Orthopedics For Kids Flashcards
Legg-Calve-Perthes disease
●Idiopathic avascular necrosis of the epiphysis of the femoral head ●2-4 year progression and almost always heals itself ●Usually occurs b/w 3 & 12 yo ●Most common in boys 5-7 yo ●4 times more common in boys ●Girls often develop it later and more severe ●Bilateral 20% of cases
Legg Calve Perthes Disease cause
Unknown etiology
Trauma-> temporary blood loss to femoral head
Maternal smoking in utero
Legg Calve Perthes disease presentation & subjective complaint
●Present with mild pain at hip/thigh/knee with activity, but subsides with rest
●Progresses to limp
• Trendelenberg gait pattern
Treatment of Legg Calve Perthes Disease
-Gait training
• assistive device as needed
-Treatment controversial
•1° goal of treatment: avoid severe degenerative arthritis and encourage proper formation of femoral head.
*conservative: observation, ROM, w/c to decrease WBing, Petrie casts (best positioning of hip is abd/ER).
- Bracing with Petrie casts (long leg casts with bar holding legs in ER)
- Surgery: triple osteotomy
Slipped Capital Femoral Epiphysis
●Most commonly diagnosed in 10-15 yo ●Growth plate abnormality ●More common in African-American pop than Caucasians ●More common in males than females ●Surgery •spica cast •maintain ROM elsewhere •Gait training •WC •Home assessment
Classification of SCFE
- Grade I: displacement of epiphysis less than 30% of width of femoral neck
- Grade II: slip between 30%-60%
- Grade III: includes slips of greater than 60% the width of neck
How can you tell the difference between SCFE and LCP?
- Similar in presentation
- LCP usually younger
- SCFE usually more pain
Osgood-Schlatter Syndrome
- Traction apophysitis (inflammation of the tendon insertion) of the patellar tendon aggravated by activity
- Osteochondrosis- degeneration followed by reossification of one or more ossification centers in children
Prevalence of Osgood-Schlatter’s Syndrome
- Common in the 8-15 year range
- More common in males
- One of the most common causes of knee pain in adolescents
Treatment of Osgood-Schlatter’s Syndrome
●Rest, ice, decrease activity ●Modalities •Estim to reduce inflammation ●Assess for: •Patella tracking problems •Patella mobility
Where can Apophysitis occur?
In addition to tibial tubercle apophysitis (Osgood-Schlatter’s disease), traction apophysitis may occur at the calcaneus, navicular and, rarely, the hip, most often as a result of repetitive trauma/overuse.
Prevalence of Developmental Dysplasia of the Hip (DDH)/ Congenital dislocation of the hip (CDH)/Infantile hip dislocation
- More common in female
- Most are unilateral
- can be due to intrauterine positioning
- can accompany torticollis
Developmental Dysplasia of the Hip (DDH)/ Congenital dislocation of the hip (CDH)/Infantile hip dislocation DIAGNOSIS AND TREATMENT
Barlow maneuver & Ortolani maneuver
Barlow maneuver
•Barlow maneuver (to determine if hip will dislocate):
●This is part of the standard infant exam performed until 8–12 weeks of age.
●Hip is adducted and gently pushed posteriorly.
●“Clunk” is heard (+)…the less pronounced the clunk, the more poorly formed the acetabulum.
Ortolani maneuver
•Ortolani maneuver (for posterior dislocation):
●passive flexion, keep flexion and abduct, then bring hip into neutral/extension.
●feel a click/pop (hip is reducing)
If you have a baby younger than 6 months and you want to immobilize their hips into abduction, what do you use?
Pavlik Harness
If you have a baby older than 6 months and you want to immobilize their hips into abduction, what do you use?
Spica cast
What is the number 1 cause of brachial plexus injuries in babies?
Ninety percent of brachial plexus injuries in children are caused by a traumatic stretching of the plexus during birth
What percent of babies will recover without surgery after a brachial plexus injury?
80%!
What is the incidence of brachial plexus injury?
1-2/1000 births
Brachial Plexus Avulsion
Nerve is torn from the spine
Most severe
Brachial Plexus rupture
Nerve is torn but not at the spinal attachment
Brachial Plexus Neuroma
The nerve has tried to heal itself but scar tissue has grown around the injury, putting pressure on the injured nerve and preventing the nerve from conducting signals to the muscles
Brachial Plexus Neuropraxia
Stretch
The nerve has been damaged but not torn
most common
Erb’s Palsy
●Paralysis involving C5 & C6 and sometimes C7.
• the arm is turned towards the body
•the elbow does not bend and the hand is in a “waiters tip” (turning backwards) position.
Klumpke’s palsy
●Paralysis involving C7, C8 & T1.
•the hand is limp
• fingers do not move
• there is often an associated Horner’s Syndrome (Horners Syndrome is when the eyelid droops, the cheek does not sweat and the pupil is smaller than the unaffected eye).
Brachial Plexus Injury Treatment
•ROM (passive and active) •Electrical stimulation **Somewhat controversial on infants •Parental education •Sensory input •Increase awareness of extremity •Positioning •Splinting
Talipes Equinovarus/Club Foot
- a congenital deformity seen in newborn children
- the feet to point down and inward
- does not cause pain in the newborn child
What are some of the future concerns with Club Foot/ Talipes Equinovarus? What is the prognosis?
• can cause long-term abnormalities in gait
•may lead to complications such as chronic skin ulcers.
•If properly treated, the deformity can resolve in early childhood.
**however this will not correct for differences in foot and calf size
How will an injury to the whole brachial plexus present?
Erb’s-Klumpke paralysis
Torticollis prevalence
1/300 live births
Torticollis cause
Intrauterine positioning
Extrauterine positioning
Trauma, structural (tumor)
Gastro esophageal reflux
In torticollis, deformation of the infant’s skull due to:
normal brain growth combined with an asymmetric pre and postnatal resting position
In torticollis, shortening of the SCM results in:
Lateral flexion of the cervical spine to one side
asymmetric pre and postnatal resting position
with cervical rotation toward the opposite side
What are come of the things that may accompany torticollis depending on its severity and presentation?
○ Plagiocephaly (“oblique head”): describes
asymmetry of the head shape
○ Often, a flattening of the head on the
preferred side.
○ “Bald spot” may be present on the
latero-posterior aspect of the preferred side of rotation.
○ Facial asymmetry is often present (muscle bulk is usually smaller on the side of with shortened SCM. )
○ Palpable knot/cord may be present in the SCM
What are some of the associated conditions that correlate with torticollis?
○ Changes in facial features ○ Hip dislocation or dysplasia ○ Equinovarus deformity (club foot) ○ Gastroesophageal reflux
How does one even begin to treat torticollis?!
○ Stretching
● until you feel a pull or at baby’s discomfort
○ Massage
● SCM
○ Positioning
● Holding/Feeding (parents should switch sides)
● Presenting objects to the child during
interaction/play
● Environmental modifications
● Helmet therapy to reshape the infant’s skull
○ Typically started around 5-6 months, earlier in more severe cases
○ Surgery
○ Parent/Caregiver training
