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Ortho > Pediatric Orthopedic Diseases > Flashcards

Pediatric Orthopedic Diseases Flashcards

1
Q

Pediatric Diseases

A 
Legg-Calve-Perthes disease
Slipped capital femoral epiphysis (SCFE)
Club foot
Metatarsus adductus
Genu varum
Genu valgus
Developmental dysplasia of the hip
Osgood-Schlatter disease
Septic Arthritis
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2
Q

Define Legg-Calve-Perthes Disease

A

Idiopathic osteonecrosis of the femoral head in children

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3
Q

Epidemiology of Legg-Calve-Perthes Disease

A

4-8

Boys > Girls

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4
Q

Clinical Presentation of Legg-Calve-Perthess Disease

A

Prolonged limp or waddling gait
Pain in the thigh, groin, or knee
Delay in bone age
Short stature

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5
Q

Diagnosis of Legg-Calve-Perthess Disease

A 
AP & lateral view of hip
Wrist/hand films for bone age
AP with hip abduction to determine containment
Technetium-99m bone scan
MRI
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6
Q

Etiology of Legg-Calve-Perthess Disease

A

Anterolateral portion of head
Ascending lateral cervical vessels from medial femoral circumflex artery
Circulation less developed in 3-10 year old boys

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7
Q

Prognosis of Legg-Calve-Perthes Disease

A

Favorable
Function well despite poor radiographs
Develop arthritis eventually

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8
Q

Goals of Treatment of Legg-Perthes-Calve Disease

A

Reduce pain
Improve function
Minimize femoral head deformity

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9
Q

Treatment of Legg-Perthes-Calve Disease

A

Revascularization
Traction
Bed rest
Surgery

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10
Q

Define Slipped Capital Femoral Epiphysis

A

Disorder in which the epiphysis becomes posterior displaced on the femoral neck

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11
Q

Sequelae of Slipped Capital Femoral Epiphysis

A

Osteoarthritis
Chondrolysis
AVN

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12
Q

Epidemiology of SCFE

A

Boys: 10-17
Girls: 8-15
Male > Female (2:1)

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13
Q

Clinical Findings of SCFE

A

Abrupt onset of anterior hip, groin, medial thigh, & knee pain
Acute: symptoms less than 3 weeks
Chronic: symptoms 3+ weeks
Antalgic gait with external rotation

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14
Q

Imaging Studies for SCFE

A

AP & lateral radiographs

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15
Q

AP Radiograph Findings Pre-Slip

A

Slight widening & fuzzy irregularity of physis

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16
Q

Lateral Radiograph Findings

A

Percent epiphyseal displacement

Lateral head/shaft angle

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17
Q

Etiology of SCFE

A

Hypothyroidism
Hyogonadism
Parathyroid adenoma with GH abnormality

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18
Q

Treatment of SCFE

A

Stabilize slipping process
Achieve premature closure of physics
Single screw fixation

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19
Q

Characteristics of Club Foot

A

Plantar flexion of ankle
Inversion of heel
High arch at midst
Adduction of forefoot

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20
Q

Epidemiology of Club Foot

A

Idiopathic

Males > Females (2:1)

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21
Q

Clinical Presentation of Club Foot

A

Look like could walk on top of foot
Plantar flexion most severe
High arch (difficult to see)
Forefoot adduction

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22
Q

Tests for Club Foot

A

Rule out neuromuscular disorders (CP, MD)

X-rays (usually not needed)

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23
Q

Treatment of Club Foot

A

Manipulation
Casting
2-4 months
Surgery if failure of conservative treatment
Surgery: lengthens tendons & ligaments

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24
Q

Prognosis of Club Foot

A

Good

Run & play afterwards

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25
Q

Describe Metatarsus Adductus (Pigeon Toe)

A

Medial deviation of the forefoot

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26
Q

Exam in Metatarsus Adductus (Pigeon Toe)

A

Convex lateral border of foot with palpable prominence of 5th metatarsal
Hindfoot in neutral
Normal dorsiflexion

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27
Q

Diagnostics in Metatarsus Adductus (Pigeon Toe)

A

Serial photocopies
Heel bisector line
Subjective

28
Q

Treatment of Metatarsus Adducts (Pigeon Toe)

A

Supine sleeping position
Start at 6 months
Serial casting (severe)

29
Q

Genu Varum

A

Tibia adducted in relation to femur
Straigthens: 12-18 months
After 30-36 months: bracing or surgery

30
Q

Genur Valgus “Knock Knees”

A

Tibia abducted in relation to femur

Treatment: observation

31
Q

Variants of Developmental Dysplasia of the Hip

A 
Teratologic
Unstable hip
Dislocated hip
Subluxated hip
Acetabular dysplasia
32
Q

