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Pediatrics > Pediatric Ortho > Flashcards

Pediatric Ortho Flashcards

1
Q

Define Scoliosis

A

Lateral curvature of the spine >10 degrees by Cobb method

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2
Q

What are common orthopedic congenital defects”

A 
Clubfoot
Developmental dysplasia of the hip (DDH)
Legg-Calve-Perthes disease
Spine deformities
Muscular dystrophy
Limb defects
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3
Q

Anatomic Changes in Clubfoot

A

Talus plantar flexed
Heel cord tight
Fore foot adducted/supinated

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4
Q

What is the Ponseti Method in Clubfoot?

A

Casting

Percutaneous heel cord lengthening

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5
Q

Physiological & Mechanical Factors in Developmental Dysplasia of the Hip (DDH)

A

Ligamentous laxity, hormonal, & family factors

Breech position & congenital deformities

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6
Q

Presentation of Developmental Dysplasia of the Hip (DDH)

A

Hip reduced but unstable and can be dislocated
Dislocation can be reduced
Fixed dislocation
Bony deformities

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7
Q

Barlow’s Test

A

Hip reduced but can be dislocated

Knee bent, internal rotation, push down

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8
Q

Ortolani’s Test

A

Hip dislocated but can be reduced

Knee bent, pull up, external rotation

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9
Q

Treatment of Developmental Dysplasia of the Hip (DDH)

A

Harness or pillow

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10
Q

What is Legg-Calve-Perthes Disease?

A

Loss of blood supply to femoral head

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11
Q

How here there loss of blood supply to the femoral head in Legg-Calve-Perthes Disease?

A

Head can collapse & subluxation of head

Eventually revascularizes

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12
Q

Symptoms of Legg-Calve-Perthes Disease

A

Variable hip/knee symptoms
Limping
Pain

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13
Q

What range of motion is limited in Legg-Calve-Perthes Disease?

A

Internal rotation

Abduction of hip

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14
Q

How to reduce pressure on femoral head in Legg-Calve-Perthes Disease?

A

Relative rest
Bracesm crutches
Traction
Adductor muscle release

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15
Q

Treatment of Legg-Calve-Perthes Disease

A

Femoral and/or acetabular osteotomy

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16
Q

Define Scoliosis

A

Lateral curvature of the spine >10 degrees by Cobb method

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17
Q

Types of Scoliosis

A

Idiopathic
Congenital
Secondary
Neuromuscular

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18
Q

Forms of Idiopathic Scoliosis

A

Lumbar
Thoracic
Thoracolumbar

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19
Q

Most common age group for idiopathic scoliosis

A

Adolescent (10 years to end of growth)

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20
Q

Most common type of scoliosis

A

Idiopathic scoliosis

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21
Q

Screening Methods for Scoliosis

A

Adam’s forward bend test
Radiographic examination
MRI

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22
Q

Define Kyphosis

A

Increased thoracic curvature in the saggital plane

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23
Q

Types of Kyphosis

A

Postural

Scheuermann’s disease

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24
Q

Postural Kyphosis

A

Usually in females
Gentler, more pliable curve
Corrects with time/bracing

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25
Q

Scheuermann’s Disease

A 
Osteochondrosis of the spine
Wedged vertebrae
Usually in males
Sharper curve
Surgical correction needed
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26
Q

Define Muscular Dystrophy

A

Progressive weakness & wasting of muscles

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27
Q

Signs/Symptoms of Muscular Dystrophy

A 
Waddling gait
Fatigue
Mobility
Frequent infections
Psychological effects
Maintain function
Hx of motor developmental delays
Clumsiness
Frequent falls
Difficult climbing stairs, running, riding trike
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28
Q

Diagnosis of Muscular Dystrophy

A

Biopsy

Electromyography (EMG)

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29
Q

Treatment of Muscular Dystrophy

A

PT/OT
Bracing
Surgery (scoliosis)

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30
Q

Types Limb Defects

A

Polydactyly

Syndactyly

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31
Q

Define Polydactyly

A

Too many digits on one limb

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32
Q

Define Syndactyly

A

Webbed fingers or toes

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33
Q

Treatment of Limb Defects

A

Live with deformity

Reconstruction surgery

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34
Q

Normal Musculoskeletal Variants

A 
Metatarsus adductus
Axial rotation
idiopathic toe walking
Pes cavus (flat foot)
Angular variations
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35
Q

