Pediatric Orthopedic Diseases Flashcards
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
Define Legg-Calve-Perthes Disease
Idiopathic osteonecrosis of the femoral head in children
Epidemiology of Legg-Calve-Perthes Disease
4-8
Boys > Girls
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
Diagnosis of Legg-Calve-Perthess Disease
AP & lateral view of hip Wrist/hand films for bone age AP with hip abduction to determine containment Technetium-99m bone scan MRI
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
Prognosis of Legg-Calve-Perthes Disease
Favorable
Function well despite poor radiographs
Develop arthritis eventually
Goals of Treatment of Legg-Perthes-Calve Disease
Reduce pain
Improve function
Minimize femoral head deformity
Treatment of Legg-Perthes-Calve Disease
Revascularization
Traction
Bed rest
Surgery
Define Slipped Capital Femoral Epiphysis
Disorder in which the epiphysis becomes posterior displaced on the femoral neck
Sequelae of Slipped Capital Femoral Epiphysis
Osteoarthritis
Chondrolysis
AVN
Epidemiology of SCFE
Boys: 10-17
Girls: 8-15
Male > Female (2:1)
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
Imaging Studies for SCFE
AP & lateral radiographs
AP Radiograph Findings Pre-Slip
Slight widening & fuzzy irregularity of physis
Lateral Radiograph Findings
Percent epiphyseal displacement
Lateral head/shaft angle
Etiology of SCFE
Hypothyroidism
Hyogonadism
Parathyroid adenoma with GH abnormality
Treatment of SCFE
Stabilize slipping process
Achieve premature closure of physics
Single screw fixation
Characteristics of Club Foot
Plantar flexion of ankle
Inversion of heel
High arch at midst
Adduction of forefoot
Epidemiology of Club Foot
Idiopathic
Males > Females (2:1)
Clinical Presentation of Club Foot
Look like could walk on top of foot
Plantar flexion most severe
High arch (difficult to see)
Forefoot adduction
Tests for Club Foot
Rule out neuromuscular disorders (CP, MD)
X-rays (usually not needed)
Treatment of Club Foot
Manipulation
Casting
2-4 months
Surgery if failure of conservative treatment
Surgery: lengthens tendons & ligaments
Prognosis of Club Foot
Good
Run & play afterwards
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)
