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Clin Med II MHM - FINAL > Pediatric Ortho > Flashcards

Pediatric Ortho Flashcards

1
Q

Definition of torticollis

A
  • Unilateral contraction of neck muscles causing head to be tilted to one side
  • Chin rotates to opposite side of contraction
  • 80% are congenital (rest are trauma/disease)
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2
Q

When does congenital torticollis MC occur?

A

Following breech deliveries

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3
Q

What can congenital torticollis be associated with?

A
  • Hip dysplasia

- Clubfoot

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4
Q

What happens to the SCM in congenital torticollis?

A

Fibrosis of SCM causes a palpable “mass”

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5
Q

When does the SCM mass resolve in congenital torticollis?

A
  • A few weeks after birth

- SCM is shortened and contracted after

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6
Q

What happens if congenital torticollis is left untreated?

A
  • Plagiocephaly (facial asymmetry/skull deformity)

- Changes in cervical vertebrae

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7
Q

How is congenital torticollis diagnosed?

A
  • Clinically (based on PE and palpable mass of SCM)

- Xray of cervical spine is recommended

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8
Q

Conservative treatment of congenital torticollis

A
  • Stretching exercises

- Doc band to help improve secondary plagiocephaly

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9
Q

Surgical treatment of congenital torticollis

A
  • For pts who fail conservative tx or are diagnosed late

- Release of SCM (traction/casting and exercises)

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10
Q

Define plagiocephaly

A

Skull deformity from external forces (either in utero or infancy)

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11
Q

Risk factors for plagiocephaly

A
  • Position in womb
  • Multiple births
  • Premature
  • Torticollis
  • Sleeping on the back
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12
Q

Treatment of plagiocephaly

A
  • Encourage belly time
  • Reposition often
  • Stretching for torticollis
  • Doc Band (4-6 months)
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13
Q

Define scoliosis

A

Lateral curvature with rotation of the spine in upright position

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14
Q

MC cause of scoliosis?

A

Idiopathic (80%)

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15
Q

Classifications of scoliosis

A

Structural: fixed, nonflexible, does NOT correct w/side bending
Non-structural: Flexible and corrects w/side bending

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16
Q

Who is most affected by scoliosis?

A

Adolescent girls (including serious curvatures)

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17
Q

What is the MC type of curvature in scoliosis?

A

Right thoracic

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18
Q

How large does curve have to be in scoliosis?

A

Greater than 10 degrees

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19
Q

What is the most serious complication of scoliosis?

A

Cardiopulmonary dysfunction

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20
Q

Clinical presentation of scoliosis

A

Usually asymptomatic

Pain is RARE and if present is a red flag

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21
Q

What is the Cobb angle?

A

Angle of spinal curvature in scoliosis (identified on x-ray)

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22
Q

What is the Risser sign?

A

Sensitive indicator of skeletal maturity

Ossification progression from lateral to medial (SI joint)

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23
Q

When do respiratory symptoms occur in scoliosis?

