Pediatric Orthopedic Diseases Flashcards by Alicia Daum

Pediatric Diseases

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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Define Legg-Calve-Perthes Disease

Idiopathic osteonecrosis of the femoral head in children

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Epidemiology of Legg-Calve-Perthes Disease

4-8

Boys > Girls

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Clinical Presentation of Legg-Calve-Perthess Disease

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

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Diagnosis of Legg-Calve-Perthess Disease

AP &amp; 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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Etiology of Legg-Calve-Perthess Disease

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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Prognosis of Legg-Calve-Perthes Disease

Favorable
Function well despite poor radiographs
Develop arthritis eventually

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Goals of Treatment of Legg-Perthes-Calve Disease

Reduce pain
Improve function
Minimize femoral head deformity

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Treatment of Legg-Perthes-Calve Disease

Revascularization
Traction
Bed rest
Surgery

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Define Slipped Capital Femoral Epiphysis

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

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Sequelae of Slipped Capital Femoral Epiphysis

Osteoarthritis
Chondrolysis
AVN

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Epidemiology of SCFE

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

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Clinical Findings of SCFE

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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Imaging Studies for SCFE

AP & lateral radiographs

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AP Radiograph Findings Pre-Slip

Slight widening & fuzzy irregularity of physis

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Lateral Radiograph Findings

Percent epiphyseal displacement

Lateral head/shaft angle

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Etiology of SCFE

Hypothyroidism
Hyogonadism
Parathyroid adenoma with GH abnormality

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Treatment of SCFE

Stabilize slipping process
Achieve premature closure of physics
Single screw fixation

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Characteristics of Club Foot

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

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Epidemiology of Club Foot

Idiopathic

Males > Females (2:1)

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Clinical Presentation of Club Foot

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

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Tests for Club Foot

Rule out neuromuscular disorders (CP, MD)

X-rays (usually not needed)

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Treatment of Club Foot

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

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Prognosis of Club Foot

Good

Run & play afterwards

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Describe Metatarsus Adductus (Pigeon Toe)

Medial deviation of the forefoot

Exam in Metatarsus Adductus (Pigeon Toe)

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

Diagnostics in Metatarsus Adductus (Pigeon Toe)

Serial photocopies Heel bisector line Subjective

Treatment of Metatarsus Adducts (Pigeon Toe)

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

Genu Varum

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

Genur Valgus "Knock Knees"

Tibia abducted in relation to femur | Treatment: observation

Variants of Developmental Dysplasia of the Hip

``` Teratologic Unstable hip Dislocated hip Subluxated hip Acetabular dysplasia ```

Describe Teratology Developmental Dysplasia of the Hip

Fixed dislocation Occurs prenatally Associated with neuromuscular disorders

Describe Unstable Developmental Dysplasia of the Hip

Femoral head is reduced | Can be fully dislocated or partially subluxated

Describe Dislocated Developmental Dysplasia of the Hip

Femoral head doesn't articulate | May not be reducible

Describe Subluxated Developmental Dysplasia of the Hip

Femoral head contacts portion of true acetabulum

Describe Acetabular Developmental Dysplasia of the Hip

Acetabulum is shallow | Femoral head subluxated or normal

Etiology of Developmental Dysplasia of the Hip

Ligamentous laxity | Hormonal & familial

Mechanical Factors Associated with Developmental Dysplasia of the Hip

``` Prenatal Breech Oligohydramnios Primigravida Congenital knee recurvatum with dislocation Congenital muscular torticollis Metatarsus adductus ```

Post Natal Factors with Developmental Dysplasia of the Hip

Swaddling | Strapping

Genetic Factors with Developmental Dysplasia of the Hip

Female | Left hip 3:1

Diagnosis of Developmental Dysplasia of the Hip

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

Describe Barlow's Test

Hip that is reduced but is dislocateable

Describe Ortolani's Test

Hip that is dislocated but reducible

Arthrogram in Diagnosing Developmental Dysplasia of the Hip

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

Treatment of Developmental Dysplasia of the Hip

Closed reduction Pavlik harness Spica casts

Pavlik Harness in Treatment of Developmental Dysplasia of the Hip

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

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

Closed reduction

Closed Reduction in Developmental Dysplasia of the Hip

General anesthesia & arthrogram guidance | Spica cast: 3 months

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

Open reduction

Most Commonly Used Open Reduction in Developmental Dysplasia of the Hip

Anterior approach*** | Medial approach

Complications of Developmental Dysplasia of the Hip

Osteonecrosis Failed reduction Repeat reduction

Osteonecrosis of Developmental Dysplasia of the Hip

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

Describe Osgood-Schlatter Disease

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

Clinical Symptoms of Osgood-Schlatter Disease

Pain exacerbated by running, jumping, & kneeling

Exam & Diagnosis of Osgood-Schlatter Disease

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

Treatment of Osgood-Schlatter Disease

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

Describe Septic Arthritis

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

Types of Septic Arthritis

Hematogenous spread Contiguous spread Direct inoculation

Symptoms of Septic Arthritis

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

Exam & Diagnostics of Septic Arthritis

``` 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 ```

Joint Aspiration Analysis of a Septic Joint

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

Sequelae of a Septic Joint

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

Prognosis of Septic Joint

Good if caught within 4 days of symptoms

Treatment of Septic Joint

Refer early Surgical drainage Antibiotics

Common Organisms with Septic Joint

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