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Pediatric PT > Orthopedics evaluation and intervention > Flashcards

Orthopedics evaluation and intervention Flashcards

1
Q

What is etiology of developmental dysplasia of hip and who gets it?

A

70% female, usually first born, hereditary, breech birth

Etiology of multiple factors: mechanical-positional, cultural, increased incidence with torticollis

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2
Q

What are classifications of developmental dysplasia of hip?

A

Normal, Subluxtable, Dislocatable, Subluxed, Dislocated

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3
Q

What are evaluation instability tests for DDH?

A

Barlow: dislocates a reduced hip, “bad”, adduct and apply posterior pressure, listening for clunk
Ortalani: reduces a hip that is out, one leg at a time “out”, abduct and lift left anteriorly, feel clunk
These tests may be negative even if dyplastic because: irreducible, patient tolerance, difficult after 3-4 months of age

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4
Q

What is appearance of kids with DDH?

A

LLD, galeazzi, uneven thigh folds
Waddling gait with lordosis
Limited hip abduction: unilateral late diagnosis- difference of 10 deg, bilateral less than 60 deg

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5
Q

What imaging is used to evaluate DDH?

A

US: 6-8 weeks
Radiographs: > 4 mo, femoral head ossification 4-9 mo, AP, frog leg, Von Rosen view (45 deg abduction, 25 deg IR)

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6
Q

What are the lines drawn on Xrays when evaluating DDH?

A

Hilgenreiner’s line: horizontal through triradiate cartilages

Shenton’s line: inferior neck and inferior border of superior pubic ramus

Perkin’s line: perpendicular to Hilgenreiner’s, intersect lateral acetabular roof

Acetabular angle: Hilgenreiner’s line at triradiate to acetabular roof, less than 20 deg at 24 months, greater than 40 deg significant at birth

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7
Q

What is treatment for DDH?

A

Less than 6 months: observation, abduction orthosis

6-12 months: orthotics

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8
Q

What is orthotic for DDH?

A

Pavlik or Rhino

Pavlik: good for younger immobile kids, watch for brachial plexus and femoral nerve injury, stop if fail to reduce in 3 weeks or palsy signs, 90-95% success in 6 weeks

Factors to succeed are diagnosed under 6 weeks, bilateral, acetabular angle under 35 degrees

Factors for failure: parent education, parent motivation, “off the shelf” (because they fail to fit properly, difficult to don/doff, poor follow up)

Rhino: older, more mobile; ortolani positive

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9
Q

What if braces and orthotics don’t work for DDH?

A

Closed reduction and spica casts: 6-12 mo of age

Surgical intervention: 12 mo of age and older, muscle release and proximal femur osteotomy, spica until stable

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10
Q

What is PT intervention for DDH?

A

orthotic management

Range, strength, and gross motor skills: during immobilization, after immobilization, after surgery

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11
Q

What are the types of clubfoot and what is treatment?

A

Equinus, varus, adductus
If mild and due to fetal positioning: serial cast, weekly progressions
If severe and due to underlying neuromuscular diagnosis: surgical correction at 4-6 mo of age; night splint; PT for PROM, strength, and gross motor concerns

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12
Q

What is metatarsus adductus and calcaneovalgus?

A

Adductus: forefoot curves medially
Calcaneovalgus: forefoot curves laterally, hindfoot valgus, navicular on the floor; foot appears dorsiflexed; vertical talus or rocker bottom deformity

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13
Q

What is evaluation and treatment for pes planus?

A

Arch develops age 3-5
Compensatory posture: must determine cause, WB vs. NWB, bilateral vs. unilateral
Treatment: keep eye on it, if there’s no pain they are probably ok

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14
Q

What is cause of congenital muscular torticollis?

A

Abnormal intrauterine posture: too much baby not enough space, contracture
Injury to SCM during delivery: direct muscle trauma (fibrosis, contracture), compartment syndrome (nerve and muscle damage, swelling, fibrosis)

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15
Q

What is torticollis posture?

A

Contralateral head rotation coupled with ipsilateral tilt.

Name to side of the tilt.

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16
Q

What is plagiocephaly?

A

occurs in torticollis or craniosynostosis
Torticollis: flattened occiput, eye will appear larger on one side, ear will be lower and more anterior
Craniosynostosis: cranial sutures are sealed and you will only see a flattened occiput

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17
Q

What is etiology of torticollis?

A

Right > Left
Mean age of dx= 4 months
Associated conditions: hip dysplasia, plagiocephaly, progressive facial asymmetry, vision deficits

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18
Q

What is part of the exam for torticollis?

A

History: birth weight/multiples, unplanned events, NICU/ventilator use
Postural deviations: palpation of cervical muscles, cranial asymmetry, extremities and spine, resting and active
Range and strength: active and passive, cervical, extremities
Neuro: gross motor development, tone and posture, vision, language delays

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19
Q

What are torticollis differential diagnosis?

A

Full AROM and no fibrosis: normal radiograph- BPT, congenital absence of cervical muscle, CNS lesions or tumors, visual involvement
Without full AROM and no fibrosis: abnormal radiograph- congenital structurally absent (hemivertebrae, unsegmented bar vertebrae, scoliosis, subluxation), rule out syndromes and trauma

20
Q

What is treatment for torticollis?

A 
Begin as soon as possible: with consistent timely therapy 85-90% should resolve within 4-5 mo
PROM
Strength
HEP
shaping helmets?
21
Q

What is refractory torticollis? What are concerns and approach for this?

