Orthopedics Flashcards
Scoliosis is a spinal deformity in which there is a lateral curvature and rotation of the verebrae in the spine greater than (?) degrees?
7
What is the most common type of scoliosis?
Adolescent idiopathic
onset is 10 years and older
When does congenital scoliosis begin?
During fetal development
When does infantile scoliosis begin?
Before the age of 3
What are important facts regarding adolescent idiopathic scoliosis?
(3)
- Possible genetic link
- More common in girls
- Most common type of scoliosis
Which curve progresses more single or double?
scoliosis
double
Which gender is more at risk for further curve progression?
scoliosis
Females
What are the common symptoms (6) associated with scoliosis?
- Head not centered over body
- One shoulder higher
- One shoulder-blade higher and possibly more prominent
- Spine obviously curved
- Unequal gaps between the arms and the trunk
- One hip more prominent (may cause one leg to appear longer)
When are females screened for scoliosis?
how about males?
- Females 10 and 12
- Males 13 or 14
Females get screened TWICE.
During which events in Tanner stages are adolescents most at risk for curve progression?
Peak heigh velocity
(Stage 2 to 3 for females; 3 to 5 for males)
What are the two screening tools for scoliosis
Not-Diagnostic
- Adams bend forward test
- Scoliometer
How is Adams bend forward test conducted?
- Bend forward at waist until spine becomes parallel to the floor
- hold palms together with arms extended.
What does the Cobb angle determine?
The magnitude of the curve
Which brace is no longer used due to it not preventing curve progression
Spine-Core
What are the benefits of the RSC brace?
- Helps with lateral AND rotation associated w/ scoliosis.
- Decreases curve progression w/ chroth method (physical therapy).
Where does the Cobb angle measure from?
An angle is formed from the superior and inferior vertebrae.
What does the Risser scale evaluate?
Evaluates skeletal maturity on radiographs between 0 to 5.
0 is youngest, lots of room for growth.
When is bracing indicated?
When is surgery indicated?
Scoliosis
- Bracing > 30° or curve which increased from 10° → 25°
- Surgery > 45°
What is the goal of bracing?
Scoliosis
prevent curve progression or until curve progression can’t be controlled
allows skeletal growth and maturity
What is the goal (4) of surgery?
Scoliosis
- Arresting progression
- Permanent correction
- Improve appearance
- Reduce short & long term complications
What is the length of treatment for bracing?
Scoliosis
Until growth has stopped
(skeletal maturity achieved)
What is the most common type of clubfoot?
congenital (idiopathic) clubfoot
Talipes Equinovarus
Which gender is more likely to develop clubfoot?
Boys are twice as likely
Clubfoots involves (?) deformities and malposition with (?) contractures
- Bone
- soft tissue
Which is the most severe form of clubfoot?
Syndromic clubfoot
Which type of clubfoot occurs primarily due to intrauterine crowding?
positional clubfoot
Which type of clubfoot does not have an exact cause for it?
congenital (idiopathic) clubfoot
Talipes equinovarus (TEV)
How often does bilateral clubfoot occur?
How often are both feet affected?
50%
What is the ponseti method?
The use of cast and braces to treat clubfoot.
Talipes equinovarus (TEV)
Which type of clubfoot is associated with congenital abnormalities?
Syndromic (tetralogic)
Which clubfoot is often associated with congential abnormalities
Syndromic clubfoot
How often is serial casting changed?
Clubfoot
- The cast is changed every few days for the first 1 to 2 weeks.
- Then once every 1 to 2 weeks until maximum correction is achieved.
Define
Sprain
severe trauma to a joint causing a ligament to be partially or completely torn.
Define
Strain
injury to the muscle near the musculotendinous junction, as a result of a forceful contraction of the muscle.
Define
Dislocation
displacement of bones that form a joint
Define
Subluxation
partial or incomplete dislocation
What location does a separation occur?
Epiphysis
end part of long bones
What is the most commonly fractured bone in children?
clavicle
text says distal femur (radius/ulnar) too
Why are toddlers more at risk for fracture compared to infants?
increased mobility and immature motor (coordination) and cognitive skills
What causes stress fractures?
A tiny crack in a bone caused by overuse
What are the symptoms of stress fractures?
chronic pain that is localized on a bone w/ focal tenderness.
What is the recommended daily allownance for calcium in adolescence?
What does it reduce the risk of?
1500 mg/daily
Stress fractures
What are the five stages of bone healing?
- Hematoma
- Cellular proliferation
- Callus formation
- Ossification
- Consolidation & remodeling
What is the difference between closed (simple) and open reduction?
Closed reduction is when the bones are moved back into place w/o surgically exposing the bone.
What are the five “P’s” of compartment syndrome
signs/symptoms
- Pain
- Pallor
- Pulselessness (or weak)
- Paresthesia
- Paralysis
What causes compartment syndrome?
swelling caused by trauma and immobilizing device (e.g., casts)
compromises circulation to the muscles and nerves within the space
Define
Exogenous osteomyelitis
infection of the bone caused by direct inoculation from outside the bone.
due to open wound
Define
Hematogenous osteomyelitis
Infection of the bone causes by a pre-existing systemic infection
What labs are elevated with osteomyelitis?
(3)
- **leukocytosis **
- increased erythrocyte sedimentation rate (Blood test that measures how quickly erythrocytes (RBC) settle at the bottom of a test tube that contains a blood sample.)
- Increased C-reactive protein.
During which events in Tanner stages are adolescents most at risk for curve progression?
Peak height velocity
(Stage 2 to 3 for females; 3 to 5 for males)
Which analgesics should be avoided post scoliosis surgery?
NSAIDS
can interfere w/ fusion of the rods and vertebrae.
Which type of clubfoot is associated with congenital abnormalities?
Syndromic (tetralogic)
What nutrition is recommended for osteomyelitis?
(3)
increase in protein, calcium, and iron
What symptom would be atypical of adolescent scoliosis?
- Pain and/or neurological changes (e.g., spinal column pain)
- Bowel and bladder dysfuntion
(excludes musculoskeletal pain)
What would you use to evalaute growth potential in a child with scholiosis?
(3)
- Tanner stages (peak height velocity)
- Risser scale (skeletal maturity)
- Sander’s Bone age (hand x-rays)
Which type of injury is associated with joint laxity?
joint feels loose, hearing a pop, snap, or tear
Sprains
What is the difference between acute and subacute hematogenous?
- Acute hematogenous usually within the first few days of an infection (up to two weeks)
- Subacute hematogenous occurring after 2 weeks of pre-existing infection
