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MOD 2 Quiz 2 > Orthopedic problems in Pediatrics > Flashcards

Orthopedic problems in Pediatrics Flashcards

1
Q

Growing pains?

A

benign and intermittent
4-8 yo
usually bilateral
relieved by hear, massage, ibuprofen, tylenol

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2
Q

Plastic deformation?

A

unique to children
most common in ulna
force produces a microscopic failure on the tensile side of bone
bone is angulated beyond its elastic limit
no fracture evident radiographically

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3
Q

Buckle (Torus) fracture?

A

Compression failure of bone (usually at junction of metaphysis and diaphysis, common in distal radius)

heals in 3-4 weeks with immobilization

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4
Q

Greenstick fracture?

A

occurs when the bone is bent
not a complete fracture (is a slight fracture just not all the way through the bone)
will have bone failure on the tension side and bend deformity on the compression side

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5
Q

Epiphyseal fractures?

A

involve the growth plate
potential for deformity to occur (requires long term observation)
Classified by Salter Harris

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6
Q

Salter Harris Mneumonic?

A 
Slipped
Above
Lower
Together
Ruined
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7
Q

Salter-Harris type I?

A

separation through the physis
X-rays are often normal
Diagnosis

-may have some lateral displacement of the epiphysis, point tenderness over the growth plate

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8
Q

Salter-Harris type I manage?

A

closed reduction techniques
no not require perfect alignment
tend to remodel with growth

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9
Q

Salter Harris type II?

A

fracture through a portion of the physis, but extending through the metaphysis

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10
Q

Salter Harris type II manage?

A

usually can be managed with closed reduction techniques
do not require perfect alignment
tend to remodel with growth

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11
Q

Salter Harris type III?

A

fracture through a portion of the physis extending through the epiphysis and into the joint

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12
Q

Salter Harris type III manage?

A

Require anatomic alignment

-to prevent any stepoff, and realign the growth cells of the physis

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13
Q

Salter Harris type IV?

A

fracture across the metaphysis, physis, and epiphysis

prognosis may be poor

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14
Q

Salter Harris type IV manage?

A

requires anatomic alignment

-to prevent stepoff, realign the growth cells of the physis

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15
Q

Salter Harris type V?

A

crush injury to the physis
-no physeal fracture or displacement
Causes growth arrest and poor prognosis
-disruption of the germinal matrix, hypertophic regions and vascular supply

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16
Q

Salter Harris type V causes?

A

electric shock, frostbite, irradiation

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17
Q

Salter Harris type V diagnose?

A

difficult to differentiate from Type I
Usually not diagnosed initially
-present with growth disturbance

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18
Q

Clavicular fractures neonates vs children?

A

a direct trauma during birth

fall on the affected shoulder or direct trauma to the clavicle

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19
Q

Clavicular fractures diagnosis?

A

suggested by tenderness over the clavicle
AP xray of the clavicle
do neurovascular exam to diagnose any brachial plexus injury

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20
Q

Clavicular features treatment?

A

figure eight clavicle strap
fractures heal rapidly, usually in 3-6 wks
a palpable callus may be seen in thin children
complete restoration of shoulder motion and function is uniformly achieved

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21
Q

Toddler’s fracture?

A

occur in young ambulatory children (typically 1-4 yrs of age)
often occurs after a seemingly harmless twist or fall and is frequently unwitnessed
Radiographs may show no fracture
-nondisplaced spiral no fracture

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22
Q

Treat a toddler’s fracture?

A

above knee cast for 3 wks

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23
Q

Diagnose Toddler’s fracture?

A

physical exam-refusal to bear weight

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24
Q

When to suspect abuse?