A

Plateau in gains after 4-5 months of PT and/or 7-8 months of age.
Concerns: facial asymmetry, plagiocephaly, irreversible contracture
Approach: consider/evaluate other causes for torticollis, modify treatment approach, get physician involved (focused neuro/developmental eval, radiograph)

22
Q

What is plan for treatment of refractory torticollis based on the radiograph results?

A

Radiograph normal/physician eval normal: continue program, consider botox injections, consider CT scan if no improvement after botox

Radiograph normal/physician abnormal: neuro findings, developmental delay, MRI scan of c spine brainstem brain, may continue program

Radiograph abnormal/physician normal: refrain from PROM continue AROM, refer to ortho surgery clinic, consider botox injections

23
Q

What are injection sites for botox?

A

Rotational deficits: SCM, upper trap

Lateral flexion deficits: scalenes

24
Q

After all conservative measures have failed what is treatment for torticollis?

A

Surgical intervention

Age > 18-24 months

25
Q

What is Legg-Calve-Perthes?

A

Self limiting avascular necrosis of femoral head: from trauma, vascular anomalies, infection, thrombosis

See it in boys 3-13 years

26
Q

What is presentation for legg-calve-perthes?

A

loss of IR, abduction, extension of hip

Antalgic gait with trendelendberg

27
Q

What are the stages of legg calve perthes?

A

Condensation- femoral head turns necrotic

Fragmentation: necrotic bone fragments and reabsorbed, revascularization occurs, deformation of femoral head with flattening of acetabulum

Reossification with return of vascular supply.

Remodeling at acetabulum

28
Q

what is management of legg calve perthes?

A
29
Q

What is a slipped capital femoral epiphysis (SCFE)?

A

Displacement from normal position on femoral neck: from obesity, trauma, rapid growth
See more in males

30
Q

What is presentation for SCFE?

A

Loss of IR, abduction, flexion of hip
Antalgic gait with decreased weight bearing
ER with attempts at flexion

31
Q

How is SCFE classified?

A

By duration: acute is sudden onset, pain less than 3 weeks; chronic is gradual onset, pain greater than 3 weeks; acute on chronic is greater than 3 weeks with exacerbation

By severity: grade 1 is up to 1/3 width of neck, grade 2 is 1/3-1/2 width of neck, grade 3 is greater than 1/2 width of neck

32
Q

What is treatment for SCFE?

A

Surgical management: stabilize growth plate, immediate correction, non surgical intervention is not successful
PT: gait train with AD after surgery, NWB initially, strength and PROM with focus on core

33
Q

What are unique qualities of pediatric bones?

A

Increased malleability: more avulsions because ligaments are stronger then bones, bending fractures
Increased remodeling: malunion and non union rare, femur fracture healing rates (2-3 weeks for infants, 4 weeks preschool, 6 weeks 7-10 years, 8-10 weeks in adolescent)

34
Q

What are the types of pediatric fractures?

A 
Avulsion: ligament stronger, ORIF
Bend: deformation w/o fracture
Buckle: compression equal bulge in cortex
Greenstick: fracture on tension side only
Transverse: horizontal fracture
Oblique: angled fracture
Spiral: looks like pre made biscuit tube
Comminuted: multiple fragments
35
Q

What are they types of physeal injuries?

A

I: closed reduction, good prognosis
II: closed reduction, good prognosis
III: open or closed reduction, good if vascular intact
IV: open reduction, growth disturbance
V: not detected until growth disturbed, growth arrest and angular deformity, may need for surgical correction

36
Q

What is tibial eminence (spine) fracture? MOI? When does it occur?

A

Fracture through subchondral bone beneath ACL insertion.
Hyperextension injury
8-12 years of age

37
Q

What are signs and symptoms found on examination for tibia eminence fractures?

A

Clinical exam: pain, hemarthrosis, instability, limited ROM

Imaging: x ray, MRI

38
Q

What is management of eminence fractures?

A

Type I: cast in slight flexion (arthrocentesis)
Type II: evaluate in operating room, confirm reduction via CT
Type III: operative treatment

39
Q

What is operative management of eminence fractures?

A

Arthroscopy vs. arthrotomy
Screw vs. suture
Entrapment
Return to sports: PT use ACL reconstruction protocols

40
Q

What are complications of tibial eminence fractures?

A

Laxity/instability
Arthrofibrosis
Extension block/malunion/nonunion

41
Q

What is MOI for tibial tubercle fracture?

A

Result of violent quadriceps contraction or passive flexion of knee with contracted quad
12-17 years of age
See a lot in kids who had Osgood schlatter

42
Q

What are clinical findings in tibia tubercle fracture?

A

Pain, hemarthrosis, inability to extend knee, x-rays

43
Q

What is treatment for tibial tubercle fractures?

A

Type I: immobilization

Type II and III: ORIF

44
Q

What are complications for tibia tubercle fractures?

A

Compartment syndrome, recurvatum deformity, extension lag, patella baja, fixation complications (prominence)

45
Q

What are types of epiphysitis or apophysitis?

A

Osgood Schlatter: tibial tubercle epiphysis
Sinding-larsen-johansson: inferior patella epiphysis
Sever’s disease: calcaneal epiphysis
Little league shoulder: proximal humeral epiphysis
Little league elbow: medial humeral epiphysis

46
Q

What is treatment for epiphysitis?

A

Address acute symptoms: modalities, active rest
Address underlying cause: postural imbalances from strength or flexibility
Education

Pediatric PT (13 decks)

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