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NPTE Study Practice > Pediatric Orthopedic Conditions & Ortho Surgical Procedures > Flashcards

Pediatric Orthopedic Conditions & Ortho Surgical Procedures Flashcards

1
Q

Define foot progression angle (gait angle)

A
  • The angle made by the foot with respect to a straight line plotted in the direction the child is walking
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2
Q

Define thigh-foot angle

A
  • The angle between axis of the foot & axis of thigh measured with child prone & knees at 90º
  • Describes the degrees of tibial torsion
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3
Q

Toeing in/Pigeon toed is caused by 3 types of deformities depending on age of the child including

A
  • Metatarsus adductus
  • Internal tibial torsion
  • Increased femoral anteversion
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4
Q

Pathology of metatarsus adductus

A
  • Most common congenital foot deformity
  • More common in females
  • Rigid form: medial subluxation of tarsometatarsal joints; hind foot in slight valgus with navicular lateral to head of talus
  • Flexible form: adduction of all 5 metatarsals at the tarsometatarsal joints
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5
Q

Internal tibial torsion is associated with

A
  • Associated with W sitting
  • Most common cause of in-toeing
  • High complication rate of osteotomy
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6
Q

Which muscle is released for surgical intervention of metatarsus adductus

A
  • Abductor hallucis tendon
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7
Q

Common causes of toeing-out

A
  • Femoral retroversion
  • External tibial torsion
  • Flat feet
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8
Q

Pathology of talipes equinovarus (Clubfoot)

A
  • Abnormal development of the head & neck of talus, due to hereditary or neuromuscular disorders
  • Observed deformity: PF, adducted, & inverted foot
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9
Q

Characteristics of the affected foot with talipes equinovarus (Clubfoot)

A
  • Affected foot is a half size smaller than& less mobile
  • Calf muscles will be smaller
  • 50% can be affected bilaterally
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10
Q

Treatment of postural talipes equinovarus

A
  • Manipulation followed by casting or splinting (Ponseti method)
  • Following casting, stretching is important
  • Orthoses (Denis-Browne splints) throughout the day for up to 3 months & then at night for up to 3 yrs
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11
Q

Age norms for genu valgum/varum

A
  • Varum normal in newborns/infants
  • Max varum present at 6-12 mo
  • Zero tibiofemoral angle by 18-24 mo
  • Max valgus around 3-4 yrs with avg. tibofemoral angle of 12º
  • Valgum spontaneously corrects by age 7
  • Normal adult tibofemoral angle is 7º for males & 8) for females
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12
Q

Etiology of hip dysplasia

A
  • Abnormality in the size, shape, orientation, or organization of the femoral head, acetabulum, or both
  • Can result in subluxations/dislocations
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13
Q

Risk factors for hip dysplasia

A
  • Females > males
  • Breech position
  • Family history
  • Low levels of amniotic fluid
  • Swaddling an infant too tightly
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14
Q

What is the gold standard trwamznet for hip dysplasia

A
  • Pavlik harness
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15
Q

Special tests for hip dysplasia

A
  • Barlow test
  • Ortolani test
  • Limited hip abduction
  • Galeazzi sign
  • Klisic sign
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16
Q

Pathology of transient synovitis in children

A
  • Acute onset of sudden hip pain in children age 3-10
  • Transient inflammation of the synovium of the hip
  • Decreased hip abduction & IR
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17
Q

Signs and symptoms of transient synovitis in children

A
  • Unilateral hip/groin pain
  • Less common medial tightness or knee pain
  • Crying at night
  • Antalgic limp
  • Pain not common
  • Recent history of upper respiratory tract infection
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18
Q

Pathology of Legg-Calve-Perthes disease

A
  • Blood supply interrupted to the femoral head
  • Age of onset its 2-13 yrs
  • 4x more common in males than females
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19
Q

What MRI finding is indicative of Legg-Calve-Perthes diisease

A
  • Positive bony crescent sign
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20
Q

Signs/symptoms of Legg-Calve-Perthes disease

A
  • Psoatic limp due to weakness of psoas major
  • Moves in ER, flexion, and adduction
  • Gradual onset of achey pain at hip, thigh, & knee
  • Limited AROM in abduction and extension
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21
Q

Pathology of slipped capital femoral epiphysis (SCFE)

A
  • Femoral head is displaced posteriorly & inferiorly int elation to the femoral neck & within the confines of the acetabulum
  • Onset is 10-17 yrs for males & 8-15 yrs for females
  • 2x more common in males
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22
Q

Clinical findings of SCFE

A
  • AROM restricted in abduction, IR, and flexion
  • Vague pain at knee, thigh, and hip
  • Chronic condition may see Trendelenburg gait
23
Q

Etiology of Osgood-Schlatter disease

A
  • Mechanical dysfunction resulting in traction apophysitis of the tibial tubercle at the patellar tendon insertion
24
Q

Etiology of Sever’s disease (calcanea apophysitis)

A
  • Most common cause of heal pain in growing children, occurs before or during peak growth spurt
  • Caused by repetitive micro trauma due to increased traction by the Achilles tendon on its insertion site
  • Bilateral involvement in 60% of cases
25
Q

Etiology of Sinding-Larsen Johannson’s disease

A
  • Traction apophysitis at the patella-patellar tendon junction, overuse injury due to repeated stresses
  • Can occur after significant growth spurt and/or increase activity
26
Q

Etiology of growing pains (Benign nocturnal pains of childhood)

A
  • Etiology unknown but could be due to muscular fatigue, poor posture, stress, etc.
  • Can affect 20% of children most likely between the ages of 3-5 and 8-11
  • Not related to redness, temperature, swelling, & tenderness
  • Increase pain at night typically bilateral
27
Q

