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Peds > Orthopedic Changes > Flashcards

Orthopedic Changes Flashcards

1
Q

Out-toeing

A

Decreases over time

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2
Q

Anteversion

A

Head of the femur is directed anteriorly

Internal rotation

In-toeing

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3
Q

Retroversion

A

Head of the femur is directed posteriorly

External rotation

Out-toeing

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4
Q

Infants and Contractures

A

Anteversion and ER contractures

Appears to be out-toeing

Resolve by 5-6 years and anteversion becomes more apparent

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5
Q

Total hip rotation (ER + IR)

A

Up to age 2 - 120

Thereafter - 95-110

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6
Q

Thigh Foot Axis

A

Spontaneous de-rotation with growth and onset of walking

Infants - internal -30 to +20

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7
Q

Metatarsus (forefoot) ADD

A

Most common positional deformity in infants

Forefoot - curved medially
Hindfoot - slight Valgus as is typical for infants
Full DF ROM

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8
Q

Forefoot ADD tx

A

Mild - resolves naturally

Moderate - corrective shoes

Severe - joint manipulation and serial casting

If left untreated, increased risk of stress fractures

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9
Q

Calcaneovalgus

A

Forefoot - curved laterally
Full or excessive DF

Treatment - none, resolves naturally

Differential - vertical talus

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10
Q

Knee alignment progression

A

Peak varum - newborn

Straight - 1-2 years

Peak valgum - 2-4 years

Sex-specific norm 4-16 years

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11
Q

IN toeing rotational profile

A

Foot - metatarsus ADD

Tibia - internal tibial torsion

Hip - femoral anteversion

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12
Q

OUT toeing rotational profile

A

Foot - calcanealvalgus

Tibia - external tibial torsion

Hip - contractures of external rotators

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13
Q

Developmental Dysplasia of the hip

A

General looseness or instability of the hip

Wide range of severity...
Normal
Subluxable
Dislocatable
Subluxed
Dislocated
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14
Q

DDH Risk Factors

A

Mechanical…
Small intrauterine space
Breech position
Hips on mother’s sacrum

Physiologic…
Estrogen and relaxin effecting female fetus
6:1 female risk factor

Environmental…
Swaddling
Positioning
Carrying

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15
Q

DDH Evaluation

A

Limited hip ABD

Thigh fold asymmetry

Apparent shortening of femur/uneven knees

Hip “clicks” are usually insignificant

Imaging (US)

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16
Q

Barlow

A

Dislocates over posterior rim

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17
Q

Ortolani

A

Reduces dislocation

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18
Q

Barlow and Ortolani sign disappear by…

A

2 mos

Limited ABD is only sign after that

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19
Q

DDH Goal - Relocate and preserve joint shape

A

Infants - Pavlick harness ( 12 mos)

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20
Q

DDH sans intervention

A

Hip replacement

AVN

Femoral nerve palsy

Erosion of acetabular rim

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21
Q

Legg Calve Perthes Disease (LCPD)

A

AVN of the ossific nucleus of the femoral circumflex artery

Spontaneous resolution 1-3 years

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22
Q

LCPD Cause

A

Unknown cause

2nd hand smoke?
Small, active children
5-10 years old
Learning disabilities
More common in males
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23
Q

LCPD Exam Findings

A

Limp
Trendelenberg gait
Limited ABD, IR

Xray - subchondral fx, femoral head collapse

Pain - groin, medial thigh, medial knee

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24
Q

LCPD tx

A

WIDE RANGE

Observation, casting, derotational osteotomy

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25
Q

Slipped Capital Femoral Epiphysis (SCFE) Types

A

Acute - significant trauma

Acute on Chronic - Chronic slip, trauma makes it worse

Chronic - Most common type (progression over the course of 3 weeks)

