Pediatric Big Ten - Injuries Flashcards

1
Q

What is developmental hip dysplasia?

A

Happens in infants - can range from a totally dislocated hip to slightly subluxable joints or just a slightly abnormal socket

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some risk factors for developing hip dysplasia?

A

breech presentation - and thus first borns

torticollis (short neck)

metatarsus adductus (foot deformity)

oligohydramnios

usually the left hip

happens in girls 80% of the time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why has dysplasia historically been more common in native american populations?

A

they use swaddling more often, which leads to hip dysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What two maneuvers do you do to diagnose hip dysplasia in an infant?

A

the Barlow and Ortolani

Barlow is the dislocation (can you feel it pop out)

Ortolani is the reduction (can you feel it click back in)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Late diagnosis of hip dysplasia will eventually be made with what two tests?

A

look for limited abduction of the leg

Galeazzi sign - apparent leg length discrepancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

THe difficult of reducing a dysplastic hip ____ with age.

A

increases

they have tighter adductor and liiopsoas muscles and other intraarticular obstacles develop like capsular construction ligamentum teres and labrum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What imaging is best for hip dysplasia?

A

ultrasound (but its only as good as your technician)

x-ray after 4-8 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the treatment for hip dysplasia in a kiddo less than 6 months?

A

the Pavlik harness

super successful

full time 6-12 weeks on average

However, if the parents take it off and then put it back on when the hip is unreduced, it will make later treatment more difficult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the treatment for hip dysplasis in a kid months to 2 years?

A

closed reduction of the hip using arthrogram to be sure, followed by Spica casting

only use open reduction if closed fails and you continue to get persistent subluxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the treatment for hi dysplasia in a kid older than 2?

A

open reduction, usually with femoral shortening and acetabular procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When should you refer if you’re concerned about hip dysplasia?

A

with an abnormal exam, abnormal ultrasound, or abnormal x-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is Perthes Disease?

A

It’s a temporary vascular insult to the epiphysis- we’re not sure what causes it

the femoral head loses blood supply and it gets soft and can fragment to the point where it gets flat within the acetabulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Who is at greatest risk for Perthes Disease?

A

grade school-aged boys with a positive family history

they usually have delayed bone age and are shorter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do kids with Perthes disease usually present?

A

present with an insidious limb and mild to moderate pain in the hip, thigh or knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the treatment for Perthes disease?

A

you can’t really stop it once it starts, but…

rest, NSAIDS for pain, physical therapy, casting

bracing doesn’t work actually

goal is to contain the femoral head within the acetabulum so that it won’t fragment so much and may stay as round as possible.

the petri cast is placed so that the hips are abducted and inwardly rotated so that the head stays in the acetabulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What hip disorder can develop in adolescence? Usually in overweight males….

A

slipped capital femoral epiphysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

WHat happens in slipped capital femoral epiphysis syndrome?

A

it’s a mechanical problem where the growth plate slips a bit

can be related to renal osteodystrophy, radiation therapy, or hypothyroidism or GH deficiency

18
Q

What will a patient with slipped capital femoral epithpysis syndrome?

A

THey’ll have pain in the thigh or knee

importantly, they’ll have a limp with externally rotated gait

on exam they’ll have limited internal rotation and flexion

19
Q

What is the difference between stable slipped capital femoral epiphysis and unstable slipped cpaital femoral epiphysis?

A

stable you can still walk on

unstable is too painful to walk

20
Q

What is the treatment for slipped capital femoral epiphysis?

A

in situ fixation

osteotomy for deformity

you put a pin thorugh the growth plate so that it won’t continue to grow

21
Q

In what situations would you prophylactically pin the hip that isn’t affected in slipped capital femoral epiphysis/

A

if it’s a high risk patient

those with hypothryodisim, renal osteodystrophy, or endocrinopathis

of if they’re younger than 10 years old because otherwise they’ll grow lopsided

22
Q

What is the difference between static and dynamic intoeing/outtoeing?

A

static happens at rest, dynamic is only with walking

23
Q

How does one do a static exam for intoeing/outtoeing?

A

have the patient lay prone

plex the knee and look where the foot goes relative to the thigh.

If it is outward, it’s actually an internal rotation

if it’s inward, it’s an external rotation

24
Q

Describe increased femoral anteversion

A

it’s an increased medial hip rotation- they will intoe

more common in girls

will increase until age 10 and then normalizes

25
Q

Describe internal tibial torsion

A

it’s internal rotation of the tibia

this causes intoeing as well

it usually normalizes on its own but isn’t even that big of an issue if it doesn’t

26
Q

How do you test the dynamic omponent of intoeing/outtoeing?

A

watch them walk and compre their foot angle to a straight line they walk on. measure the angulation

called the line or progression

note that more people externally rotate by about 15 degrees

27
Q

What is genu varum?

A

bowed legs

28
Q

Describe physiologic bowing

A

usually bilateral leg bowing seen in young toddlers - usually in early and agile walkers

29
Q

Where is the bowing distributed in physiologic bowing?

A

usually between the femur and the tibia - so over the knee

30
Q

What is the treatment for physiologic bowing?

A

spontaneous correction is the rule - it will fix itself in almost every case

bracing is not effective

31
Q

Although physical bowing normalizes, what are some thing syou need to rule on on DD?

A

Blounts DIsease

skeletal dysplasia

neoplasm

metabolic bone disease like rickets (nutritional or hypophosphatemic)

32
Q

What happens in Blounts dissease?

A

it’s an osteochondrosis defomity of the proximal medial tibia epiphysis

you get progressive fragmentaion of the medial tibial plateau and eventually physeal bar formation

It will NOT get better

different than physiologic bowing because the femur is straight but the tibia is bent - more focal

33
Q

What is the treatment for Blounts disease?

A

les than 2 years old: brace treatment

over 2: valgus proximal tibial osteotomy with pinning

34
Q

When should you refer someone with bow legs?

A

if the height is less than the 5%ile

positive family history

assymetry

progressive

localized varus deformity

35
Q

WHat is genu valgum?

A

valGUM (knees stick together)

knock-knees

36
Q

Genu valgum usually resolves by about age 7

if it doesn’t, what will happen to the patella?

A

patellar subluxation can be associated with it

37
Q

What is metatarsus adductus?

A

medial deviation of the forefoot on the hind foot

there will be a medial crease and the forefot will be slightly supinated

they’ll have full dorsiflexion

38
Q

What is the lay term for talipes equinovarus?

A

clubfoot

39
Q

What happens in talipes equinovarus?

A

forefoot aductus and hindfoot equinus

shortening of the foot and atrophy of the calf

40
Q

What is the treatment for clubfoot?

A

serial casts after birth

should be seen each week

bracing will be needed to prevent recurrence

usually requirs percutaneous achilles tenotomy too

41
Q
A