Pediatric Orthopedic Conditions Flashcards
When the head of femur is directed anteriorly
anteversion
in-toeing
When the head of femur is directed posteriorly
retroversion
out-toeing
negative foot angle is associated with wich hip angle torsion
in-toeing associated with anterversion
positive foot angle is associated with wich hip angle torsion
out-toeing (+) with retroversion
what is the normal foot pregression angle?
-3 to +20
name angle
Foot Progression Angle
The foot progression angle includes wich other torsional segments?
torsion of the hip, tibia, and forefoot
hip torsion is the relationship between
femoral neck and shaft of femur
typical progression of hip rotation
- Infants have anteversion + ER contractures
- Resolve by 5-6 yr becomes more apparent
Thigh Foot Axis is a measure of….
tibial torsion
typical progression of Thigh Foot Axis
- Infants: IR -30 to -20
- Spontaneous de-rotation with growth and walking
Treatment of Thigh Foot Axis (tibial torsion) required if natural resolution
does not happen
- Friedman Counter Strap
- Derotation strap
- Dennis Browne bar (picture)
Metatarsus (forefoot) Adductus
Most common positional deformity in infants:
Metatarsus (forefoot) Adductus
when the foreffot is curved laterally is called?
Calcaneovalgus
Treatment of calcaneovalgus and matatarsus (forefoot) adductus
- matatarsus (forefoot) adductus: corrective shoes, joint manipulation, serial casting
- calcaneovalgus: none, resolves naturally
progression of knee alignment
- Newborn: peak varum
- 1-2 yr: straight
- 2-4 yr: peak valgum
- 4-16 yr: approaching sex specific norm
the 2 lower extremity rotational profiles are:
- In-toeing: femoral anteversion, tibial internal torsion, metatarsus adductus.
- Out-toeing: contracture of hip external rotators, tibial external torsion, calcaneovalgus.
General “looseness” or “instability” of the hip joint
Developmental Dysplasia of the Hip
name sign
Galeazzi Sign
seen in developmental dysplasia
Barlow and Ortolani test for developmental dysplasia:
- Barlow: will dislocate the hip (hip started reduced)
- Ortolani: will reduce the hip (hips started dislocated)
what is the main intervention for developmental dysplasia for children under 6 mo
Pavlick Harness
what is the main intervention for developmental dysplasia for children 6-12 mo
closed reduction and abduction orthosis
what is the main intervention for developmental dysplasia for children over 12 mo
surgery
Avascular necrosis of the ossific nucleus of the femoral head
Legg Calve Perthes Disease (LCPD)
cause not known
treatment of Legg Calve Perthes Disease
- usually resolve spontaneously
- Wide variety of treatment
- Scotish wide brace (picture)
- derotational osteonomy
usual population of Legg Calve Perthes disease
- active boys between 5-10 y/o
- with learning disabilities
- 2nd hand smoke at home
Slipped Capital Femoral Ephiphysis (SCFE)
casues of Slipped Capital Femoral Ephiphysis (SCFE)
- significant trauma
- chronic slip (obesity)
treatment for Slipped Capital Femoral Ephiphysis (SCFE)
pinning surgery
presentation of Slipped Capital Femoral Ephiphysis (SCFE)
- hip ER
- hips moves passivelly into ER with hip FLX
- 50% cases are bilateral
Blount’s Disease (infantile tibia vara)
intervention for Blount’s Disease (infantile tibia vara)
- KAFO 23h per day
- Sx
what lenght difference is considered the normal range in leg lenght discrepancies?
a discrepancy of less than 2.5 cm
impairment in leg length discrepancies include
- pelvic obliquity, spinal alignment
- increase energy expenditure
leg lenght measurement
- ASIS to lateral malleolous
- Umbillicus to heel pad
treatment of leg lenght discrepancies
- shoe lift
- or surgery
Club Foot, Talipes Equinovarus
Cobb angle
Cobb angle > 10 =
scoliosis diagnosis
structural scoliosis
- vertabrae rotate towards convex side
- cannot be corrected
non structural scoliosis
- usually non progressive
- corrects with side bend towards convex side
in scoliosis, the direction of the curve is named after the
convex side
types of scoliosis
- Congenital: anomalous vertebral development, may not progress
- Neuromuscular: C types curves, SCI, may progress
- Idiopathic: infantile, juvenile, adolescent
80% of all idiopathic scoliosis cases are…
Adolescent Idiopathic Scoliosis (AIS)
more in females
progression of scoliosis is defined as
a cobb angle change of >5 deg on two consecutive exams
scoliosis, non-surgical treatment in angles of
<40
the main goal of surgical intervention for scoliosis
to halt the progression
congenital joint contractures in two or more areas of the body, genrally not genetically based
Arthrogryposis Multiplex Congenita (AMC)
a group of genetic disorders that mainly affect the bones. It results in bones that break easily.
Osteogenesis Imperfecta
