Orthopedics Flashcards
Most likely demographics to have developmental dysplasia of hip and you should US them all
female breech
Are hip clicks benign or worrisome?
benign
What other abnormalities are associated with DDH?
Torticollis, metatarsus adductus
Work up for DDH in children <4 months?
US
Workup for DDH in children >4 months
Xray
What does DDP look like on Xray
Femor goes up and out, delayed ossification, acetabulum angle bigger
Rx for DDP <6m
Pavlik
Rx for DDP 6-18mo
Operate or cast
Rx for DDP 18m
Open reductin, acetabular osteotomy
What is complication of HHP
AVN of femoral head
What are the three causes of in-toeing and at what age?
Metatarus adductus <1yrs
Medial tibial torsion 1-3yr
Femoral torsion 3-9yr
Which cause of intoeing is seen more often in breech or twin
Metatarsus adductus
Which of the intoeing causes requires casting
Metatarsus adductus - if flexible, observe but cast if persist at 9-12 months. If rigid, will need to cast
What are associated anomalies with clubfoot?
DDH, myelodysplastia, arthrogyprosis, myotonic dystrophy
Rx for torticollis?
SCN release at 12-18 months
Age of benign paroxysmal torticollis
2-8 months
Age of resolution of benign paroxysal torticollis
2-3 yrs
Pattern: cervical spinal fusion with shortening of neck and neck stiffness
Klippel-Feil syndrome
What can be associated with Klippel-Feil?
Congenital scoliosis, renal/cardiac abnormalities, deafness, sprengel deformity, congenital elevation of scapula
What can be seen with Erb’s?
Unilateral diaphragmatic paralysis
What can be seen with Klumpke’s
Horner’s
Which has worse prognosis, Erbs or Klumpke’s
Klumpke’s
What are causes of bowlegs?
Poor bone mineralization, skeletal dysplasia, trauma, infection, abnormal diet, tibia vara
When does bowlegs usually resolve?
by 2 yrs
What are warning signs of casting?
- Not improving by 2 years
- Asymmetry or severe bowing.
- Short stature
- rickets, skeletal dysplasia
- Abnormal diet
- Positive family history
- H/o trauma/infection
What do knock knees usually result from?
Exaggerated by hyperextension of knees
When do knock knees resolve?
by 10 years
What is the cause of tibia vara?
Abnormal growth of medial proximal growth plate
Pattern: AA, obese, unilateral or bilateral bowing and painless
tibia vara
Rx for tibia vara
Brace, osteotomy, kill growth plate on opposite side
Pattern: Painful limp, refusal to walk in 3-6 yr old, low fever, leg internal rotation is decreased, mild/mod pain with hip movement worse in morning
Transient synovitis of hip
Rx for transient synovitis of hip
Bed rest, NSAIDs
If presumed diagnosis of transient synovitis of hip doesn’t improve, what should you think about?
LeggCalve-Perthes
Pattern: child refused to bear weight, may crawl, with localized tenderness or swelling pain with gentle twisting of tibia in 9mo to 3yr
Toddler’s fracture - non displaced spiral fracture of distal tibial metaphysis
What is the pathology of Legg-Calve-Perthes?
idiopathic ischemia and necrosis of femoral head
Pattern: 3 to 12yr male, short stature, with decreased internal rotation, insidious onset, limp w/ or w/out pain, +/- pain with passive rotation, positive Trendelenburg, leg length discrrepancy
Legg-Calve Perthes
What are the causes of Legg-Calve-Perthes disease
Trauma, steroids, hypoth, epiphyseal dysplasia, mucopolysaccharidosis, infection, sickle cell disease
Picture of LCP on xray
widening of joint, patches and deformation
Rx of LCP?
<5yrs restrict activity, NSAIDS, ROM exercise
>8yrs Abductor brace or surgery osteotomy, keep femoral head within acetabulum
Pathology of slipped capital epiphyses
Displacement of femoral head secondary to abnormal growth plate
What do you see with slipped capital epiphyses
ice cream slipping off cone, use AP and frog leg lateral (more sensitive)
Rx SCE
to prevent further slipping not to put it back because of concern for avascular necrosis; use percutaneous screw into epiphysis
Pattern: discrepancy when you stand, when you sit it goes away, no fracture, no scoliosis
leg length discrepancy
Which pattern of scoliosis should you most worry about at thoracic and lumbar level?
Left thoracic, right lumbar
At what degree do you observe, refer, and brace scoliosis?
<20 degrees
>20 degrees
>30 degrees or >20 and progresses over 5 over 6 to 8 months
Pattern: fixed kyphosis in thoracic older adolescent and male, vertebral body narrowing of disc spaces, irregularity of vertebral and plates, wedging of anterior vertebral bodies, Schmorl’s nodules
Scheuermann’s disease
For Scheuermann’s disease, what degree do you brace or do surgery
Brace >50 degrees
Surgery >70 degrees
Best xray angle for spondylolysis and spondylolisthesis
Spondylolysis - oblique film (Scotty dog)
Spondylolisthesis - lateral film
Pattern: tight hamstrings, tenderness L5-S1, limited straight leg raise, poorly defined lower back pain, pain with increased activity
Spondylolysis
Pattern: gradual onset with symptoms for weeks, fever, refusal to walk in toddler, fever, limp or abdominal distress, back pain in adolescent stiffness of back and pain with motion, tenderness over different disc space, positive Gower’s sign
Discitis, staph aureus
Warning signs of back pain
Age <4yrs, pain lasting >2 to 4 weeks, sever pain, pain that wakes from sleep, fever, weight loss, painful scoliosis, neuro abnormalities, focal abnormalities
What are child abuse patterns?
Metaphyseal corner (chip) fractures, femoral fracture, scapular fracture
Pattern: radial fracture on outstretch arm
torus or buckle
Describe Salter-Harris classification
Type 1 - through growth plate Type 2 - above, physis and metaphysis Type 3 - lower, physis and epiphysis Type 4 - totally through all layers Type 5 - compression with obliteration
What are signs of benign bone tumors?
sharp or sclerotic border, small in size or multiple lesions, no cortical destruction or extension into soft tissue, do not extend across growth plate
Nurse maid’s elbow
radial head subluxation
Pattern: most common in 10-20 yr old, pedunculated cauliflower like lesion painless hard mass
solitary osteochondroma
Pattern: 10-12 years, multiple osteochondrosis, if grows rapidly and painful can be malignant
hereditary multiple osteochondrosis
What is the location for osteoid osteoma and unicameral bone cyst?
Osteoid osteoma, proximal or distal femur and tibia
Unicameral bone cyst - proximal humerus and femur
Osteochondroma, hereditary multiple osteochondrosis, osteoid osteoma, unicameral bone cyst, aneurysmal bone cyst: which are painful which are not
Painful - multiple osteochondrosis, osteoid osteoma, aneursymal bone cyst
Not painful - solitary osteochondroma, unicameral bone cyst
Pattern: poorly localized, wakes from sleep, pain comes and goes
growing pain
Pattern: tibial tubercle - apoplysitis inflammation at growth place; fragmentation/bone pulled off of tuberosity
Osgood Schlatter’s
Pattern: Calcaneus at insertion of Achilles tendon. Early adolence, pain increases with activity, pain over apoplhysis or if squeeze heel, decrease dorsiflexion secondary to concurrent tight heel cord
Sever’s
Pattern: medial, femoral condyle of knee, bone fragment development and searption at distal femur
osteochondritis dessicans
