- Adduct the flexed hip and gently push the thigh posteriorly (dislocate the femoral head). - In a (+) test, the hip is felt to slide out of the acetabulum. - As the pressure is released, the hip can be felt slip back into the acetabulum.

- While gripping the thighs, lift the greater trocanther while simultaneously abducting the hip. - When the test is positive, the femoral head will slip into the socket with a delicate clunk that is palpable.

Orthopedics Flashcards by Grazielle Verzosa

_____ describes a deformity involving malalignment of the calcaneotalar-navicular complex.

Talipes Equinovarus (Clubfoot)

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_____ is a normal foot that has been held in a deformed position in utero and is found to be flexible on examination in the newborn nursery.

Positional Clubfoot

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Clubfoot is extremely common in patients with _____.

Myelodysplasia

Arthrogryposis

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Examination of the infant clubfoot demonstrates _____.

Forefoot Cavus & Adductus

Hindfoot Varus & Equinus

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A common radiographic finding in clubfoot is _____ between lines drawn through the axis of the talus and the calcaneus on the lateral view, indicating _____.

parallelism

hindfoot varus

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_____ is initiated in all infants with clubfoot and should be started as soon as possible following birth.

Nonoperative Treatment

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_____ has a definite role in the management of clubfeet, especially congenital clubfeet that have failed nonoperative or minimally invasive methods, and for the neuromuscular and syndromic clubfeet that are characteristically rigid.

Surgical Realignment

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______ manifests as pain over the tibial tubercle in a growing child.

Osgod-Schlatter Disease

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The patellar tendon inserts into the _____, which is an extension of the _____.

tibial tubercle

proximal tibial epihysis

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_____ is likely a traction of the tibial tubercle growth plate an the adjacent patellar tendon.

Osgod-Schlatter Disease

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Osgod-Schlatter Disease is self-limited in most patients and resolves with _____.

skeletal maturity

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In Osgod-Schlatter Disease, _____ is the usual complaint, and _____ is often of concern.

pain over the tubercle

swelling over the tubercle

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_____ refers to a spectrum of pathology in the development of the immature hip joint.

Developmental Dysplasia of the Hip (DDH)

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Developmental Dysplasia of the Hip is classified into _____.

typical

teratologic

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_____ DDH occurs in otherwise normal patients or those without defined syndromes or genetic conditions.

Typical

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_____ DDH usually have identifiable causes such as arthrogryposis or genetic syndrome and occur before birth.

Teratologic

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The final common pathway in the development of DDH is _____, which fails to maintain a stable femoroacetabular articulation.

increased laxity of the hip capsule

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Any condition that leads to _____ and, consequently, _____ may be associated with DDH.

tighter uterine space

less room for normal fetal motion

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The _____ assesses the potential for dislocation of a nondisplaced hip in a neonate.

Barlow Maneuver

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Barlow Maneuver

Adduct the flexed hip and gently push the thigh posteriorly (dislocate the femoral head).
In a (+) test, the hip is felt to slide out of the acetabulum.
As the pressure is released, the hip can be felt slip back into the acetabulum.

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The _____ attempts to reduce a dislocated hip.

Ortolani Maneuver

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Ortolani Maneuver

While gripping the thighs, lift the greater trocanther while simultaneously abducting the hip.
When the test is positive, the femoral head will slip into the socket with a delicate clunk that is palpable.

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Shortening of the thigh, the _____, is best appreciated by placing both hips in a 90° flexion and comparing the height of the knees.

Galeazzi Sign

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The walking child often presents to the physician after the family has noticed a _____.

limp
waddling gait
leg-length discrepancy

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_____ is the diagnostic modality of choice for DDH before the appearance of the femoral head ossific nucleus (4-6 weeks).

Ultrasonography

During the early newborn period (0-4 weeks), _____ is preferred in diagnosing DDH due to high incidence of false-positive sonograms.

Physical Examination

_____ are recommended for an infant once the proximal femoral epiphysis ossifies, usually by 4 mos.

Radiographs

The goals in the management of DDH are to obtain and maintain a _____ to provide the optimal environment for the normal development of the femoral head and acetabulum.

concentric reduction of the femoral head within the acetabulum

Newborn hips that are Barlow (+) or Ortolani (+) should be treated with a _____.

Pavlik Harness

The pruncupal goals in the treatment of ate-diagnosed dysplasia are to obtain and maintain _____.

reduction of the hip without damaging the femoral head

The most important complication of DDH is _____.

avascular necrosis of the femoral epiphysis

_____ is a hip disorder of unknown etiology that results from temporary interruption of the blood supply to the proximal femoral epiphysis, leading to osteonecrosis and femoral head deformity.

Legg-Calve-Perthes Disease (LCPD)

The initial stage of LCPD, which often lasts months, is characterized by_____.

synovitis joint irritability early necrosis of the femoral head

The 2nd stage of LCPD is the ____, which lasts 8 mos., where the femoral epiphysis begins to collapse, usually laterally, and begins to extrude from the acetabulum.

Fragmentation Stage

The _____ of LCPD, which lasts ~ 4 yrs., begins with new bone formation in the subchondral region.

Healing Stage

The final stage of LCPD is the _____, which begins after the entire head has ossified.

Residual Stage

The most common presenting symptom of LCPD is a _____ of varying duration.

limp

_____ is the primary diagnostic tool for LCPD.

Radiography

The goal of treatment of LCPD is _____.

- preservation of a spherical, well-covered femoral head | - maintenance of hip range of motion

Nonoperative treatment of LCPD consists of _____.

activity limitation protected wright bearing NSAIDs physical therapy

A _____ of the proximal femur is the most common surgical containment procedure for LCPD.