Pathology of osteochondritis dissecans

A
  • Occurs in adolescents b/w ages 12-15 yrs
  • Most common is separation of articular cartilage from underlying bone usually involving the medial femoral condyle
  • Can occur at humeral capitellum central/lateral aspect from repetitive compressive forces
28
Q

Etiology of Panner’s disease

A
  • Localized AVN of capitellum leading to loss of subchondral bone with fissuring & softening of articular surfaces of radiocapitellar joint
  • Occurs in children 10 of younger
29
Q

Describe structural versus nonstructural scoliosis

A
  • Structural: irreversible lateral curvature of the spine with a rotational component
  • Nonstructural: reversible lateral curvature of spine without a rotational component which straightens as individual flexes the spine
30
Q

Treatment options of scoliosis

A
  • Conservative: degree of curvature <25º
  • Bracing: degree of curvature 25-45º
  • Surgery with placement of Harrington rod instrumentation; curvature >45º
31
Q

Pathology of pes planus

A
  • Can be caused by genetic weakness, ligamentous laxity, paralysis, excessive pronation, trauma, or disease
  • Normal arches develop around 2-3 yrs
  • Reduction of the medial longitudinal arch
32
Q

Etiology of plagiocephaly (flat head syndrome)

A
  • Development of a flat spot on the back or side of the head as the skull is soft & malleable & can be misshapen easily
33
Q

Etiology of arthogryposis multiplex congenita

A
  • Congenital deformity of skeleton & soft tissues, characterized by limitation ion joint motion & a sausage like appearance of limbs
  • Nonprogressiive contractures
  • Intelligence develops normally
34
Q

Pathology of osteogenesis imperfect (OI)

A
  • Inherited disorder transmitted by autosomal dominant gene
  • Characterized by abnormal collagen synthesis leading to imbalance b/w bone deposition & reabsorption
  • Cortical & cancellous bones become very thin leading to fx & deformity of weight bearing bones
35
Q

Difference between spondylolysis and spondylolisthesis

A
  • Spondylolysis: fracture of the pars interarticularis with positive “scotty dog” on oblique radiographic view of the spine
  • Spondylolisthesis: actual anterior or posterior slippage of one vertebra on another following bilateral fracture of pars interarticularis
36
Q

Grading of slippage for spondylolisthesis

A
  • Grade 1: 25% slippage
  • Grade 2: 50% slippage
  • Grade 3: 75% slippage
  • Grade 4: 100% slippage
37
Q

What are the key issues with tendon surgery

A
  • Are prevention of mobility impairments without overloading repair and preventing excessive atrophy
38
Q

How long and in what position is the knee put in following a PCL repair

A
  • Frequently immobilized in full extension for a period of 6 wks
39
Q

How long and in what position is the knee put in following a flexor tendon repair of the hand

A
  • Immobilized for 3-4 wks with wrist and digits flexed
40
Q

What positions should be avoided early on following a repair of the knee meniscus

A
  • Weight bearing with flexion
41
Q

What positions should be avoided early on following a repair of the shoulder anterior-inferior labrum (Bankart)

A
  • ER
42
Q

What positions should be avoided early on following a repair of the hip labrum

A
  • Passive unilateral hip extension, excessive hip flexion, abduction, & ER
43
Q

Describe an osteochondral autograft transplantation (OAT)

A
  • Transfers articular cartilage from areas of low-loading to areas of high-loading
44
Q

Describe an autologous chondrocyte implantation (ACI)

A
  • Healthy articular cartilage is harvested from the patient & injected under a periosteal flap closed with additional sutures & fibrin glue
45
Q

Computer assisted navigation systems (CAS) or robotic surgery are new techniques, often associated with

A
  • Minimally invasive surgery that improve surgeon precision, flexibility, and control with less soft tissue trauma
46
Q

Difference between cemented and non cemented joint replacements

A
  • Cemented joint replacements can tolerate full weight bearing immediately following surgery
  • Noncemented joint replacements are more stressful on bones during surgeries
47
Q

Difference between a total hip arthroplasty (THA) and a hemiarthroplasty

A
  • THA: replacement of both femoral and acetabular articulator surfaces
  • Hemiarthroplasty: replacement of the femoral head articular surface only
48
Q

Difference between a total knee arthroplasty (TKA) and an unicompartmental knee arthroplasty (UKA)

A
  • TKA: replacement of medal/lateral femoral condyle, tibial plateau. & patellar articular surfaces
  • UKA: replacement of the articular surface either medially or laterally
49
Q

Difference between a total shoulder arthroplasty (TSA) and a shoulder hemiarthroplasty

A
  • TSA: replacement of humeral head & glenoid articular surfaces
  • Shoulder hemiarthroplasty: replacement of only the humeral head articular surface
50
Q

What are the hip precautions following a THA

A
  • Avoid >90º hip flexion, adduction past midline, & IR for the first 6 wks post-op as these positions place the hip at risk for dislocation
51
Q

PT protocol following a Harrington rod placement for idiopathic scoliosis

A
  • Early mobilization in bed and effective coughing
  • Begin ambulation b/w 4-7 day post-op
  • Avoid heavy lifting & excessive twisting & bending
52
Q

Precautions following a lumbar nonfusion procedure

A
  • Avoid end range rotation & flexion
  • No joint mobilization for 3 months
53
Q

Lumbar precautions following a lumbar fusion procedure

A
  • Avoid end range rotation & extension
  • No intensive abdominals
  • No impact loading for 3 months
54
Q

Cervical precautions following a cervical fusion procedure

A
  • No lifting >5-10 lbs for 4 wks

NPTE Study Practice (17 decks)

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