Pediatric orthopedic conditions

Question 1

Torsional conditions - toeing in/out - foot progression angle is the angle made by the foot with respect to

Answer 1

a straight line plotted in the direction the child is walking

Question 2

Torsional conditions - toeing in/out - foot progression angle can be normal in children with combined torsional deformity - (+) sign denotes? (-) sign denotes

Answer 2

+ sign denotes out toeing angle

- sign denotes in toeing angle

Question 3

Torsional conditions - toeing in/out - thigh foot angle is the angle between

Answer 3

axis of foot and axis of thigh measured with child prone and knees at 90
The angle describes the degrees of tibial torsion

Question 4

Torsional conditions - toeing in/out - toeing in (pigeon toed) is common in

Answer 4

W sitting and is caused by three types of deformities

Question 5

Torsional conditions - toeing in/out - toeing in is caused by what 3 types of defomities

Answer 5

metatarsus adductus
internal tibial torsion
increased femoral anteversion

Question 6

Torsional conditions - toeing in/out - most common congenital foot deformity

Answer 6

metatarsus adductus

Question 7

Torsional conditions - toeing in/out - matatarsus adductus greater occurance in

Answer 7

females on left side

Question 8

Torsional conditions - toeing in/out - most common cause for metatarsus adductus

Answer 8

intrauterine packing

Question 9

Torsional conditions - toeing in/out - metatarsus adductus - types

Answer 9

Rigid

Flexible

Question 10

Torsional conditions - toeing in/out - metatarsus adductus - Rigid form results in

Answer 10

medial subluxation of tarsometatarsal joints

Hindfoot slightly in valgus with navicular lateral to head of talus

Question 11

Torsional conditions - toeing in/out - matatarsus adductus - flexible form is observed as

Answer 11

adduction of all five metatarsals at the tarsometatarsal joints

Question 12

Torsional conditions - toeing in/out - metatarsus adductus - flexible form treatment

Answer 12

85-90% identified at birth will resolve without treatment in 1 year

Question 13

Torsional conditions - toeing in/out - most common cause of toeing in

Answer 13

internal tibial torsion

Question 14

Torsional conditions - toeing in/out - increased femoral anteversion

Answer 14

Normal is 10-15 degrees

Considered excessive if angle is greater than 25-30 degrees

Question 15

Torsional conditions - toeing in/out - toeing out is how common? can be caused by what?

Answer 15

less common

can be caused by femoral retroversion, external tibial torsion, flat feet

Question 16

Torsional conditions - toeing in/out - toeing out - retroversion defined as

Answer 16

less than 10 degrees

Question 17

Talipes equinovarus (clubfoot) - etiology

Answer 17

postural from intrauterine malposition

Question 18

Talipes equinovarus (clubfoot) - observation

Answer 18

PF, adducted, and inverted foot

Question 19

Talipes equinovarus is defined as

Answer 19

PF at talocrural joint
Inversion at subtalar, talocalcaneal, talonavicular, and calcaneocuboid joints
Supination at midtarsal joints

Question 20

Angular conditions - genu valgum

Answer 20

excessive lateral tibial torsion, referred to as knock knees
Excessive lateral patellar positioning

Question 21

Angular conditions - genu varum

Answer 21

excessive medial tibial torsion

referred to as bowlegs

Question 22

Genu varum is normal in

Answer 22

newborns and infants

Question 23

Maximal varum occurs at what age

Answer 23

6 to 12 months

Question 24

Lower limbs straighten with a zero tibiofemoral angle by what age

Answer 24

18 to 24 months

Question 25

Knees gradually drift into valgus and is max at what age

Answer 25

3 to 4 years with avg lateral tibiofemoral angle of 12

Question 26

Genu valgum corrects by age

Answer 26

7 to adult alignment | 8 in females and 7 in males

Question 27

Hip dysplagia - who is at higher risk

Answer 27

``` females breeched position family hx low levels of amniotic fluid swaddling infant too tightly ```

Question 28

Hip dysplagia - gold standard tx

Answer 28

Pavlik harness - 95% success in those under 6 months

Question 29

Transient synovitis in children - etiology

Answer 29

acute onset of sudden hip pain in children ages 3 to 10 | Transient inflammation of synovium of the hip

Question 30

Transient synovitis in children - s/s

Answer 30