Types of Angular Variations

A 
Genu varus (bow legged)
Genu valgus (knock -knees
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36
Q

Define Metatarsus Adductus

A

Excessive amount of adduction of the metatarsals relative to the long axis of the foot

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37
Q

What is the most common congenital foot deformity

A

Metatarsus adductus

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38
Q

Statistics of Metatarsus Adductus

A

Female > Male
Left > Right
Intrauterine restriction
85-90% resolve spontaneously

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39
Q

Metatarsus Adductus Management

A

Flexible: stretching 5x at diaper changes
Flexible beyond 8 months: biweekly casting (3-4 casts)
Extreme adduction of great toe: surgical release of abductor hallicus

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40
Q

Axial Rotation Toe-In

A

Internal femoral torsion: “W” sitting
Internal tibial torsion: intrauterine positioning
Metatarsus adductus

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41
Q

Axial Rotation Toe-Out

A

External femoral torsion: intrauterine position
External rotation contracture
External tibial torsion
Flat foot

42
Q

Treatment for Axial Rotation

A 
Good sleeping positions
Good sitting habits
Nocturnal bar
Corrective casting
Surgery
43
Q

Define Idiopathic Toe Walking

A

Walk with toe-toe pattern in the absence of any known cause

44
Q

Etiology of Idiopathic Toe Walking

A

Unclear

Children

45
Q

Idiopathic Toe Walking Management

A

PT/OT
Orthotics (D/N)
Serial casting
Surgical Achilles lengthening

46
Q

Angular Variations: Types of Genu Varum

A

Physiology bowing
Metabolic bowing
Blount’s disease

47
Q

Genu Varum: Physiologic bowing

A

Usually corrects by age 2

48
Q

Genu varum: Metabolic Bowing

A

Vitamin D deficiency

49
Q

Genu Varum: Blount’s Disease

A

Damage to epiphysis

May need bracing or surgery

50
Q

Angular Variations: Genu Valgum

A

Knock knees
Correct spontaneously
After 11-13 may need surgery

51
Q

Common Pediatric Orthopedic Injuries

A 
Slipped capital femoral epiphysis (SCFE)
Radial head dislocation (Nursemaid elbow)
Common pediatric fractures
Osteochondrosis
Patellofemoral arthralgia (PFA)
Spondylolysis
52
Q

Slipped Capital Femoral Epiphysis (SCFE) Statistics

A

Most common 9 years to end of growth
Males
Increase frequency with hypothyroid, renal disease, growth, & sex hormone imbalance
Obesity increases likelihood

53
Q

Signs/Symptoms of Unstable SCFE

A

Sudden, severe pain

Limp

54
Q

Signs/Symptoms of Stable SCFE

A

Limp with groin pain

Variable medial knee/anterior thigh pain

55
Q

What range of motion is restricted in SCFE?

A

Internal rotation
Abduction
Flexion

56
Q

Types of X-rays for SCFE

A

AP

Frog leg lateral

57
Q

Complications of SCFE

A

Avascular necrosis (AVN)
Chondrolysis
Osteoarthritis

58
Q

Define Radial Head Dislocation (Nursemaid’s Elbow)

A

Subluxation or dislocation injury from sudden pull of child’s arm

59
Q

Signs/Symptoms of Radial Head Dislocation (Nursemaid’s Elbow)

A

Guarding of elbow
Refuses to use arm
Swollen/tender with palapation

60
Q

Treatment of Radial Head Dislocation

A

Gental supination of hand while flexing elbow

Sling for a few days for comfort

61
Q

Types of Pediatric Fractures

A

Growth plate (epiphyseal) fractures
Supracondylar humerus fracture
Wrist/forearm fractures
Clavicle fractures

62
Q

Growth Plate Fractures

A

Disrupt bone growth

Stimulate excessive bone growth

63
Q

Types of Growth Plate Fractures

A 
1- slipped
2- above
3- lower
4- through
5- rammed
64
Q

How does a supracondylar humerus fracture occur?

A

Fall on outstretched hand

65
Q

What can supracondylar humerus fracture be associated with?

