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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
Scheuermann's Disease
``` Osteochondrosis of the spine Wedged vertebrae Usually in males Sharper curve Surgical correction needed ```
26
Define Muscular Dystrophy
Progressive weakness & wasting of muscles
27
Signs/Symptoms of Muscular Dystrophy
``` Waddling gait Fatigue Mobility Frequent infections Psychological effects Maintain function Hx of motor developmental delays Clumsiness Frequent falls Difficult climbing stairs, running, riding trike ```
28
Diagnosis of Muscular Dystrophy
Biopsy | Electromyography (EMG)
29
Treatment of Muscular Dystrophy
PT/OT Bracing Surgery (scoliosis)
30
Types Limb Defects
Polydactyly | Syndactyly
31
Define Polydactyly
Too many digits on one limb
32
Define Syndactyly
Webbed fingers or toes
33
Treatment of Limb Defects
Live with deformity | Reconstruction surgery
34
Normal Musculoskeletal Variants
``` Metatarsus adductus Axial rotation idiopathic toe walking Pes cavus (flat foot) Angular variations ```
35
Types of Angular Variations
``` Genu varus (bow legged) Genu valgus (knock -knees ```
36
Define Metatarsus Adductus
Excessive amount of adduction of the metatarsals relative to the long axis of the foot
37
What is the most common congenital foot deformity
Metatarsus adductus
38
Statistics of Metatarsus Adductus
Female > Male Left > Right Intrauterine restriction 85-90% resolve spontaneously
39
Metatarsus Adductus Management
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
40
Axial Rotation Toe-In
Internal femoral torsion: "W" sitting Internal tibial torsion: intrauterine positioning Metatarsus adductus
41
Axial Rotation Toe-Out
External femoral torsion: intrauterine position External rotation contracture External tibial torsion Flat foot
42
Treatment for Axial Rotation
``` Good sleeping positions Good sitting habits Nocturnal bar Corrective casting Surgery ```
43
Define Idiopathic Toe Walking
Walk with toe-toe pattern in the absence of any known cause
44
Etiology of Idiopathic Toe Walking
Unclear | Children
45
Idiopathic Toe Walking Management
PT/OT Orthotics (D/N) Serial casting Surgical Achilles lengthening
46
Angular Variations: Types of Genu Varum
Physiology bowing Metabolic bowing Blount's disease
47
Genu Varum: Physiologic bowing
Usually corrects by age 2
48
Genu varum: Metabolic Bowing
Vitamin D deficiency
49
Genu Varum: Blount's Disease
Damage to epiphysis | May need bracing or surgery
50
Angular Variations: Genu Valgum
Knock knees Correct spontaneously After 11-13 may need surgery
51
Common Pediatric Orthopedic Injuries
``` Slipped capital femoral epiphysis (SCFE) Radial head dislocation (Nursemaid elbow) Common pediatric fractures Osteochondrosis Patellofemoral arthralgia (PFA) Spondylolysis ```
52
Slipped Capital Femoral Epiphysis (SCFE) Statistics
Most common 9 years to end of growth Males Increase frequency with hypothyroid, renal disease, growth, & sex hormone imbalance Obesity increases likelihood
53
Signs/Symptoms of Unstable SCFE
Sudden, severe pain | Limp
54
Signs/Symptoms of Stable SCFE
Limp with groin pain | Variable medial knee/anterior thigh pain
55
What range of motion is restricted in SCFE?
Internal rotation Abduction Flexion
56
Types of X-rays for SCFE
AP | Frog leg lateral
57
Complications of SCFE
Avascular necrosis (AVN) Chondrolysis Osteoarthritis
58
Define Radial Head Dislocation (Nursemaid's Elbow)
Subluxation or dislocation injury from sudden pull of child's arm
59
Signs/Symptoms of Radial Head Dislocation (Nursemaid's Elbow)
Guarding of elbow Refuses to use arm Swollen/tender with palapation
60
Treatment of Radial Head Dislocation
Gental supination of hand while flexing elbow | Sling for a few days for comfort
61
Types of Pediatric Fractures
Growth plate (epiphyseal) fractures Supracondylar humerus fracture Wrist/forearm fractures Clavicle fractures
62
Growth Plate Fractures
Disrupt bone growth | Stimulate excessive bone growth
63
Types of Growth Plate Fractures
``` 1- slipped 2- above 3- lower 4- through 5- rammed ```
64
How does a supracondylar humerus fracture occur?