Varus Osteotomy

_____ describes the clinical findings of tilting of the head to the right or left side in combination with rotation of the head of the opposite side.

Torticollis

_____ is the most common etiology of torticollis.

Congenital Muscular Torticollis (CMT)

Treatment of congenital muscular torticollis involves _____.

stretching stimulation positioning

For the patients with a late diagnosis of congenital muscular torticollis or those in whom the stretching program has failed to correct the deformity, _____ is considered.

surgical release of the sternocleidomastoid

_____ torticollis can result from strabismus (weakness of the 4th cranial nerve) or a superior oblique muscle palsy.

Ocular torticollis

_____ describes torticollis in association with GER.

Sandifer's Syndrome

_____ are the most common pathogens in acute skeletal infections.

Bacteria

In osteomylitis, _____ is the most common infecting organism in all groups, including newborns.

Staphylococcus aureus

_____ may be the 2nd mot common cause of osteomyelitis in children < 5 y.o. in some parts of the world.

Kingella kingae

Neonates with osteomyelitis might exhibit _____ or pain with the movement of the affected extremity (ex. diaper changes).

pseudoparalysis

_____ are principally involved in osteomyelitis.

Long Bones

The _____ and _____ are equally affected and together constitute almost 1/2 of all cases of osteomyelitis.

femur | tibia

The bones of the _____ account for 1/4 of all cases of osteomyelitis.

upper extremities

There is usually a single site of the bone or joint involvement except in _____ in whom ≥ 2 bones are involved in almost 1/2 the cases.

neonates

Children with subacute symptoms of osteomyelitis and a focal finding in the metaphysial area might have a _____, with radiographic lucency and surrounding reactive bone.

Brodie Abscess

_____ is the best radiographic imaging technique for identifying anscesses and for differantiating between bone and soft tissue infection.

MRI

In neonates, osteomyelitis treatment must cover for _____.

S. aureus Group B Streptococcus G (-) Bacilli

In neonates, osteomyelitis is treated with _____.

``` Antistaphylococcal Penicillins (Nafcillin, Oxacillin) Broad-Spectrum Cephalosporin (Cefotaxime) ```

_____ is the gold standard agent for treateing invasive MRSA osteomyelitis.

Vancomycin

_____ is the agent of choice for parenteral treatment caused by methicillin-susceptible S. aureus.

Cefazolin

For most cases of osteomyelitis, the minimal duration of antibiotics is _____, provided that the patient shows prompt resolution of signs and symptoms (5-7 days) and the ESR & CRP have normalized.

21-28 days

Treatment of chronic osteomyelitis consists of _____.

surgical removal of sinus tracts and sequestrum

_____ has emerged as the most common cause of septic arthritis in all age groups.

Staphylococcus aureus

In sexually active adolescents, _____ is a common cause of septic arthritis and tenosnovitis, usually of small joint or as a monoarticular infection of a large joint (knee).

Gonococcus

_____ is an imprtant cause of septic arthritis in neonates.

Group B Streptococcus

Erythema and edema of the skin and soft tissue overlying the site of infection are seen earlier in septic arthritis than in osteomyelitis because _____.

the bulging infected synovium is usually more superficial

Joints of the _____ constitute 75% of all cases of septic arthritis.

lower extremities

Aspiration of _____ provides the best specimen for culture of septic arthritis.

joint pus

_____, compared to radiographs, is more sensitive in providing evidence of the diagnosis of septic arthritis.

Radionuclide Imaging

In neonates, septic arthritis treatment must cover for _____.

S. aureus Group B Streptococcus G (-) Bacilli

In neonates, septic arthritis is treated with _____.

``` Antistaphylococcal Penicillins (Nafcillin, Oxacillin) Broad-Spectrum Cephalosporin (Cefotaxime) ```

_____ are alternatives when treating CA-MRSA septic arthritis.

Clindamycin | Vancomycin

Antibiotic Duration for S. pneumonia and K. kingae Septic Arthritis

10-14 days

Infection of the _____ is a surgical emergency because of the vulnerability of the blood supply to the head of the femur.

hip

_____, the most common genetic cause of osteoporisis, is a generalized disorder of connective tissue.

Osteogenesis Imperfecta (OI)

Structural or quantitative defects in _____ cause the full clinical spectrum of OI.

Type I Collagen

_____ is the primary component of the extracellular matrix of bone and skin.

Type I Collagen

OI has the triad of _____.

fragile bones blue sclerae early deafness

OI Type _____ is sufficiently mild that it is often found in large pedigrees.

OI Type I

Infants with OI Type _____ may be stillborn or die in the 1st yr. of life.

OI Type II

OI Type _____ is the most severe nonlethal form of OI and results in significant physical disability.

OI Type III

OI Type _____ can present at birth with in utero fractures or bowing of the lower long bones, but fracture rates decrease after puberty.

OI Type IV

Type _____ OI patients clinically have OI Type IV, but have distinct finding on bone histology.

OI Type V (Hyperplastic Callus) | OI Type VI (Mineralization Defect)

OI Type _____ patients have null mutations.

OI Type VII (P3H1) | OI Type VIII (CRTAP)

The diagnosis of types I-IV and VII/VIII is confirmed by _____.

collagen biochemical studies using cultured dermal fibroblasts

The morbidity and mortality of OI are _____.

cardiopulmonary

Recurrent pneumonia and declining pulmonary function occur in _____ OI patients.

pediatric

Cor pulmonale occurs in _____ OI patients.

adult

A several-year course of treatment of children with OI with _____ confers some benefits.

Bisphosphonates

MoA of Bisphosphonates

decrease bone resorption by osteoclasts

Bisphosphonate treatment should be limited to _____ to maximize benefits and minimize detriment to cortical material properties.

2-3 yrs. in mid-childhood