Orthopedics Flashcards
What is Metatarsus Adductus?
Forefoot is feed inward; non-rigid
When should metatarsus adducts resolve and when should you seek treatment?
Should resolve in 3 months if not you should do serial casting
What are the three intrauterine disorders from improper positioning?
- Torticollis
- Metatarsus adductus
- Hip dysplasia
What is Club foot (Talipes equinovarus)?
Rigid; C-shaped; BOTH heel and forefoot are turned in - needs casting or surgery
What are the two causes of Club foot?
- Hypoplasia of the foot bones
- Intrauterine position
*Some genetic component involved
To make a diagnosis of club foot, what three things must be present?
- Heel varus
- Forefoot varus
- Ankle equinus
Management of club foot includes (2):
- Serial casting in the first week of life up to 2 months
- Sometimes you need surgery - BUT WAIT until 6-12 months old
Medial tibial torsion is when the knees point __ and the feet point ___
Knees: Forward
Feet: Inward
Most common cause of in-toeing under three is:
Medial tibial torsion
What resolves spontaneously and what resolves by 8-10 years?
Spontaneously: Medial Tibial Torsion
8-10 years: Medial Femoral Torsion
When both the knees and the toes point inward; W-sitting - Dx: ___
Medial Femoral Torsion
What is physiologic out-toeing of infancy? Resolves by?
External rotation of soft tissue due to the way the baby was positioned in the uterus - Resolves by 18 months
External tibial torsion may __ with age but rarely requires treatment
Worsen
What age group are Bow legs (Geru Varum) most present in? Common?
1-2 YO; Is the most common variant during the first two years of life
What are the problems with Bow Legs (vacrum)?
- More than 10 cm between the knees
- Unilateral
- Not resolved by 2.5
What is Genu Valgum? Common? Resolve by? Refer if not resolved?
Knocked kneed; common in ages 3-4, should resolve by 5-7 if not, refer by 8-9
What is the procedure done to the tibia to resolve various leg problems?
Osteotomy
What is acetabular dysplasia?
Complete dislocation of the femoral head - may exist at birth or develop during infancy
Congenital dysplasia is a:
Partial dislocation; may exist at birth or develop during infancy
Five reasons an infant may have congenital hip dysplasia:
- Mom has tight abdominal/uterine muscles
- Breeched
- Position of the baby’s hip is against moms sacrum
- Ligamentous laxity (if a girl - estrogen effects)
- Swaddling: Legs externally rotated and adducted
Who gets congenital hip dysplasia? What hip is at higher risk?
White girl first borns are at the highest risk, especially if frank breeched; Left hip is at higher risk
What is a Galeazzi Sign?
When the knees are at different heights - can be a sign of hip dysplasia
What is most helpful for a newborn and a 6 month old for hip dysplasia?
Newborn: ultrasound
6 month: X-ray (cannot use until the baby is 6 mo old)
How long should babies be in the Pavlik harness?
Newborns - 3 months
>4 months - Double the age
>6 months - Traction
>18 months - open reduction
What are two signs of older children with hip dysplasia?
Tip-toeing and limping
What is Legg-Calve-Perthes?
Avascular necrosis of the femoral head
What is the epidemiology of LCP?
3-12 year olds, age 5-7 - Males 4x more
When does LCP hurt most and description of pain?
After activity, painless or painful
What can the leg not do with LCP?
Cannot abduct or internally rotate
What imaging do you get for LCP?
Frog leg and AP
Early in the disease of LCP, what may be the only way to image the hip?
MRI or ultrasound
What are the four stages of LCP?
- Synovitis: widening
- Necrosis: decreased size
- Fragmentation
- Reconstitution: flattening of femoral head
What is the management for LCP? (3)
- NSAIDS
- Restrict activity
- Crutches
- refer to ortho
What is the ideal management goal for LCP?
Want to attain a spherical femoral head when the hip heals
What is something 50% of kids with LCP develop later in life?
Osteoarthritis in their 60’s - kids diagnosed over the age of 8 are at more risk
Slipped cap femoral epiphysis occurs in what age group?
Pre-adolescent right before the growth spirt
What is the epidemiology for slipped cap? (age, body habits, boys or girls, race)
- 9-16 (girls 11.5; boys 13)
- Very obese/tall >90%
- More males than females
- More common in AA and hispanics
What is present with walking and accentuated as external rotation with running?
Slipped cap
What are the two characteristics of Slipped Cap?
- Medial thigh or knee pain
- Altered gait (external
Slipped cap can be stable or unstable, what is the difference?
Stable: Can walk with crutches
Unstable: Cannot bear weight
How do you fix Slipped Cap?
- Rest, ortho consult
- Will place a pink to prevent further displacement
Epidemiology for Transient (toxic) synovitis of the hip?
- 3-8 YO
- Males x2 more
Most common cause of a limp in a young child:
Transient Toxic synovitis
What are the two causes of Toxic synovitis in kids?