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26
Q

SCFE Risk Factors

A

Obesity
African American
Males

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27
Q

SCFE Exam Findings

A

Pain - groin, medial thigh, medial knee

Hip held in ER

Hip moves passively in ER when hip flexion

50% cases bilateral

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28
Q

SCFE Intervention

A

Pinning surgery

Non WB

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29
Q

Blount’s Disease

A

Infantile tibial Vara

Compression at medial knee causes suppression of growth

Differential from typical genu varum, Ricket’s, Vitamin D deficiency

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30
Q

Blount’s Evaluation

A

Thickening of medial tibial cortex

Breaking of medial metaphysics

Lateral thrust of knee in stance

Overweight, early walkers

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31
Q

Blount’s Intervention

A

HKAFO 23 hours per day

Surgery

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32
Q

Leg Length Discrepancies

A

ASIS to Medial malleolus, Lat malleolus, Heel pad

Umbilicus to Heel pad

You can measure it via X-Ray

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33
Q

Causes LLD

A

Epiphyseal - injury

Congenital - hemihypertrophy, hemimelia

Neuromm - decreased mm forces, decreased growth

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34
Q

LLD Impairments

A

Pelvic obliquity, spinal alignment

Increased energy expenditure for ambulation

35
Q

Measuring for LLD

A

ASIS to medial malleolus, lat malleolus, Heel pad

Umbilicus to Heel pad

36
Q

LLD Intervention

A

Conservative - shoe lift

Surgical - Illizarov procedure, stop growth of other limb

37
Q

How much movement for Illizarov Procedure

A

1 mm per day

1/4 mm 4 times a day

38
Q

Talipes Equinovarus

A

Club foot

Hypo plastic mm

Position...
Ankle PF
Forefoot MEDIALLY curved (ADD and pron)
Hindfoot varus
Calcaneus small
Talar head small and flattened
39
Q

Club Foot Intervention

A

Ponseti Method…
Serial casting
Talonavicular joint reduction
Percutaneous Achilles’ tendon lengthening

40
Q

Goal for Club Foot

A

Restore alignment

Allow for WB and ambulation

41
Q

Congenital Limb Deficiencies

A

40% Acquired

60% Congenital…
Typical unilateral
Most are spontaneous mutations

Most common - Left below elbow congenital amputation in females

42
Q

Embryonic Failure CLD

A 
Failure of formation
Failure of differentiation
Duplication
Overgrowth
Undergrowth
Band Syndrome
43
Q

Skeletal CLD

A

Transverse

Longitudinal

44
Q

Proximal Femoral Focal Deficiency (PFFD)

A

Congenital absence or hypo plasma of the proximal femur

Acetabulum, femoral head, patella, tibia, and fibula may be involved

Severity graded A-D

45
Q

PFFD Severity Determined By…

A

Femoral head presence, shape

Acetabulum presence, shape

Femur length

Joint presence, articulation

46
Q

Acquired Amputation Break Down

A

70-85% due to trauma

15-30% due to disease…
Ewing’s sarcoma
Osteosarcoma

47
Q

Acquired Amputations

Intervention

A

Surgical tx…
Further amputation to revise residual limb

Limb replantation…
UE more successful than LE
Children achieve better functional outcomes than adults

Phantom sensations…
Increasing prevalence with age
Not always pain

48
Q

Scoliosis

A

Deviation of spinal axis

49
Q

Scoliosis screening

A

Shoulder and pelvic asymmetries

Forward bend test

Scoliometer

Radiography

50
Q

Risser Sign

A

Scoliosis evaluation tool

Skeletal maturity
Graded 0-5
Based on ossification of iliac crest

51
Q

Cobb Angle

A

Scoliosis evaluation tool

Severity of curvature
End vertebrae are cephalon and caudal with most tilt
Intersection of lines perpendicular to end vertebrae
> 10-degrees is diagnostic

52
Q

Scoliosis Descriptors

A

Direction of curve - convex side

Magnitude - with Cobb Angle

Flexibility - structural vs non-structural

53
Q

Structural Scoliosis

A

Cannot be corrected

Vertebrae rotate towards the convex side - Rib hump

54
Q

Non-structural Scoliosis

A

Corrects with sidebend towards convex side

Usually non-progressive

55
Q

Scoliosis Types

A

Congenital
Neuromm
Idiopathic

56
Q

Congenital Scoliosis

A

Caused by anomalous vertebral development…
Error in segmentation
Error in formation