Fall on outstretched hand
65
What can supracondylar humerus fracture be associated with?
Distal radius fracture | Forearm fracture
66
Treatment of Supracondylar Humerus Fracture
Stable: long arm cast Unstable: percutaneous fixation with K-wires
67
Types of Wrist/Forearm Fractures
Torus (buckle) fractures Greenstick fractures Complete (transverse) fractures
68
Torus (buckle) fractures
Nondisplaced-strong periosteum | Subtle
69
Greenstick fractures
Disruption of only one cortex
70
Complete (transverse) fractures
Disruption of both cortexes
71
Treatment of Torus Fractures
Short arm cast for 4 weeks X-ray to show healing Spint 2 more weeks
72
Treatment of Greenstick Fractures
Not-displaced: short arm cast | Displaced: reduce & immobilize; 4 weeks in cast; 2 weeks in splint
73
Treatment of Complete Fractures
Non-displaced: short arm cast 3-6 weeks Displaced: reduce ASAP & cast X-rays normal initially: Immobilize 2 weeks
74
Distal Radius Fractures
Most from fall on an outstretched arm Median/ulnar nerve Examine elbow/wrist
75
Clavicle Fractures
Most common | Non-displaced: 10 years
76
Define Osteochondrosis
Pain at tendons insertions at secondary ossification centers
77
Causes of Osteochondrosis
Increase in activity level Increase in mass puberty
78
Types of Osteochondrosis
Osgood-Schlatter: patellar tendon-tibial tuberosity | Sever Disease: (Achilles-calcaneus)
79
General Features of Osgood Schlatter
Inflammation where patellar tendon inserts on tibia Leaves a lump Patient usually outgrows it
80
Treatment of Osgood Schlatter
``` Conservative Eccentric strengthening Iontophoresis/Steroids Brace/Pressure Band Excision of detached/fragmented bone fragment Surgery ```
81
Conservative Treatment for Osteochondrosis
``` Rest NSAIDs Ice PT Casting/Boot (Sever's Disease) ```
82
Define Patello-Femoral Arthralgia (PFA)
Inflammation of articular surface of the patella
83
Sign/Symptoms of Petallo-Femoral Arthralgia (PFA)
``` Anterior knee discomfort Pain with stairs Can't sit with bent knee Tender undersurface of the patella Tight hamstrings Weak quadriceps ```
84
Patello-Femoral Arthralgia (PFA) Treatment
Good management Conservative Surgical- rarely
85
Management of Patella-Femoral Arthralgia (PFA)
Exercise programs Setting realistic goals May need to involve parents
86
Conservative Treatment of PFA
``` Relative Rest PT Ice NSAIDs Patellar stabilization brace ```
87
Spondylolysis
Stress fracture of pars Repetitive hyperextension of back Progressive low back pain with activity
88
Diagnostics of Spondylolysis
X-ray CT Bone scan
89
Treatment of Spondylolysis
Rest Brace Fusion (rare)
90
Define Acute Septic Arthritis
Pyogenic bacteria invade a synovial joint
91
Most common joints in acute septic arthritis
Hip | Elbow
92
Most common organism in acute septic arthritis
Staph aureus
93
Clinical Manifestations of Acute Septic Arthritis in Infants
``` Tenderness Increased warmth over joint Pseudoparalysis Painful restriction Fever WBC misleading ```
94
Clinical Manifestations of Acute Septic Arthritis in Older Children
``` Severe pain with passive motion Guarding Marked tenderness Fever Elevated WBC Elevated ESR/CRP ```
95
Evaluation of an Acute Septic Arthritis
Culture & sensitivity blood/urine X-ray Ultrasound Immediate needle aspiration
96
What are we looking for in the needle aspiration for acute septic arthritis?
Inspection of aspirate (cloudy) Culture & Sensitivity Gram stain Crystals
97
Treatment for Acute Septic Arthritis
Immediate I&D | Empiric IV antibiotics
98
Types of Antibiotics used in Acute Septic Arthritis
3rd generation cephalosporin Penicillinase resistant synthetic penicillin Clindamycin (MRSA) Vacomycin (MRSA)
99
Define Open Fracture
Fracture with overlying skin compromise
100
Treatment of Open Fractures
Immediate I&D | Empiric antibiotics

Pediatrics (23 decks)

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