Orthopedic Flashcards
What are the torsional conditions covered in this course?
In and Out toeing
Hip rotation
Tibial Torsion
Foot alignment
What are the angular conditions covered in this course?
Knee conditions- geny
Foot conditions- Equino-calcaneal
What is the general definition of in and out toeing?
Rotation variations within 2 standard deviations of normal alignment and range of motion
Torsional deformaties fall outside the range
What is foot progression angle?
Angle between longitudinal axis of foot and line of gait
Negative for in toeing positive for out toeing
Variable in infancy
What is the normal range for foot progression angle?
-3 to +20 in childhood
What is hip IR and ER up to age 2?
What is hip IR and ER over age 2?
120 degrees up to age
95-110 over age 2
What is version of the femur?
Angular difference between transverse axis of condyles and femoral neck
What value is given for internal tibial torsion?
Negative value
What value is given for external tibial torsion?
Positive value
What type of tibial torsion is normal in infants?
Internal tibial torsion
When would you expect to see External tibial torsion (ETT)?
First 6 months after walking
What is normal tibial torsion at birth?
-15 (range -30 to -10)
What is normal tibial torsion at age 3?
+5 (range -10 to +20)
What is normal tibial torsion mid childhood to skeletal maturity?
+10 (range -5 to +20)
How is mild, moderate, and severe metatarsus adductus treated?
Mild- Resolve on its own
Mod- Stretching corrective shoes
Severe- Manipulation, serial casting and corrective shoes
FPA is the summation of what three segments for in toeing?
Femoral anteversion
ITT
metatarsus adductus
FPA is the summation of what three segments for out-toeing?
ER contracture of the hip
ETT
Calcaneovalgus
What age is genu valgum normal?
Between 2-4 years old
What age is genu varum normal?
Normal in newborns up to 4
What is a surgical treatment for severe cases of genu varum and valgum?
Stapling one side of epiphyseal growth plate or femoral osteotomy
Development of the arch occurs between what ages?
2-6 years old
When does a physiological flat foot require no treatment?
Medial longitudinal arch absent non wt bearing and tip toes is present.
What is the position of limbs and spine in a windswept deformity?
ABD and ER of one hip, with opposite hip ADD and IR
For the mid tarsal joint give the nomenclature for the deformity:
Adduction Abduction Flexion Extension Pronation Supination
Adductus Abductus Cavus deformity Rocker-Bottom Pronation deformity Supination deformity
What is DDH?
Developmental dislocation hip
What are factors predisposing to DDH?
Breech presentaiton
Ligamentous laxity
Female to male 6:1
What are some factors that promote a healthy hip joint?
Normal muscle balance
Concentric femoral head
Deep and concentric acetabulum
What is the Barlow sign?
flex and adduct the leg. Hip will gently be pushed posteriorly – toward the back – along the line of the femur shaft.
Positive test= femoral head slip out of the acetabulum as the hip dislocates out of the socket.
What is ortaloni sign?
Abducts, or moves the infant’s legs apart, into the frog-leg position. If hip dislocated, the femoral head slides into the hip socket during this movement.
Palpable and audible clunk as the head slips back into the socket.
What kind of curve is typically observed in a 6 month old?
More lumbah curve
What is Talipes equino varus?
Clubfoot
Equino= Plantarflexion; Varus= Inversion
A child with a right scoliosis presents with a windswept deformity. Name the position of each leg.
Left leg ABD/ER
Right leg ADD/IR
For the ankle joint give the nomenclature for the deformity of each of the following motions:
Flexion
Extension
Flexion= Equinus Ext= Calcaneus
For the subtalar joint give the nomenclature for the deformity of each of the following motions:
Inv
Ever
Inv= Heel Varus Ever= Heel Valgus