A 
femur fractures in nonambulatory children
unexplained spiral fractures
posterior rib fractures
scapular spinous process fractures
proximal humerus fractures
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25
Craniosynostosis?
premature closure of cranial sutures Primary (closure of one or more sutures due to abnormalities of skull development) Secondary (failure of brain growth and expansion) Treatment (surgery)
26
Plagiocephaly?
asymmetric cranium may be caused by deformational mechanisms (in utero positioning, back to sleep) Treatment -reposition or tummy time, OMT, Helmet, surgery
27
Plagiocephaly vs Craniosynstosis?
plagio- ipsilateral lateral frontal bosing cranio- contralaeral frontal bosing
28
Congenital muscular torticollis?
lateral bending of head with rotation to opposite side may result from abnormal positioning in utero involves contracture of the SCM
29
Treat torticollis?
gentle streching exercise and crib positioning surgical release of SCM
30
Cleft lip?
hypoplasia of the mesenchyal layer | failure of the medial nasal and maxillary processes to join
31
Cleft palate?
Failure of the palatal shelves to approximate or fuse
32
problem with cleft palate and cleft lip?
immediate issue is feeding | -soft, artificial nipples with a squeezable bottle
33
Treatment cleft lip/ cleft palate?
cleft lip- usually by 3 months of age, cosmetic results vary cleft palate- usually before 1 yr of age to enhance normal speech development, recurrent OM and hearing loss are frequent
34
Scoliosis?
lateral curvature of the spine
35
Cause scoliosis?
``` Idiopathic Congenital Associated with neuromuscular disease or syndromes Compensatory from leg-length discrepancy Intraspinal abnormality ```
36
Idiopathic scoliosis?
unknown etiology most common in adolescents incidence equal in boys and girls, females have higher risk of developing curvature greater 30 degreees
37
Idiopathic scoliosis presentation?
change in appearance back pain may have -asymmetry of shoulder height, leg-length discrepancy, loss of the normal thoracic kyphosis in the region of curvature
38
The adams test?
asymmetry of the posterior chest wall on forward bending | used for scoliosis
39
Idiopathic scoliosis work-up?
complete neurological exam | PA and lateral radiographs (cobb angle)
40
Cobb angle?
the angle between the superior and inferior end vertebra is measured
41
Idiopathic scoliosis treatment guidelines?
Curvature under 25 degrees needs observation Curvature 25-40 degrees with more than 2 yrs of growth expected, needs bracing Lumbar or thoracic curve over 40 degrees needs surgery
42
Congenital scoliosis?
abnormal growth and development of the vertebral column evident at birth or early in childhood Need to rule out other malformations in other organ systems -GU abnormalities, Cardiac anomalies
43
Congenital scoliosis most pronounced?
during the periods of rapid growth (first 2-3 yrs of life) adolescent growth spurt
44
treat congenital scoliosis?
bracing is not indicated | often requires both anterior and posterior spinal fusion, ideally performed before singificant deformity
45
Subluxation of the radial head?
nursemaid's elbow annular ligament slips off radial head and into the elbow joint mechanism is sudden traction applied to the extended arm (catching by arm when child falls)
46
History or nurse maid's elbow?
parent pulling childs arm to prevent fall child being swung by arms child attempts to pull away from parents
47
Clinical symptoms of radial head subluxation?
immediate pain arm held close to body (elbow flexed and forearm pronated) no tenderness or swelling on exam limited on supination
48
Xray radial head sublux?
normal, not necessary
49
Treatment radial head sublux?
apply pressure over radial head and supinate the forearm pain relief immediate return of function is evident quickly
50
Developmental dysplasia of the hip? DDH
subluxation-partial contact between the femoral head and acetabulum dislocation- hip with no contact between the articulating surfaces of the hip
51
Associated conditions with DDH?
anything causing tighter intrauterine space breech presentation female gender
52
Presentation of DDH?
Barlow | Ortolani
53
Barlow?
adduct the flexed hip and gently push the thigh posterior to try and disloacte the femoral head pos: hip is felt to side out the acetabulum
