting +percutaneous heel cord lengthening (gold std)
- severe, long-standing deformity may require several surgeries
- serial casting, bracing
3
Q
What is DDH? Incidence? Presentation?
A
- loss of normal femoral head-acetabular relationship/stability: 2.7-17/1000 live birhts
- caused by physiological and mechanical factors: ligamentous laxity, hormonal and familial factors, breech position and congenital deformities
- wide range of presentations:
- hip that is reduced but is unstable and can be dislocated
- dislocation can be reduced
- fixed dislocation that can’t be reduced
- bony deformities that reqr surgery
- all cases may not be detectable at birth: late cases are not always cases of missed dx
- routine sonography isn’t cost effective
4
Q
What is Barlow and ortolani test?
A
- barlow: hip is reduced but can be dislocated
- ortolani: hip is dislocated but can be reduced
(clunk positive sign while being reduced) - lack of full abduction: hip is out and it can’t be reduced
5
Q
Tx of DDH?
A
- depends on extent of defomrity and if hip can be reduced
- if hip can be reduced, harness or pillow first 6 months of life, confirm reduction with u/s after 3 weeks, effective 90% of time
- if hip won’t stay in, reduce under anesthesia, hold with spica cast: confirm reduction with U/S after 3 weeks, femoral head isn’t visible on x-ray for 4-6 months
- if it still won’t stay in: need surgery, femoral and/or acetabular osteotomy
- if femoral head can be held in normal relationship with socket: pt will develop a normal hip
6
Q
Hip abduction devices?
A
- pavlik harness (most common)
- Frejka pillow
- boch harness
7
Q
What is Legg-Calve-Perthes Disease?
A
- males 3-11
- loss of blood supply to femoral head:
head can collapse and subluxation of femoral head, eventually revascularizes, but may not occur until fixed deformity present - variable hip/knee sxs: limping and pain
- limited internal rotation and abduction of hip
8
Q
Tx of Legg-Calve-Perthes disease?
A
- reduce pressure on femoral head: relative rest braces, crutches traction adductor muscle release - correct resulting deformity: femoral and/or acetabular osteotomy (later on in life)
9
Q
What is scoliosis, diff types?
A
- lateral curvature of spine of more than 10 degrees by cobb method (become concerned when over 25 degrees)
- types:
idiopathic
congenital
secondary
neuromuscular
10
Q
Idiopathic scoliosis? Forms?
A
- infantile (birth -3 yrs): 1%
- juvenile (4-9): 12-21%
- adolescent (10 yrs - end of growth): 80-90%
- forms:
lumbar, thoracic, thoracolumbar
11
Q
Adolescent idiopathic scoliosis?
A
- lateral curvature of spine with rotation in child older than 11 without any obvious cause
- most common type
- typically right thoracic curve
- frequency: 1.9-3%
- family hx: 30%
- more severe forms more common in females
12
Q
Dx adolescent idiopathic scoliosis?
A
- adam’s forward bend test
- radiographic exam: AP and lat full length of spine while standing
- MRI: useful if neuro deficits, neck stiffness or HA
- usually R scapulae becomes more prominent
13
Q
What is kyphosis? More common in who?
A
- increased thoracic curvature in saggital plane
- postural: usually seen in girls, gentler, more pliable curve
- corrects with time/bracing
14
Q
What is Scheuermann’s disease?
A
- more severe: in boys more, but not that common
- osteochondrosis of the spine
- ring apophyses don’t develop normally, resulting in wedged vertebra
- sharper, more rigid curve
- may need surgical correction
15
Q
What is muscular dystrophy? Signs?
A
- progressive weakness and wasting of muscles
- onset: 3-5, genetic: primarily males
- clumsiness, frequent falls, **difficulty climbing stairs, running, riding bike, waddling gait, breathing muscles become affected, life threatening infections common
16
Q
Dx and tx of muscular dystrophy?
A
- dx: bx, EMG
- tx: PT/OT, bracing, surgery (scoliosis)
17
Q
Tx of limb defects?
A
- live with deformity
- referral to ortho specialist for reconstruction surgery
18
Q
Normal musculoskeletal variants?
A
- metatarsus adductus
- axial rotation
- idiopathic toe walking
- pes cavus (flat foot)
- angular variations:
genu varus (bow legged)
genu valgus (knock-knees)
19
Q
What is metatarsus adductus?
A
- excessive amt of adduction of metatarsals relative to long axis of foot
- **most common congenital foot deformity
- female more than males affected
- left more than right
- most likely cause: intrauterine restriction
- 85-90% resolve spontaneously by 1
20
Q
Management of metataruss adductus?
A
- flexible metatarsus adductus: stretching 5x at each diaper change
- flexible MA beyond 8 mo: referral for biweekly casting, correction usually achieved in 3-4 casts
- extreme adduction of great toe: surgical release of abductor hallucis done b/t 6-18 months of age
21
Q
Toe in axial rotation causes?
A
- internal femoral torsion (too much hip anteversion) - results from W sitting
- internal tibial torsion (most common cause): results from intrauterine positioning
- metatarsus adductus
22
Q
Toe-out axial rotation causes?
A
- external femoral torsion (too much hip retroversion): results from intrauterine positioning
- external rotation contracture
- external tibial torsion
- flat foot
