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Pediatrics Exam 2 > Orthopedics > Flashcards

Orthopedics Flashcards

1
Q

What is Metatarsus Adductus?

A

Forefoot is feed inward; non-rigid

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2
Q

When should metatarsus adducts resolve and when should you seek treatment?

A

Should resolve in 3 months if not you should do serial casting

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3
Q

What are the three intrauterine disorders from improper positioning?

A
  • Torticollis
  • Metatarsus adductus
  • Hip dysplasia
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4
Q

What is Club foot (Talipes equinovarus)?

A

Rigid; C-shaped; BOTH heel and forefoot are turned in - needs casting or surgery

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5
Q

What are the two causes of Club foot?

A
  • Hypoplasia of the foot bones
  • Intrauterine position

*Some genetic component involved

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6
Q

To make a diagnosis of club foot, what three things must be present?

A
  • Heel varus
  • Forefoot varus
  • Ankle equinus
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7
Q

Management of club foot includes (2):

A
  • Serial casting in the first week of life up to 2 months

- Sometimes you need surgery - BUT WAIT until 6-12 months old

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8
Q

Medial tibial torsion is when the knees point __ and the feet point ___

A

Knees: Forward
Feet: Inward

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9
Q

Most common cause of in-toeing under three is:

A

Medial tibial torsion

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10
Q

What resolves spontaneously and what resolves by 8-10 years?

A

Spontaneously: Medial Tibial Torsion

8-10 years: Medial Femoral Torsion

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11
Q

When both the knees and the toes point inward; W-sitting - Dx: ___

A

Medial Femoral Torsion

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12
Q

What is physiologic out-toeing of infancy? Resolves by?

A

External rotation of soft tissue due to the way the baby was positioned in the uterus - Resolves by 18 months

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13
Q

External tibial torsion may __ with age but rarely requires treatment

A

Worsen

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14
Q

What age group are Bow legs (Geru Varum) most present in? Common?

A

1-2 YO; Is the most common variant during the first two years of life

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15
Q

What are the problems with Bow Legs (vacrum)?

A
  • More than 10 cm between the knees
  • Unilateral
  • Not resolved by 2.5
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16
Q

What is Genu Valgum? Common? Resolve by? Refer if not resolved?

A

Knocked kneed; common in ages 3-4, should resolve by 5-7 if not, refer by 8-9

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17
Q

What is the procedure done to the tibia to resolve various leg problems?

A

Osteotomy

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18
Q

What is acetabular dysplasia?

A

Complete dislocation of the femoral head - may exist at birth or develop during infancy

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19
Q

Congenital dysplasia is a:

A

Partial dislocation; may exist at birth or develop during infancy

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20
Q

Five reasons an infant may have congenital hip dysplasia:

A
  • 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
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21
Q

Who gets congenital hip dysplasia? What hip is at higher risk?

A

White girl first borns are at the highest risk, especially if frank breeched; Left hip is at higher risk

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22
Q

What is a Galeazzi Sign?

A

When the knees are at different heights - can be a sign of hip dysplasia

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23
Q

What is most helpful for a newborn and a 6 month old for hip dysplasia?

A

Newborn: ultrasound

6 month: X-ray (cannot use until the baby is 6 mo old)

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24
Q

How long should babies be in the Pavlik harness?

A

Newborns - 3 months
>4 months - Double the age
>6 months - Traction
>18 months - open reduction

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25
Q

What are two signs of older children with hip dysplasia?

A

Tip-toeing and limping

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26
Q

What is Legg-Calve-Perthes?

A

Avascular necrosis of the femoral head

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27
Q

What is the epidemiology of LCP?

A

3-12 year olds, age 5-7 - Males 4x more

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28
Q

When does LCP hurt most and description of pain?

A

After activity, painless or painful

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29
Q

What can the leg not do with LCP?

A

Cannot abduct or internally rotate

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30
Q

What imaging do you get for LCP?