54
Ortolani?
lift the greater trochanter whild abducint the hip | palpable clunk signifies femoral head slipping into the hip socket
55
Developmental dysplasia of the hip?
asymmetry of skin folds of thighs and buttocks
56
Imaging Developmental dysplasia of the hip?
hip ultraosound under 4 mths | hip xray if 4-5 mths of age
57
Treat Developmental dysplasia of the hip?
palvik harness:keeps hips flexed and abducted | doesn't work= closed reduction and immbolization in a spica cast
58
Legg-Calve-Perthes Disease?
caused by temporary interruption of the blood supple to the femoral head etioloy unknown more common in boys peak incidence btw 4-8
59
Legg-Calve-Perthes Disease presentation?
limp | pain in groin, knee, thigh
60
Physical exam Legg-Calve-Perthes Disease?
hip painful and limited on internal rotation and abduction atrophy of the muscles of the thigh, calf, or buttock from disuse secondary to pain leg length discrepancy
61
Legg-Calve-Perthes Disease long term?
self limited typically lasts 1-2 years long term prognosis- most patients are active, pain free, and have a good ROM
62
Legg-Calve-Perthes Disease treatment?
goal is to create a spherical, well covered femoral head with ROM close to normal Mainstay: non-operative more severe cases
63
Slipped Capital Femoral Epiphysis (SCFE)?
``` Displacement of femoral head through epiphyseal plate 12-15 yo males>females associated obesity unknown etiology ```
64
SCFE presentation?
pain in hip, thigh or knee change in hip ROM painful limp affected extremity held in external rotation with patient refusing to bear weight
65
Slipped Capital Femoral Epiphysis (SCFE) xrays?
AP and lateral views widening and irregularity of the physis displacement of femoral head on proximal femur (ice cream falling off the cone)
66
Slipped Capital Femoral Epiphysis (SCFE) treatment?
surgical pinning
67
Blount disease?
Tibia vera growth disorder of the medial tibial epiphysis (varus agnulation, medial roation of the tibia) incidence greater in female black obese children etiology unknown
68
Blount disease radiographs?
weight bearing radiographs - allow max presentation of deformity, fragmentation of epiphysis, breaking of the medial tibial epiphysis, depression of the medial tibial plateau
69
Osgood-schlatter disease?
pain over tibial tubercle in a growing child traction apophysitis of the tibial tubercle late childhood or adolescence boys due to repetitive tensile microtrauma
70
History Osgood-schlatter disease?
pain and swelling over tibial tubercle | pain aggrevated by activity, but persists at rest
71
Phyiscal exam Osgood-schlatter disease?
point tenderness over the tibial tubercle and patellar tendon
72
Radiographs Osgood-schlatter disease?
soft tissue swelling around the tibia apophysis | fragmentary ossification of the tibial tubercle may be noted
73
Treatment Osgood-schlatter disease?
rest, restrict activities, knee immobilize occasionally, NSAIDs for pain relief, complete resolution may require 12-24 months
74
Clubfoot deformity?
Talipes equinovarus apparent after birth more common in males unilateral of bilateral
75
Clubfoot deformity positional?
held in a deformed position in utero | flexible on exam
76
Clubfoot deformity congenital?
spectrum of severity | those associated with neurovascular causes or syndromes are more rigid and difficult to treat
77
Clubfoot deformity physical exam?
watch for musculoskeletal or neuromuscular problems | calf atrophy
78
xray clubfoot?
may not be necessary
79
Treat Clubfoot deformity?
manipulation with serial casting | surgical realignment if nonoperative measures have failed or for clubfeet that are rigid
80
Metatarsus adductus?
adduction of the forefront relative to the hindfoot metatarsals are deviated medially most likely form intrauterine molding no pathologic changes in structures of foot should be distinguished from congenital clubfoot may be passively correctable by examiner
81
xray Metatarsus adductus?
abnormal deviation of metatarsals medially | no other osseous abnormality
82
treatment Metatarsus adductus?
ranges from passive manipulation to casting to surgery | should be started prior to walking age

MOD 2 Quiz 2 (13 decks)

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