Orthopedics Flashcards
newborn child has uneven gluteal folds; on P/E they can be displaced posteriorly and snapped back into place - dx?
developmental dysplasia of the hip
what test should be ordered if you suspect developmental dysplasia of the hip?
USG
tx. of developmental dysplasia of hip
Pavlik harness - abduction splinting
6 yo boy comes in due to development of limping and decreased hip motion; he also complains of knee pain on the same side and walks with an antalgic gait - dx?
suspect Legg-Perthes disease (avascular necrosis of the capital femoral epiphysis)
what test do you do if you suspect Legg-Perthes disease?
AP and lateral XR of the hip
tx. of Legg Perthes disease
controversial
- contain the femoral head w/in the acetabulum with casting and crutches
a 13 yo obese/lanky boy comes in because he recently started limping and has pain in his groin; when he sits you notice the sole of the foot on the affected side points toward the other foot - what do you suspect? what test should you order?
slipped capital femoral epiphysis
- order AP and lateral XR
what do you find on PE in slipped capital femoral epiphysis?
there is limited hip motion and when the hip is flexed, the leg goes into external rotation and cannot be internally rotates
tx. for slipped capital femoral epiphysis
orthopedic surgery - pin the femoral head into place
a mother brings her toddler in because he refuses to move one of his legs; he was recently sick with the flu and now he is in pain and holds the leg with the hip flexed, in slight abduction and external rotation - what do you suspect?
septic hip
- his ESR will be elevated
tx. for septic hip in a toddler
aspiration under general anesthesia and open arthrotomy for drainage if pus present
a child with a febrile illness (no history of trauma) present with persistent, severe localized pain in a bone - dx?
acute hematogenous osteomyelitis
how do you confirm dx. of osteomyelitis? and how would you tx it?
MRI
- give antibiotics
a 2 year old child is brought in by concerned parents bc he is bow-legged
genu varum - normal up to age of 3
Blount disease
genu varum that persists after age 3
- disturbance of the medial proximal tibial growth plate
- should be tx. surgically
a 5 yo child is brought in by parents because he is knock-kneed
genu valgus is normal between ages 4-8 and no treatment is needed
physical exam findings in Osgood-Schlatter disease
aka. osteochondrosis of tibial tubercle
- persistent pain/localized tenderness over tibial tubercle that is aggravated by contraction of quadriceps
tx. of Osgood-Schlatter disease
first - RICE
second - immobilization of knee in an extension or cylinder cast for 4-6 weeks
deformities present in club-foot (4)
plantar flexion of ankle inversion of foot adduction of the forefoot internal rotation of tibia - both feet are turned inward
tx. of clubfoot deformity
serial plaster casts in the neonatal period
- if surgery done, it should be done after age 6-8 months but before age 1-2
what is the most important thing in management of scoliosis?
the disease will continue progressing until skeletal maturity is reached, so if you patient is before puberty they should be braced to prevent progression
- surgery for severe cases
what do you do if you do an XR on a child with a broken bone in a cast and it shows significant angulation of the broken bone?
nothing… kids have tremendous ability to heal and remodel broken bones
what kind of fracture can you suspect in a young patient who breaks their arm by hyperextension injury?
supracondylar fracture of humerus
why is a supracondylar fracture in a child worrisome?
may produce vascular or nerve injuries resulting in Volkmann contracture