A

Frog leg and AP

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31
Q

Early in the disease of LCP, what may be the only way to image the hip?

A

MRI or ultrasound

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32
Q

What are the four stages of LCP?

A
  1. Synovitis: widening
  2. Necrosis: decreased size
  3. Fragmentation
  4. Reconstitution: flattening of femoral head
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33
Q

What is the management for LCP? (3)

A
  • NSAIDS
  • Restrict activity
  • Crutches
  • refer to ortho
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34
Q

What is the ideal management goal for LCP?

A

Want to attain a spherical femoral head when the hip heals

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35
Q

What is something 50% of kids with LCP develop later in life?

A

Osteoarthritis in their 60’s - kids diagnosed over the age of 8 are at more risk

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36
Q

Slipped cap femoral epiphysis occurs in what age group?

A

Pre-adolescent right before the growth spirt

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37
Q

What is the epidemiology for slipped cap? (age, body habits, boys or girls, race)

A
  • 9-16 (girls 11.5; boys 13)
  • Very obese/tall >90%
  • More males than females
  • More common in AA and hispanics
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38
Q

What is present with walking and accentuated as external rotation with running?

A

Slipped cap

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39
Q

What are the two characteristics of Slipped Cap?

A
  • Medial thigh or knee pain

- Altered gait (external

40
Q

Slipped cap can be stable or unstable, what is the difference?

A

Stable: Can walk with crutches
Unstable: Cannot bear weight

41
Q

How do you fix Slipped Cap?

A
  • Rest, ortho consult

- Will place a pink to prevent further displacement

42
Q

Epidemiology for Transient (toxic) synovitis of the hip?

A
  • 3-8 YO

- Males x2 more

43
Q

Most common cause of a limp in a young child:

A

Transient Toxic synovitis

44
Q

What are the two causes of Toxic synovitis in kids?

A
  • Viral - URI**

- Trauma

45
Q

A child with Toxic synovitis will not have:

A

Systemic symptoms (no fever)

46
Q

What is the best for detecting hip effusion in toxic synovitis?

A

Ultrasound

47
Q

What is the gold standard for diagnosing toxic synovitis?

A

Joint aspiration

48
Q

What is the management for toxic synovitis (3)?

A
  • NSAIDS
  • Crutches
  • Close follow-up
49
Q

When will you heal with toxic synovitis, what is the risk for recurrence?

A
  • Will heal in 3-10 days

- Reoccurrence within 6 months (15%)

50
Q

What is the most common cause of septic hip?

A

Staph aureus - CA-MRSA is becoming more common

51
Q

What is the easiest way to get septic hip?

A

Bacteremia and hematogenous spread

52
Q

What is the number one predictor that an infant has septic hip?

A

Fever

53
Q

How is the hip held when it is septic?

A

Abduction, flexed and externally rotated

54
Q

What will you see in a septic hip joint aspiration?

A

> 50,000 WBC

55
Q

What is the treatment for Septic Hip (3):

A
  • Surgically drain
  • Oxacillin or Nafcillin - 2-4 wks (IV)
  • Clinda or Vanceo if MRSA
56
Q

What is Osgood-Schlatter?

A

Repetitive microtrauma causes avulsion o fate patellar tendon at its insertion on the tibia

57
Q

When is Osgood-Schlatter most commonly found?

A

IN boys 10-15

58
Q

Treatment for Osgood-Schlatter (3):

A
  • NSAIDS
  • Restrict activity
  • Stretching/banding
59
Q

What is Calcaneal Apophysitis?

A

Microtruama and pulling on the calcanea apophysis by the achilles tendon

60
Q

When are Toddler’s fractures most common?

A

9 months - 3 years

61
Q

What is the X-ray finding of a Toddler’s fracture?

A

Oblique/spiral non-displaced fracture of the tibia

62
Q

What is the treatment for Toddler’s Fracture?

