Orthopedic Pediatrics Flashcards
DDH
-developmental dysplasia of the hip
Cause of DDH
- mechanical-positional
- cultural
- increased incidence with torticollis
DDH Population
- 70% female
- first born
- heredity
- breech birth
DDH Classifications
- normal
- subluxable
- dislocatable
- subluxed
- dislocated
DDH Evaluation Instability tests
- Barlow
- Ortolani
Barlow
- dislocates a reduced hip
- hip flexion, adduction with posterior force
Ortolani
- reduces a hip that is out
- flexed hips, abd with distraction
DDH Appearance
- LLD, Galeazzi, Uneven Thigh folds
- Waddling gait with lordosis
- limited hip abduction
DDH and limited hip abduction
- Unilateral late diagnosis-difference of 10*
- Bilateral <60*
DDH Diagnostic Imaging
- US: 6-8 weeks
- Radiographs after 4 months
- AP, frog leg
DDH Radiograph Eval
- Shenton’s line
- Hilgenreiner’s Line
- Perkin’s line
- Acetabular angle
Shenton’s line
inf neck and inf border of sup pubic ramus
Hilgenreiner’s line
-horizontal through triradiate cartilages
Perkin’s Line
- perpendicular to hilgenreiner’s line
- intersect lateral acetabular roof
-Acetabular angle
- hilgenreiner’s line at tri radiate to acetabular roof
- <40* significant at birth
DDH Treatment
- <6 months: observation; abduction orthosis
- 6-12 months: orthotics
Pavlik Orthosis
- DDH
- works well if diagnosed under 6 weeks old, bilateral, acetabular angle <35*
Rhino Orthosis
- for older more mobile children
- hard plastic shell with foam padding
- hold legs in flexion and abd
PT for DDH
- orthosis management
- ROM
- strength
- gross motor skills
Talipes Equinovarus
- Club foot
- mild to severe
Tx for Mild talipes equinovarus
- serial casting
- (weekly progressions)
Tx for severe talipes equinovarus
- surgical correction
- night splint
- PT: PROM, strength, gross motor concerns
Metatarsus Adductus
-forefoot curves medially
calcaneovalgus
- forefoot curves laterally
- hindfoot valgus
- navicular on floor
- foot appears dorsiflexed
- vertical talus (rocker bottom) deformity
Arch develops at:
age 3-5
Pes Planus
- flat foot
- determine cause
- WB vs NWB
- bilat vs unilat
Torticollis Types
- Congential Muscular Torticollis
- Benign paroxysmal Torticollis
- Torticollis Spasmodica
Congenital Muscular Torticollis
- infancy
- CMT
Benign Paroxysmal Torticollis
- childhood
- BPT
Torticollis Spasmodica
- childhood to adulthood
- cervical dystonia
Primary Mm Involved in Torticollis
- SCM
- Upper trap
- Scalenes
- Splenius capitis/cervicis
Secondary Mm Involved in Torticollis
- Longissimus
- illiocostalis
- suboccipital Mm
Cause of Torticollis
- abnormal intrauterine posture (space too small)
- injury to SCM during delivery (Mm trauma/compartment syndrome)
Direct SCM Trauma
- contracture
- fibrosis
Compartment Syndrome (SCM)
- nerve and Mm damage
- swelling
- fibrosis
Associated Conditions of Torticollis
- hip dysplasia
- plagiocephaly
- progressive facial asymmetry
- vision deficits
Torticollis
- contralateral head rotation with ipsilateral tilt
- named to side of tilt
Torticollis Exam
- Hx
- Postural deviations
- range/strength
- neurologic function
- vision
- gross motor development
- language delays
Torticollis Tx
- PROM
- Strength
- HEP
- Shaping Helmets
Refractory Torticollis
-little/no improvements after 4-5 months PT
AND/OR
-over 7-8 months of age
Concerns with Refractory Torticollis
- facial asymmetry
- plagiocephaly
- irreversible contracture
- if botulinum toxin injections don’t work consider CT scan
Surgical Intervention for Torticollis
- when non-responsive to conservative treatment and botox
- age >18-24 months
Legg-Calve-Perthes
- self-limiting AVN of femoral head
- boys 3-13>girls
causes of Legg-Calve-Perthes
- trauma
- vascular anomalies
- infection
- thrombic incidents