``` unilateral hip or groin pain less common medial thigh or knee pain crying at night antalgic limp pain not common recent hx of upper resp. infection ```

Question 31

Leg Calve Perthes disease - etiology

Answer 31

blood supply interrupted to femoral head onset age 2 to 13 years 4x greater incidence in boys

Question 32

Leg Calve Perthes disease - clinical s/s

Answer 32

Psoatic lump from weakness of psoas mm - moves in ER, flex, add gradual onset of aching pain at hip, thigh, and knee AROm limited in abd and ext

Question 33

Slipped capital femoral epiphysis - etiology

Answer 33

most common hip disorder observed in adolescents of unknown etiology

Question 34

Slipped capital femoral epiphysis - what is it

Answer 34

femoral head is displaced post and inf in relation to femoral neck and within confines of acetabulum

Question 35

Slipped capital femoral epiphysis - onset in males is? females?

Answer 35

Males 10-17 yrs with avg being 13 Females 8-15 yrs with avg 11 2x greater incidence in males

Question 36

Slipped capital femoral epiphysis - dx based on clinical exam

Answer 36

AROM restricted in abd, flex, IR Pt describes pain as vague at knee, thigh, hip Chronic - might see trendelenburg gait

Question 37

Tendon lengthening conditions - osgood schlatter disease - etiology

Answer 37

mechanical dysfunction resulting in traction apophysitis of tibial tubercle ate the patellar tendon insertion

Question 38

Tendon lengthening conditions - Sever's disease (calcaneal apophysis) - etiology

Answer 38

most common cause of heel pain in growing children - occurs before or during peak growth spurt Caused by repetitive microtrauma due to inc traction by achilles tendon at insertion

Question 39

Tendon lengthening conditions - sinding larsen johannsons disease - etiology

Answer 39

traction apophysitis at patella-patellar tendon junction, overuse from repeated stresses, can occur after significant growth spurt and/or increase in activity

Question 40

Growing pains - etiology

Answer 40

unknown but could be due to muscular fatigue, poor posture, stress

Question 41

Growing pains - effects what ages

Answer 41

most likley between 3 to 5 and 8 to 11

Question 42

Osteochondritis dissecans - etiology

Answer 42

adolescents between ages of 12 and 15 yrs Most common cause is a separation of articular cartilage from underlying bone Osteochondral bone fragment becomes detached and forms loose body in joint

Question 43

Panners disease - etiology

Answer 43

localized avascular necrosis of capitelum leading to loss of subchondral bone with fissuring and softening of articular surfaces of radiocapitellar joint Unknown etiology - usually ages 10 or younger

Question 44

Scoliosis - treatment

Answer 44

conservative if less than 25 degrees bracing if between 25 and 45 surgery if over 45 degrees

Question 45

Ped planus (flat foot) - normal in who

Answer 45

infant and toddler feet and develop around 2 to 3 years

Question 46

Congenital muscular torticollis - observation

Answer 46

side bending toward and rotation away from affected SCM

Question 47

Spasmodic torticollis - is what

Answer 47

movement disorder with CNS pathology

Question 48

Plagiocephaly (flat head syndrome) - etiology

Answer 48

flat spot on back or side of head as skull is soft and malleable No lasting harmful effects on infant

Question 49

Arthrogryposis multiplex congenita - etiology

Answer 49

congenital deformity of skeleton and soft tissues characterized by limitation in joint motion and sausage like appearance of limbs Nonpregressive contractures Intelligence develops normally

Question 50

Osetogenesis imperfecta - etiology

Answer 50

inherited transmitted by autosomal dominant gene Characterized by abnormal collagen synthesis leading to imbalance between boen deposition and reabsoroprtion Leads to fractures and deformity of WB bones

Question 51

Spondylolistheiss - etiology

Answer 51

congenitally defective pars interartciularis lysis - fracture listhesis - anterior slippage

Question 52

Spondylolisthesis - grades

Answer 52

graded from grade 1 (25% slippage) to a grade 4 (100% slippage)