A

Distal radius fracture

Forearm fracture

66
Q

Treatment of Supracondylar Humerus Fracture

A

Stable: long arm cast
Unstable: percutaneous fixation with K-wires

67
Q

Types of Wrist/Forearm Fractures

A

Torus (buckle) fractures
Greenstick fractures
Complete (transverse) fractures

68
Q

Torus (buckle) fractures

A

Nondisplaced-strong periosteum

Subtle

69
Q

Greenstick fractures

A

Disruption of only one cortex

70
Q

Complete (transverse) fractures

A

Disruption of both cortexes

71
Q

Treatment of Torus Fractures

A

Short arm cast for 4 weeks
X-ray to show healing
Spint 2 more weeks

72
Q

Treatment of Greenstick Fractures

A

Not-displaced: short arm cast

Displaced: reduce & immobilize; 4 weeks in cast; 2 weeks in splint

73
Q

Treatment of Complete Fractures

A

Non-displaced: short arm cast 3-6 weeks
Displaced: reduce ASAP & cast
X-rays normal initially: Immobilize 2 weeks

74
Q

Distal Radius Fractures

A

Most from fall on an outstretched arm
Median/ulnar nerve
Examine elbow/wrist

75
Q

Clavicle Fractures

A

Most common

Non-displaced: 10 years

76
Q

Define Osteochondrosis

A

Pain at tendons insertions at secondary ossification centers

77
Q

Causes of Osteochondrosis

A

Increase in activity level
Increase in mass
puberty

78
Q

Types of Osteochondrosis

A

Osgood-Schlatter: patellar tendon-tibial tuberosity

Sever Disease: (Achilles-calcaneus)

79
Q

General Features of Osgood Schlatter

A

Inflammation where patellar tendon inserts on tibia
Leaves a lump
Patient usually outgrows it

80
Q

Treatment of Osgood Schlatter

A 
Conservative
Eccentric strengthening
Iontophoresis/Steroids
Brace/Pressure Band
Excision of detached/fragmented bone fragment
Surgery
81
Q

Conservative Treatment for Osteochondrosis

A 
Rest
NSAIDs
Ice
PT
Casting/Boot (Sever's Disease)
82
Q

Define Patello-Femoral Arthralgia (PFA)

A

Inflammation of articular surface of the patella

83
Q

Sign/Symptoms of Petallo-Femoral Arthralgia (PFA)

A 
Anterior knee discomfort
Pain with stairs
Can't sit with bent knee
Tender undersurface of the patella
Tight hamstrings
Weak quadriceps
84
Q

Patello-Femoral Arthralgia (PFA) Treatment

A

Good management
Conservative
Surgical- rarely

85
Q

Management of Patella-Femoral Arthralgia (PFA)

A

Exercise programs
Setting realistic goals
May need to involve parents

86
Q

Conservative Treatment of PFA

A 
Relative Rest
PT
Ice
NSAIDs
Patellar stabilization brace
87
Q

Spondylolysis

A

Stress fracture of pars
Repetitive hyperextension of back
Progressive low back pain with activity

88
Q

Diagnostics of Spondylolysis

A

X-ray
CT
Bone scan

89
Q

Treatment of Spondylolysis

A

Rest
Brace
Fusion (rare)

90
Q

Define Acute Septic Arthritis

A

Pyogenic bacteria invade a synovial joint

91
Q

Most common joints in acute septic arthritis

A

Hip

Elbow

92
Q

Most common organism in acute septic arthritis

A

Staph aureus

93
Q

Clinical Manifestations of Acute Septic Arthritis in Infants

A 
Tenderness
Increased warmth over joint
Pseudoparalysis
Painful restriction
Fever
WBC misleading
94
Q

Clinical Manifestations of Acute Septic Arthritis in Older Children

A 
Severe pain with passive motion
Guarding
Marked tenderness
Fever
Elevated WBC
Elevated ESR/CRP
95
Q

Evaluation of an Acute Septic Arthritis

A

Culture & sensitivity blood/urine
X-ray
Ultrasound
Immediate needle aspiration

96
Q

What are we looking for in the needle aspiration for acute septic arthritis?

A

Inspection of aspirate (cloudy)
Culture & Sensitivity
Gram stain
Crystals

97
Q

Treatment for Acute Septic Arthritis

A

Immediate I&D

Empiric IV antibiotics

98
Q

Types of Antibiotics used in Acute Septic Arthritis

A

3rd generation cephalosporin
Penicillinase resistant synthetic penicillin
Clindamycin (MRSA)
Vacomycin (MRSA)

99
Q

Define Open Fracture

A

Fracture with overlying skin compromise

100
Q

Treatment of Open Fractures

A

Immediate I&D

Empiric antibiotics

Pediatrics (23 decks)

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