Ortho Pediatrics Flashcards
idiopathic avascular necrosis of proximal femoral epiphysis
Legg-Calve-Perthes disease
how is avascular necrosis different in children vs adults?
can heal and remodel in children
what are 4 risk factors for Legg-Calve-Perthes disease?
+ family history
low birth weight
abnormal birth presentation
secondhand smoke
what is the pathophys of LCP disease?
osteonecrosis d/t lack of blood supply to femoral head
what is the presentation of LCP disease? (2)
change in gait
painless limp
a patient presents with loss of abduction and internal rotation of hip, and a limp (antalgic gait/trendelenburg gait). Dx?
Legg-Calve-Perthes disease
what is a late sign of Legg-Calve-Perthes disease?
limb length discrepancy
how is an xray taken for Legg-Calve Perthes disease? what will be seen? (3)
frog leg
joint space widening
irregular femoral head ossification
crescent sign
Dx?
Legg-Calve Perthes disease
what should be considered when determining treatment of Legg-Calve Perthes disease?
age + bone age
degree of necrosis
what patients should be treated for Legg-Calve Perthes disease non-operatively? (2)
patient < 8 yrs
bone age < 6 yrs
what is the non-op treatment for Legg-Calve Perthes disease? (2)
activity restriction
physical therapy
what is the operative treatment for Legg-Calve Perthes disease?
osteotomy
what is the most common complication of Legg-Calve Perthes disease?
premature physical arrest
what 2 situations lead to a good long term prognosis of Legg-Calve Perthes disease?
spherical femoral head
<6 at presentation
abnormal development resulting in dysplasia, subluxation, and dislocation of hip secondary to capsular laxity and mechanical instability
developmental dysplasia of the hip
what is the most common orthopedic disorder in newborns?
developmental dysplasia of the hip
where is developmental dysplasia of the hip most common?
left hip
what are 4 risk factors for developmental dysplasia of the hip?
female
first born
frank breech
+ family history
what classification is developmental dysplasia of the hip if it is subluxable?
barlow-suggestive
what classification is developmental dysplasia of the hip if it is dislocatable?
barlow-positive
what classification is developmental dysplasia of the hip if it is dislocated? (2)
ortolani-positive when reducible
ortolani-negative when irreducible
dislocation of hip by adduction and depression of the flexed femur
barlow exam
reduction of dislocated hip by elevation and abduction of flexed femur
ortolani exam
limb length discrepancy
galeazzi exam
at what age can an xray be taken if a parent is concerned for their newborn’s hip click?
4-6 months old
at what age can an ultrasound be taken if a parent is concerned for their newborn’s hip click?
birth-4 months old
when should newborn patients with a hip click receive an ultrasound if they are considered high risk?
at 6 weeks old
what is the 1st line non-op treatment for developmental dysplasia of the hip in a patient that is younger than 6 months with a reducible hip?
pavlik harness (abducting splinting)
what is the 2nd line non-op treatment for developmental dysplasia of the hip in a patient that is 6-18 months? (2)
closed reduction
spica casting
what is the operative treatment for a patient over 18 months, with developmental dysplasia of the hip, who has failed non-op treatment? (2)
open reduction
spica casting
what is the operative treatment for a patient over 2 years, with developmental dysplasia of the hip, who has failed non-op treatment? (2)
open reduction
osteotomy
injury that occurs with sudden, longitudinal traction to the hand with elbow extended and forearm pronated
nursemaid elbow
a patient presents with an audible click of their arm, the elbow is kept in flexion with the forearm pronated, they refuse to use it, and they have pain with supination. Dx?
nursemaid elbow
what is the treatment for nursemaid elbow?
closed reduction with supination technique OR hyperpronation technique
arm supinated, elbow maximally flexed with pressure over radial head
supination technique for nursemaid elbow
hyperpronation of arm in flexed position
hyperpronation technique for nursemaid elbow
tibial tubercle apophysitis; there is osteochondrosis or traction apophysitis of the tibial tubercle
osgood-schlatter disease
a patient presents with pain on anterior knee, exacerbated with kneeling, has an enlarged and tender tibial tubercle, with pain on resisted knee extension. Dx?
osgood schlatter disease
Dx?