May have a rotational component
Kyphoscoliosis
Lordoscoliosis

Many become stable and do not progress

57
Q

Neuromm Scoliosis

A

Long, C type curve, may become S curves with compensation

Develop at a young age

Tend to be progressive

Most associated with SCI in young children, SMA, or MD

To - Botox, custom seating, surgery

58
Q

Idiopathic Scoliosis

A

Lateral curvature of unknown cause

Most common form in children

Infantile, juvenile, or adolescent

59
Q

Adolescent Idiopathic Scoliosis

A

80% of all idiopathic scoliosis cases

Decreased high level balance activities

Decreased lung capacity on the convex side, increased on the concave

More common in females

60
Q

Progression AIS

A

Defined as a change of greater than 5-degrees on two consecutive exams

Increased risk...
Younger age/lower Risser sign at dx
Double curve pattern
Increased curvature
Females
61
Q

AIS Non-surgical Intervention

A

Idiopathic curves

62
Q

AIS Exercise Intervention

A

Used as first line of intervention for curves > 20

Goals…
Maintain or improve trunk and pelvic strength
Improve lateral flexion and trunk shift ROM
Stretching - pectorals and LEs
Increase lung capacity and volume

Exercise alone has not been shown to prevent progression, even with high patient compliance

63
Q

AIS Indications for Orthotic Management

A

Skeletally immature - Risser Sign 0-2

Curve from 25-45

Impact of orthotic management decreases as size of curve increases

64
Q

Milwaukee

A

Controls thoracic the most

65
Q

Charleston

A

Worn at night

66
Q

Brace weaning in scoliosis

A

12 mos

67
Q

Successful scoliosis treatment

A

If curve is no more than 5-degrees different from when brace was discontinued

68
Q

AIS

Goals of Surgical Intervention

A 
Halt progression
Prevent complications
Achieve maximal correction
Balanced trunk
Solid fusion

Posterior approach most common

More advanced curves may include BOTH anterior and posterior approach

69
Q

Foot Progression Angle

A

Angle between long axis of foot and progression of body

  • in-toeing
    + out-toeing

Normal -3 to +20

Mean +10

70
Q

Harrington

A

Metal stabilization rod

Does not allow sagittal plane correction

Rarely used

Flattened lumbar lordosis

71
Q

Luque

A

Metal stabilization rod

Prevents loss of lumbar lordosis

Risk of neurological damage

72
Q

Scoliosis Post-Op Care

A

Orthosis for 9-12 mos until fusion is solid on radiographs

Avg hospital stay 5-7 days

PT role…
Precautions lifted gradually over 1 year by MD - no trunk rotation, no lifting > 5 lbs
Donning/doffing prosthesis - to be done in bed
Encourage functional mobility, isometrics

73
Q

Arthrogryposis Multiplex Congenita (AMC)

A

Present at birth

Non-progressive

Unknown etiology

Most children affected are bright and motivated

Majority of cases not genetically based

74
Q

Hallmarks AMC

A

Joint contractures in 2 or more body areas

Lack of mm development/weakness

Featureless, cylindrical extremities

Fibrosis

Decreased DTRs

75
Q

AMC Type A Evaluation

A 
Flexed and dislocated hips
Extended knees
Equinovarus
IR shoulders
Flexed elbows
Flexed and ulnarly deviated wrists
76
Q

AMC Type B Evaluation

A 
ABD and ER hips
Flexed knees
Equinovarus
IR shoulders
Ext elbows
Flexed and UD wrists
77
Q

Type A AMC

A

More UE flexion

78
Q

Type B AMC

A

More UE extension

79
Q

AMC Intervention

A

Well-timed surgical intervention

Club foot repair when standing
Debate over surgically reducing dislocated hips
Knee flexion contracture when ambulation G
Shoulders are rarely addressed surgically

80
Q

AMC PT

A 
Positioning
Splinting
Stretching
Normalizing development
Balance skills
With aging... Pain management, WC training
81
Q

Osteogenesis Imperfecta

A

Inherited connective tissue disorder - many different mutations

Wide variability in manifestations…
Bowing of long bones
Spinal deformities
Recurrent fractures with minimal trauma

82
Q

OI may also exhibit

A 
Blue sclera
Dental deformities
Hearing loss
Growth deficiency
Easy bruising
Excessive sweating
83
Q

OI Intervention

A

Goal - prevent deformities

Limit immobilization

Scoliosis cannot be managed with brace

Internal fixation with IM rods and/or spinal fusion

Fracture risk decreased by puberty in MOST patients

Strengthening

Environmental adaptation

Caregiver education

Encouraging independence and social integration

Peds (25 decks)

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