A

Immobilization for 4 weeks

63
Q

The arm for nursemaid’s elbow presents like”

A

Flexed, pronated and splinted

64
Q

When are Growing Pains most common?

A
  • 3-12 YO, Females > Males
65
Q

What are the characteristics of the growing pains? (timing, area, duration)

A
  • Awaken from sleep
  • Involves thighs/calves
  • Short duration/bilateral
66
Q

What is the clinical presentation of torticollis?

A

Head tilted towards the affected side, chin pointing to the opposite side

67
Q

When does Torticollis manifest?

A

2-4 weeks after birth

68
Q

If a baby has torticollis, you should also check:

A

Their hips for dysplasia

69
Q

Looking for ___ in babies with torticollis is important

A

Plagiocephaly (helmet head)

70
Q

How do you treat torticollis?

A

DOC band - passive stretching exercises

71
Q

Epidemiology for scoliosis? (What side curve, F/M, age?)

A
  • R thoracic curve is more common
  • Females more than males
  • School aged kids
72
Q

If someone is bending forward and they have the right side of their rib cage more prominent than the left it is a:

A

Right sided scoliosis

73
Q

When should you screen boys and girls for Scoliosis?

A

Females: 10/12
Males: 13-14

74
Q

What vertebrae is used to determine the curvature of the spine; __ angle determines if the curve of the spine is abnormal at 15 degrees

A

T7; Cobb’s angle

75
Q

What do you do to manage Scoliosis?

A

Refer to ortho

76
Q

If the curves are <20-25 in a scoliosis patient, you can monitor them:

A

Every 6 months

77
Q

If curves are between 25 and 45 degrees you can brace in:

A

Growing kids (not skeletally mature) - Want to reduce the current

78
Q

When do you operate on a scoliosis patient?

A

> 45 degrees and a Harrington rod or post spinal fusion

79
Q

What determines skeletal maturity?

A

Risser sign

80
Q

What are the two most common fractures in kids:

A

Torus and greenstick

81
Q

What is more common in kids between ligamentous injuries and fractures?

A

Fractures are more common than ligamentous injuries - The bones are weaker than the tendons

82
Q

How do you treat a Buckle Fracture (Torus)?

A

Immobilization in a cast for 3-4 weeks

83
Q

A Buckle (Torus)fracture is ___ and the cortex will remain on ___ opposite the side of the fracture

A

Stable; intact opposite the side of fracture

84
Q

What happens with a Greenstick fracture?

A

Fracture of one cortex causing the other to bend but one to train intact

85
Q

What is the treatment for a Greenstick fracture?

A

Cast for 6 weeks without reduction

86
Q

What is the big concern with childhood fractures?

A

Mal-union - only about 15-30% of fractures involve the growth plate

87
Q

Type 1 fractures will appear as what on the x-ray?

A

Will NOT APPEAR on an x-ray - may only show soft tissue swelling

88
Q

Casting and immobilization is done for SALTER fractures type __ and ___

A

1 and 2

89
Q

Reduction and casting is done for SALTER fractures type ___ and ___

A

3 and 4

90
Q

Reconstruction surgery is done for SALTER fractures type:

A

5

91
Q

The most common benign bone tumor that is made out of cartilage and bone is found in what two areas:

A

Osteochondroma - shoulder and knee

92
Q

What is a non-ossifying fibroma? It resolves when?

A

Ovoid, scalloped lucency’s in the middle fete long bone with a rim (white portion) of a long bone - Spontaneous resolution

93
Q

What is a Simple/Unicameral Bone cyst? Found where?

A

Benign, fluid filled - found in the femur and the humerus

94
Q

What age is the simple/unicameral bone cyst found in? Treatment?

A

5-15; treat with observation and surgical resection with steroid injections if painful

95
Q

Adam’s forward bend:

A

Scoliosis way to check for spine curvature

Pediatrics Exam 2 (7 decks)

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