Osgood schlatter disease
what is the conservative treatment for osgood schlatter disease? (3
NSAIDs
RICE
quad stretching
what is the non-op treatment for osgood schlatter disease that does not respond to conservative treatment?
cast immobilization
slippage of the metaphysis relative to the epiphysis; femoral neck slides off of femoral head
slipped capital femoral epiphysis
what is the most common disorder affecting adolescent hips?
slipped capital femoral epiphysis
what part of the body is a slipped capital femoral epiphysis most common?
left hip
an overweight male patient presents with pain that has been present for months, the affected leg is crossed over the other. On physical exam they have abnormal gait, abnormal leg alignment, externally rotated foot, and thigh weakness/atrophy. Dx?
slipped capital femoral epiphysis
what xray view should we obtain for a slipped capital femoral epiphysis?
frog leg
what labs should be ordered for a slipped capital femoral epiphysis if the patient is less than 10 yrs, pre-pubertal, short, or has a weight below 50th percentile? (4)
TSH
free T4
BUN
serum creatinine
Dx?
slipped capital femoral epiphysis
what is the treatment for a slipped capital femoral epiphysis?
percutaneous in situ fixation
in which 3 situations should a contralateral hip prophylactic fixation be done if a slipped capital femoral epiphysis occurred on the other side?
initial slip < 10 yrs old
obese males
+ endocrine disorder
coronal plane spinal deformity
scoliosis
what side is scoliosis most common?
right thoracic curve
what score on a scoliometer during Adams forward bending test indicates scoliosis?
7 degree curve
a patient presents with leg length discrepancy, shoulder height differences, truncal shift, waist asymmetry with pelvic tilt, and a flat foot (cavovarus). Dx?
scoliosis
what sign in scoliosis indicates neurological involvement?
delayed bowel/bladder control
when should we get an xray on a patient to check for scoliosis?
cobb angle (>10 degrees)
when should we get an MRI on a patient to check for scoliosis? (2)
children < 10 yrs w/ curve > 20 degrees
left thoracic curve
what is the non-op treatment for scoliosis with curves < 20 degrees?
observation w/ serial imaging
what is the non-op treatment for scoliosis with curves 20-50 degrees?
bracing x 16-23 hrs/day until skeletal growth is completed
what is the operative treatment for scoliosis of curves > 50 degrees with significant growth remaining?
non-fusion procedure
what is the operative treatment for scoliosis of curves > 50 degrees to prevent crankshaft phenomenon (curving/twisting of spine)?
anterior/posterior spine fusion
pediatric fracture involving the physis (growth plate) that is most common in active children
salter-harris fracture
what extremities are most commonly affected by salter-harris fractures?
upper extremities
in which 2 zones does a salter-harris fracture most commonly occur?
zone of provisional calcification
zone of hypertrophy
a patient presents with a history of a traumatic event, has localized joint pain, swelling, TTP, limited ROM, and inability to bear weight. Dx?
salter-harris fracture
where does a type I salter-harris fracture occur?
Straight across growth plate
where does a type II salter-harris fracture occur?
Above growth plate
where does a type III salter-harris fracture occur?
Lower (below) level of growth plate
where does a type IV salter-harris fracture occur?
Through Everything
where does a type V salter-harris fracture occur?
Rush (extra-articular)
what is the treatment for a type I and II salter-harris fracture? (2)
closed reduction
cast/splint
what is the treatment for a type III and IV salter-harris fracture?
ORIF
what is the treatment for a type V salter-harris fracture? (2)
emergent ortho consult
what should all patients with a salter-harris fracture be given after treatment?
re-evaluation in 7-10 days
