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SD- Pediatrics > Ortho Lecture > Flashcards

Ortho Lecture Flashcards

1
Q

Wide ranging spectrum of hip abnormalities:

  • generalized hip laxity
  • complete hip dislocation
  • acetabular abnormality
A

Developmental dysplasia of the hip (DDH)

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2
Q

Usually present at birth
May present at 8-24 months
Affects left hip 3:1

Risks:
first child
girls>boys
breech presentation
family hx

A

Developmental dysplasia of hip

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3
Q

Initially asymptomatic
First noticed with walking (decreased leg length, limp)
Asymmetry of skin folds if unilateral
Loss of motion (abduction)

A

Developmental dysplasia of the hip (DDH)

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4
Q

PE:
Perform until walking age
Barlow’s test (dislocation test)
Ortolani test (relocation test)

Xrays:
AP view of pelvis

A

Developmental dysplasia of the hip (DDH)

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5
Q

Barlow’s test tests for….

A

dislocation

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6
Q

Ortolani’s test tests for…

A

Relocation

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7
Q

If the baby is female and was breech, perform ultrasound at..

A

6 weeks

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8
Q

Pavlik (brace/harness) for tx

best used under 6 months of age
brace until stable, usually 8-12 weeks
90-95% successful

A

Developmental dysplasia of the hip (DDH)

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9
Q

Tx for Developmental dysplasia of the hip (DDH) if kid is over 6 months old?

A

Casting!

spica cast for 8-12 weeks

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10
Q

Tx for Developmental dysplasia of the hip (DDH) if kid is over 2 years old?

A

Surgical reduction

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11
Q

Idiopathic osteonecrosis of femoral head

A

Legg-Calve-Perthes disease

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12
Q

Progression:

Loss of blood supply
Bone dies (osteonecrosis)
Loss of structural rigidity
Femoral head collapses

A

Legg-Calve-Perthes dz

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13
Q

Onset: age 2-12 yo, ususally 4-8 yo

Boys>girls 4:1
90% unilateral

Typical child:
Small stature, thin, physically active

(rare in Black children)

A

Legg-Calve-Perthes dz

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14
Q

Pain and limping
worse with activity
pain radiates to groin/proximal thigh

Decreased AROM and PROM
abduction (20-30 degrees)
internal rotation

A

Legg-Calve-Perthes dz

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15
Q

Dx made with:

X rays..AP and frog lateral
initial increased density at femoral head
crescent sign
shear fx in subchondral bone

A

Legg-Calve-Perthes dz

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16
Q

Tx:

Femoral head re-vascularizes
Usually regenerative in 12-18 months
Restrict vigorous activity
NSAIDs
Crutches if needed

A

Legg-Calve-Perthes dz

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17
Q

Slippage of femoral head epiphysis (usually posteriorly)

MC adolescent hip disorder
Girls 8-15 yo, boys 9-16 yo (MC in boys)

Bilateral in 30-40%

A

Slipped Capital Femoral Epiphysis (SCFE)

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18
Q

“Red flags”=

older child
male
obesity (over 50% are in the 95th percentile for weight)
limp
pain in hip, groin, thigh or knee

A

Slipped Capital Femoral Epiphysis (SCFE)

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19
Q

Onset may be sudden or progressive
Pain with activity
Pain in hip, groin, thigh, knee
Limp
Decreased hip motion (internal rotation)
Possible limb shortneing

A

Slipped Capital Femoral Epiphysis (SCFE)

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20
Q

Dx made with Xray:

AP and frog lateral
“fuzzy” irregularities on physis
appears that the epiphysis has slipped/rotated

A

Slipped Capital Femoral Epiphysis (SCFE)

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21
Q

What is the tx for Slipped Capital Femoral Epiphysis (SCFE)

A

Surgical fixation:

single cannulated screw into epiphysis
non weight bearing for ~6 weeks

(if left untreated, SLIPPAGE WILL PROGRESS)

22
Q

Sterile effusion of the hip

ages 2-5 most common
2-3x more common in boys

A

Transient Synovitis of the Hip (Toxic Synovitis)

23
Q

Acute onset (usually)
Worse in AM
Limp is initial presentation
Pain in groin/thigh
Decreased abduction
AFEBRILE!