Describe Teratology Developmental Dysplasia of the Hip

A

Fixed dislocation
Occurs prenatally
Associated with neuromuscular disorders

33
Q

Describe Unstable Developmental Dysplasia of the Hip

A

Femoral head is reduced

Can be fully dislocated or partially subluxated

34
Q

Describe Dislocated Developmental Dysplasia of the Hip

A

Femoral head doesn’t articulate

May not be reducible

35
Q

Describe Subluxated Developmental Dysplasia of the Hip

A

Femoral head contacts portion of true acetabulum

36
Q

Describe Acetabular Developmental Dysplasia of the Hip

A

Acetabulum is shallow

Femoral head subluxated or normal

37
Q

Etiology of Developmental Dysplasia of the Hip

A

Ligamentous laxity

Hormonal & familial

38
Q

Mechanical Factors Associated with Developmental Dysplasia of the Hip

A 
Prenatal
Breech
Oligohydramnios
Primigravida
Congenital knee recurvatum with dislocation
Congenital muscular torticollis
Metatarsus adductus
39
Q

Post Natal Factors with Developmental Dysplasia of the Hip

A

Swaddling

Strapping

40
Q

Genetic Factors with Developmental Dysplasia of the Hip

A

Female

Left hip 3:1

41
Q

Diagnosis of Developmental Dysplasia of the Hip

A 
Barlow test
Ortolani's test
X-ray: difficult to interpret
US (less than 6 months)
Arthrogram
CT: reconstruction
42
Q

Describe Barlow’s Test

A

Hip that is reduced but is dislocateable

43
Q

Describe Ortolani’s Test

A

Hip that is dislocated but reducible

44
Q

Arthrogram in Diagnosing Developmental Dysplasia of the Hip

A

Demonstrates soft tissue impediments to reduction & concentricity & stability of reduction

45
Q

Treatment of Developmental Dysplasia of the Hip

A

Closed reduction
Pavlik harness
Spica casts

46
Q

Pavlik Harness in Treatment of Developmental Dysplasia of the Hip

A

Dislocated & capable of being reduced
Reduction confirmation at 3 weeks
Effective 90% of time

47
Q

What is the preferred method of treatment of developmental dysplasia of the hip under 24 months?

A

Closed reduction

48
Q

Closed Reduction in Developmental Dysplasia of the Hip

A

General anesthesia & arthrogram guidance

Spica cast: 3 months

49
Q

What is the primary option for treatment of developmental dysplasia of the hip in older children?

A

Open reduction

50
Q

Most Commonly Used Open Reduction in Developmental Dysplasia of the Hip

A

Anterior approach***

Medial approach

51
Q

Complications of Developmental Dysplasia of the Hip

A

Osteonecrosis
Failed reduction
Repeat reduction

52
Q

Osteonecrosis of Developmental Dysplasia of the Hip

A

Failure of appearance for 1+ year
Broadening of femoral neck
Residual deformity of femoral head & neck
Increased density followed by fragmentation

53
Q

Describe Osgood-Schlatter Disease

A

Condition results from repetitive injury & small avulsion injuries at the bone-tendon junction where the patellar tendon inserts into the secondary ossification center of the tibial tuberosity

54
Q

Clinical Symptoms of Osgood-Schlatter Disease

A

Pain exacerbated by running, jumping, & kneeling

55
Q

Exam & Diagnosis of Osgood-Schlatter Disease

A

Tenderness & swelling at tibial tuberosity bilaterally
Stable joint
No restriction
X-ray: soft-tissue swelling, small spicules of heterotypic ossification anterior to tibial tuberosity

56
Q

Treatment of Osgood-Schlatter Disease

A

Ice
NSAIDs
Protective knee pads
Decreased activity (2-3 months)

57
Q

Describe Septic Arthritis

A

Join infections most commonly at the hip, knee, & ankle

58
Q

Types of Septic Arthritis

A

Hematogenous spread
Contiguous spread
Direct inoculation

59
Q

Symptoms of Septic Arthritis

A 
Pain
Malaise
Loss of appetite
Failure to use affected joint
Temp: 102+
Neonates may not have fever
Hip most common
60
Q

Exam & Diagnostics of Septic Arthritis

A 
Swelling, tender, warmth
Hip held in flexion, abduction, & external rotation
Knee/elbow in flexion
Pseudo paralysis shoulder
AP/lateral x-rays (8-14 days to show)
Labs: CBC with diff, ESR, CRP, cultures
Joint aspiration
61
Q

Joint Aspiration Analysis of a Septic Joint

A 
WBC: >50,000 mm^3
PMNs: 90%
Decreased glucose
Increased protein
Lower WBCs with N. gonorrhea
62
Q

Sequelae of a Septic Joint

A

Destruction of joint surface
Secondary arthritis
Scarring of the capsule
Osteonecrosis of femoral head

63
Q

Prognosis of Septic Joint

A

Good if caught within 4 days of symptoms

64
Q

Treatment of Septic Joint

A

Refer early
Surgical drainage
Antibiotics

65
Q

Common Organisms with Septic Joint

A

S. aureus
Group B strep (infants)
H. influenza (6 months-4 years)
N. gonorrhea (12-18 years)

Ortho (22 decks)

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