A

Spinal curvature over 60 degrees

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24
Q

General treatment of scoliosis

A
  • Early detection is key to preventing progression

- Referral is mandatory for all patients

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25
Non-surgical treatment of scoliosis
Will NOT fully correct curve, but will prevent progression and maintain flexibility
26
Surgical treatment of scoliosis
Will correct the curve BUT reduces flexibility | Deformity correction AND spinal fusion
27
When is spinal bracing indicated in scoliosis?
- In curves less than 20 degrees IF they are progressing - In curves 20-40 degrees (esp skeletally immature pt) - 23 hrs/day for 2 years or longer
28
When is surgical treatment indicated in scoliosis?
Curves over 45 degrees
29
Define nursemaid's elbow
"Pulled elbow" | Head of radius subluxes distally through annular ligament
30
Who is MC affected by nursemaid's elbow?
Children 1-3 yo | Rare after 6 yo
31
Treatment of nursemaid's elbow
- Reduction | - Immobilization NOT recommended except for recurrent cases
32
Define little league elbow
- Traction injury to medial epicondylar physis | - Caused by repetitive throwing
33
Pathophys of little league elbow
Repetitive valgus stress
34
What would an x-ray of little league elbow show?
Widening of apophysis
35
Treatment of little league elbow
Complete rest from throwing PT is helpful Prevention is key
36
Define development dysplasia of hip (DDH)
- Spectrum of hip disorders in young children - 98% reversible - MSK abnormalities increase the risk
37
When is the hip fully formed?
11th week of gestation
38
Prognosis of DDH
Early diagnosis and intervention!
39
Hallmark sign of DDH
Restricted hip abduction
40
What is the Barlow Maneuver?
- To examine for DDH in infants | - Hip is purposefully dislocated and then reduced (via Ortolani maneuver)
41
What is the Ortolani maneuver?
Gentle reduction of dislocated hip (used w/Barlow maneuver in infants)
42
Imaging in DDH
- Not reliable in children under 6 wks old - US is 1st line in 6 wks to 4 mo children - X-ray is 1st line in children over 6 mos
43
When is the most opportune time to treat DDH?
Birth to 6 wks old
44
What is the gold standard treatment for DDH?
Pavlik harness - Maintains hip flexion of 100 degrees, prevents adduction - Worn several weeks
45
Define Legg Calve Perthes Disease (LCPD)
Disruption of blood supply to femoral head resulting in AVN
46
Who is MC affected by LCPD?
4-10 yo Males 4:1 Bilateral in 15% cases
47
Stages of LCPD
1. Early (6 months) 2. Regenerative/fragmentation (1-2 years) 3. Reossification
48
Gold standard for diagnosing LCPD?
AP and lateral frog X-ray
49
Treatment of LCPD
Based on age - Less than 6 yo w/mild disease: symptomatic care - Over 6 yo: abduction brace to keep femoral head w/in acetabulum (worn continuously for up to 2 years)
50
Define slipped capital femoral epiphysis (SCFE)
- Displacement of proximal femoral epiphysis due to disruption of the growth plate - Results in upward and anterior displacement of femoral neck
51
Clinical features of SCFE
- Bilat in up to 25% cases - Primarily gradual onset - Trauma or hormonal
52
Who is MC affected by SCFE?
Boys 10-17 yo African Americans Hypothyroid Obese or tall/thin
53
Imaging of SCFE
AP and lateral x-ray of BOTH HIPS - Klein's line - Ice cream scoop slipping off cone
54
Treatment of SCFE
- Refer immediately to ortho surgeon | - Non wt bearing w/crutches
55
Prophylaxis of SCFE
- Pinning of contralateral hip | - Controversial, not recommended
56
Define transient synovitis of hip
``` Self limited, nonspecific synovial inflammation of hip joint Results in joint effusion Cause unknown (viral infection maybe) ```
57
What is the MC cause of hip pain in children under 10 yo?
Transient synovitis of hip
58
Who is MC affected by transient synovitis of hip?
Males | Peak age 5-6 yo
59
What is the MC angular/rotational deformity of the legs?
In toeing
60
Define genu varum
Bow leg (tibial rotation toward midline)
61
Define Blount's disease
- Pathologic, developmental bow legs - Caused by disrupted growth of upper medial tibial epiphysis - MC in obese early walkers, African Americans, fam hx
62
Define genu valgum
Knock knee (tibial rotation away from midline) 3-8 yo May be caused by skeletal dysplasia and rickets Out-toeing
63
Etiologies of toeing in
Metatarsus adductus/varus of foot in infants Internal tibial torsion in toddler Increased femoral torsion in child over 10 yo
64
Define Osgood-Schlatter's disease
- Inflammation of patella tendon attachment to tibial tubercle apophysis - Potentially partial avulsion - 20% occur bilaterally
65
Who is MC affected by Osgood-Schlatter's disease?
Early adolescent males (especially athletic)
66
What is a common cause of knee pain in adolescents?
Osgood-Schlatter's disease
67
Treatment of Osgood-Schlatter's disease
Conservative - rest, ice, NSAIDs
68
What is Sever's disease?
Calcaneal apophysitis - similar to Osgood-Schlatter's - Low grade inflammation at insertion of Achilles tendon - Often bilateral
69
Who is MC affected by Sever's disease?
Boys 8-14 yo | High impact sports, activities
70
Treatment of Sever's disease
Conservative - ice, rest, NSAIDs, heel cups
71
What is talipes equinovarus?
Club foot MC in males 3 categories: idiopathic, neurogenic, a/w abnormal syndromes
72
What features must be present to diagnose club foot?
- Plantar flexion of foot at ankle joint (equinus) - Inversion deformity of heel (varus) - Medial deviation of forefoot (varus)
73
Treatment of club foot
Stretch contracted tissues followed by casting to hold correction
74
Define osteogenesis imperfecta
- Rare genetic CT disorder characterized by multiple and recurrent fractures - Type 1 MC - Type 2 results in fetal death - Can look similar to child abuse
75
Clinical presentation and diagnosis of osteogenesis imperfecta
Blue sclera, hyperextensibility of ligaments, Wormian bones (accessory skull bones) Genetic testing and x-ray findings
76
Treatment of osteogenesis imperfecta
Bisphophonates to decrease fractures Surgery to correct deformities Preventive measures

Clin Med II MHM - FINAL (16 decks)

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