Pediatric orthopedic disorders (obj 28) Flashcards
3 risk factors for congenital hip dysplasia, in order of most to least risk
family history
breech position
female
How do you interpret the results of a hip abduction test on a baby?
suspect hip disease if asymmetric or if abduction > 60 degrees is possible
Testing a baby for hip DISLOCATABILITY (grasp knees, adduct legs, push down and back - dislocation is palpable as femur head slips out of acetabulum)
Barlow test
Testing a baby for hip DISLOCATION (start with knees together, abduct and externally rotate - clunk = reduction and is a positive finding)
Ortolani test
Allis sign
when hips and knees are flexed, the knees are at unequal heights, with dislocated side lower
On a 2 month old baby, xrays are the most useful way to look at hip dysplasia.
T/F
FALSE - up until 5-6 months of age, xrays are NOT useful because of lack of ossification centers - do ULTRASOUND
avascular hip necrosis caused by impairment of blood supply to the developing femoral head - cause unknown
Legg-Calve-Perthes disease
Parents bring their 12 year old son to your office - he is limping and complaining of pain on walking.
You see that he is overweight.
You observe his gait and see that his right thigh is externally rotated.
You obtain an xray, and see that Klein’s line does not pass through the right femoral head.
Diagnosis? Treatment?
Diagnosis: SCFE
Slipped Capital Femoral Epiphysis
Treatment: surgical fixation of femoral head
SCFE and Legg-Calve-Perthes disease are both known for affecting boys around the age of 10. What’s one way you can differentiate them?
SCFE has PAINFUL limp
Legg-Calve-Perthes has PAINLESS limp
The treatment for Legg-Calve-Perthes disease:
Legg-Calve-Perthes USUALLY RESOLVES ON ITS OWN!
Fancy term for clubfoot
talipes equinovarus
Treatment options for clubfoot:
mild clubfoot: serial plaster casting
severe clubfoot: surgery
“toeing-in”
tibial torsion
treatment for tibial torsion
usually resolves spontaneously
baby’s head is turned to one side due to anomalies of SCM
torticollis
torticollis can be associated with _____ so be sure to do a thorough full-body musculoskeletal exam
hip dysplasia
two possible treatments for torticollis
stretching/passive ROM
surgery if necessary
greater than 10 degree curve by Cobb angle = ______
scoliosis
What physical exam test can be done to check for scoliosis?
Adams forward bend
What xray views do you want to get for scoliosis?
STANDING full column AP and lateral
What are three treatment options for scoliosis?
observation
bracing
surgical spinal fusion
genu _____ is normal from 0 - 2 yrs old, then switches to genu _____, after which adult alignment is usually obtained.
genu varum is normal from 0 - 2 yrs old
genu valgus is normal from 2 - 8 yrs old
most common foot deformity in newborns
metatarsus varus/metatarsus adductus
two names for the same thing
metatarsus varus/adductus usually _________ by age _____________
usually spontaneously resolves by age 1-2
treatment for femoral anteversion:
femoral anteversion is a variant of normal and requires NO treatment
subluxation of the radial head = ________
and is caused by ________
nursemaid’s elbow; caused by pulling child’s arm or lifting by pulling on hand
treatment for nursemaid’s elbow:
place elbow in full supination; slowly move from full extension to full flexion; palpate for click at radial head; this should provide immediate pain relief
~6+ weeks of joint swelling
~no other cause of childhood arthritis
~diagnosis?
Juvenile Idiopathic Arthritis
aka
Juvenile Rheumatoid Arthritis
Treatment for Juvenile Idiopathic Arthritis?
- NSAIDs
- glucocorticoids
- DMARDs
Acute onset of hip or knee monoarticular joint swelling, redness, & pain = _____, most likely caused by _____ (or ______)
septic arthritis
most likely caused by MSSA or N. gonorrhoeae
Synovial fluid findings in septic arthritis:
WBC count > 50,000
PMN > 80%
positive culture