- Viral - URI**
- Trauma
A child with Toxic synovitis will not have:
Systemic symptoms (no fever)
What is the best for detecting hip effusion in toxic synovitis?
Ultrasound
What is the gold standard for diagnosing toxic synovitis?
Joint aspiration
What is the management for toxic synovitis (3)?
- NSAIDS
- Crutches
- Close follow-up
When will you heal with toxic synovitis, what is the risk for recurrence?
- Will heal in 3-10 days
- Reoccurrence within 6 months (15%)
What is the most common cause of septic hip?
Staph aureus - CA-MRSA is becoming more common
What is the easiest way to get septic hip?
Bacteremia and hematogenous spread
What is the number one predictor that an infant has septic hip?
Fever
How is the hip held when it is septic?
Abduction, flexed and externally rotated
What will you see in a septic hip joint aspiration?
> 50,000 WBC
What is the treatment for Septic Hip (3):
- Surgically drain
- Oxacillin or Nafcillin - 2-4 wks (IV)
- Clinda or Vanceo if MRSA
What is Osgood-Schlatter?
Repetitive microtrauma causes avulsion o fate patellar tendon at its insertion on the tibia
When is Osgood-Schlatter most commonly found?
IN boys 10-15
Treatment for Osgood-Schlatter (3):
- NSAIDS
- Restrict activity
- Stretching/banding
What is Calcaneal Apophysitis?
Microtruama and pulling on the calcanea apophysis by the achilles tendon
When are Toddler’s fractures most common?
9 months - 3 years
What is the X-ray finding of a Toddler’s fracture?
Oblique/spiral non-displaced fracture of the tibia
What is the treatment for Toddler’s Fracture?
Immobilization for 4 weeks
The arm for nursemaid’s elbow presents like”
Flexed, pronated and splinted
When are Growing Pains most common?
- 3-12 YO, Females > Males
What are the characteristics of the growing pains? (timing, area, duration)
- Awaken from sleep
- Involves thighs/calves
- Short duration/bilateral
What is the clinical presentation of torticollis?
Head tilted towards the affected side, chin pointing to the opposite side
When does Torticollis manifest?
2-4 weeks after birth
If a baby has torticollis, you should also check:
Their hips for dysplasia
Looking for ___ in babies with torticollis is important
Plagiocephaly (helmet head)
How do you treat torticollis?
DOC band - passive stretching exercises
Epidemiology for scoliosis? (What side curve, F/M, age?)
- R thoracic curve is more common
- Females more than males
- School aged kids
If someone is bending forward and they have the right side of their rib cage more prominent than the left it is a:
Right sided scoliosis
When should you screen boys and girls for Scoliosis?
Females: 10/12
Males: 13-14
What vertebrae is used to determine the curvature of the spine; __ angle determines if the curve of the spine is abnormal at 15 degrees
T7; Cobb’s angle
What do you do to manage Scoliosis?
Refer to ortho
If the curves are <20-25 in a scoliosis patient, you can monitor them:
Every 6 months
If curves are between 25 and 45 degrees you can brace in:
Growing kids (not skeletally mature) - Want to reduce the current
When do you operate on a scoliosis patient?
> 45 degrees and a Harrington rod or post spinal fusion
What determines skeletal maturity?
Risser sign
What are the two most common fractures in kids:
Torus and greenstick
What is more common in kids between ligamentous injuries and fractures?
Fractures are more common than ligamentous injuries - The bones are weaker than the tendons
How do you treat a Buckle Fracture (Torus)?
Immobilization in a cast for 3-4 weeks
A Buckle (Torus)fracture is ___ and the cortex will remain on ___ opposite the side of the fracture
Stable; intact opposite the side of fracture
What happens with a Greenstick fracture?
Fracture of one cortex causing the other to bend but one to train intact
What is the treatment for a Greenstick fracture?
Cast for 6 weeks without reduction
What is the big concern with childhood fractures?
Mal-union - only about 15-30% of fractures involve the growth plate
Type 1 fractures will appear as what on the x-ray?
Will NOT APPEAR on an x-ray - may only show soft tissue swelling
Casting and immobilization is done for SALTER fractures type __ and ___
1 and 2
Reduction and casting is done for SALTER fractures type ___ and ___
3 and 4
Reconstruction surgery is done for SALTER fractures type:
5
The most common benign bone tumor that is made out of cartilage and bone is found in what two areas:
Osteochondroma - shoulder and knee
What is a non-ossifying fibroma? It resolves when?
Ovoid, scalloped lucency’s in the middle fete long bone with a rim (white portion) of a long bone - Spontaneous resolution
What is a Simple/Unicameral Bone cyst? Found where?
Benign, fluid filled - found in the femur and the humerus
What age is the simple/unicameral bone cyst found in? Treatment?
5-15; treat with observation and surgical resection with steroid injections if painful
Adam’s forward bend:
Scoliosis way to check for spine curvature