A

Transient Synovitis of the Hip (Toxic Synovitis)

24
Q

Rest
Monitor temp
Reassurance!
Full resolution in 3-14 days

A

Transient Synovitis of the Hip (Toxic Synovitis)

25
Q

Intrauterine constraint (ie: small uterus, twins, uterine fibroids) can cause…

A

Rotational deformities (in-toeing, out-toeing)

26
Q

MC cause of “toeing in”
Exaggerated with weight-bearing
Amount of rotation is non-progressive

no treatment necessary
(spontaneous resolution, may use braces or orthotic shoes)

A

Internal tibial torsion

27
Q

MC cause of “toeing in” after age 3
Patella may be shifted medially
Usually corrected by age 8

Braces, orthotics not helpful

A

Femoral Anteversion

28
Q

Normal in older children/adults
Pes planus may be evident

No tx

A

External tibial torsion

29
Q

Foot progression angle..watching the angle the foot is rotated while walking

in-toeing expressed as “-“
out-toeing expressed as “+”

A

A diagnostic to use if kid has a rotational disorder

(normal adults walk 0-30 degrees)

30
Q

assesses the amount of tibial rotation

patient must be prone with knees at 90º

look for rotation of foot compared to femur

20-30º of external tibial rotation is normal

A

Measurement of thigh-foot angle

31
Q

patient be prone with knees at 90º

swing lower legs toward/away from each other

40-50º in both directions is normal

compare bilaterally

A

Measurement of femoral ante/retroversion

32
Q

Inflammation at the tibial tubercle apophysis

Presents early adolescence
Usually around increased growth

Caused by: repetitive motion
jumping, running

A

Osgood-Schlatter’s

33
Q

Usually a gradual onset
Pain worsens with jumping, running, kneeling
Usually have some deformity of tibial tubercle
Point tender at tibial tubercle
Often bilateral

MC in boys

A

Osgood Schlatter’s

34
Q

Tx of Osgood Schlatter’s?

A

Ice, heat, NSAIDs
active rest, knee pads
rarely immobilize

May take several months for results

35
Q

Medially rotated forefoot
Occurs at tarsometatarsal joints

most likely due to position of fetus in utero

Usually spontaneously resolve by 6 mos
If not, serial casting at 6 mos (for about 2 mos)

A

Metatarsus Adductus

36
Q

Congenital deformity of foot

4 components
plantar flexion (equinus) of ankle
adduction (varus) of heel
high arch (pes cavus) of midfoot
adduction (varus) of forefoot

A

Talipes Equinovarus (Club foot)

37
Q

Tx:

Immediate casting (before leaving hospital)
serial casts every 1-2 weeks
treat for 2-4 months
may brace after casting

(surgery if no results after 4 months)

A

Talipes Equinovarus (Club foot)

38
Q

Lateral curvature of the spine greater than 10º

Usually thoracic or lumbar spine

May involve rotation, kyphosis and/or lordosis

A

Scoliosis

(majority are idiopathic)

39
Q

Most sensitive test for scoliosis?

A

Forward bend (Adam’s forward bend test)

Looks for unilateral elevation
Measure with inclinometer

40
Q

Diagnostics:

X-Rays
AP and lateral
measure the Cobb angle
measured from beginning and end of curve
provides objective method for monitoring curve progression

A

Scoliosis

41
Q

young age at diagnosis

female

initial curve >11º

if mature, <30º curve seldom progresses

>50º may progress, develop symptoms

A

Risks for progression of scoliosis

42
Q

Scoliosis angle of 20-40, what is tx?

A

Brace

43
Q

Scoliosis angle greater than 50 degrees, what is the tx?

A

Surgical intervention

(fusion or rodding)

44
Q

Unilateral contraction of the sternocleidomastoid (SCM) muscle

A

Torticolis

45
Q

First noticed at 4-6 weeks old

“cock robin” position

tilted toward affected side

rotated away from affected side

Possible palpable “tumor” in muscle belly

Decreased cervical motion

A

Torticolis

46
Q

Passive stretching exercises
Usually resolves within a year

Surgical intervention:
longer than 18 months
release of SCM

tx for?

A

Torticolis

47
Q

Most common elbow injury in children

Caused by increased joint laxity

Radial head is wedged in annular ligament

Occurs between ages 2-3, rarely over 7

A

“Nursemaid elbow”

subluxation of the radial head

48
Q

Caused from forceful pronation/extension
Pain initially, then minimal
Unwillingness to use arm
Arm held in extension by side

dx: HISTORY MOST IMPORTANT!

A

Subluxation of radial head

49
Q

Tx of subluxation of radial head?

A

Manipulation fo radial head:

pressure on radial head
forcefully flex and supinate forearm

50
Q

Growth plate (physis) injuries/fractures

15% of pediatric long bone fractures

Mechanism is same as other traumatic injuries, sprains or fractures

75% are type II

A

Salter-Harris fractures

51
Q

Genetically transmitted disease
Defect in Type I collagen
Fragility of skeleton

Sx:
Short stature
Lax ligaments
Several bony deformities
Blue sclera
Decreased hearing
Poor dentition

A

Osteogenesis Imperfecta

(tx symptomatically, tx fractures routinely)

SD- Pediatrics (11 decks)

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