Pediatric orthopedics Flashcards
What is the ortolani maneuver?
The Ortolani maneuver begins with the hip in adduction (at the midline) and moves the hip into abduction (away from the midline). This reduces a hip that is already OUT.
test is useful for the first few months of life; after that, a negative finding does not rule out a dislocated hip
What is the barlow maneuver?
It begins in abduction (away from midline) and moves the hip into adduction (at the midline). A dislocatable hip will fall out the Back.
This test is useful for the first few months of life; after that, a negative finding does not rule out a dislocated hip.
What is the galeazzi sign?
unequal leg lengths associated with asymmetric gluteal skin folds. Seen at 4-6 months with dislocated hip.
What is the treatment for hip dysplasia in an infant up to 6 months?
Use a pavlik harness that flexes hips above 90% and abducted slightly. Weekly check with ultrasound to make sure there is reduction
What is club foot? Epidemiology
occurs at birth when foot is down and rotated in (walking on ankle). 1/800 births.
How do you treat club foot?
Conservatively! Put in new cast each week, slowly remodeling foot. Can take a year. If not making progress, use surgical intervention.
What is the epidemiology of Adolescent idiopathic scoliosis?
25/1000 children
More females than males
What is adolescent idiopathic scoliosis?
Scoliosis is a curvature of the spine greater than 10 degrees. It causes no pain but curves increase during growth spurts.
What is the treatment for adolescent idiopathic scoliosis based on curvature?
10-20 degrees, monitor.
20-40 degrees, brace.
Over 40 degrees, surgery.
What is the key degree for stabilization of curvature over a lifetime in scoliosis.
If the curve is less than 40 degrees, stable curve throughout adulthood. If curve is greater than 40 degrees, curve worsens over time.
How often should kids be followed up with scoliosis?
Every 3 months during growth spurts. Right before menarchy for girls.
Does bracing improve a curve?
No, stabilizes curve.
What are the treatment options for scoliosis today?
Use a Boston Brace which is warn 18 hours a day. Doesn’t correct scoliosis but prevents it from worsening. Worn until growth plates close. Can play sports in it.
What is non-accidental trauma?
Trauma caused by a caregiver. Signs are: fractures before age 1, story doesn’t make sense, posterior rib, skull, and extremity fractures; fractures in various stages of healing, multiple bruises.
What are the Salter Harris Fractures?
Fractures that involve epiphyseal plate or growth plate of a bone, Types I - IV.
I – S = Slip (separated or straight across). Fracture of the physis (growth plate)
II – A = Above. The fracture lies above the physis in the metaphysis
III – L = Lower. The fracture is below the physis in the epiphysis.
IV – T = Through. The fracture is through the metaphysis, physis, and epiphysis.
What types of Salter Harris Fractures affect growth?
Type III and IV because growth plate fractured.
How should you treat fractures in children?
Always treat conservatively (cast, non-surgical) unless 1. open fracture 2. neurovascular compromise 3. compartment syndrome w/occlusion of venous blood. Under 10, use cast for femur fracture. Older child, surgery.
What is osteomyeltis
infection of the bone, causes primarily by staph aureus or pseudomonas (puncture through tennis shoe)
What are the signs/sx of osteomyelitis?
Fever, lots of swelling, very painful and tender
How do you treat osteomyelitis
3-4 weeks of antibiotics. Check C-reactive protein for improvement. High = infection
What is a septic hip?
bacterial infection of the hip, find a joint filled with pus. Hip will be flexed and externally rotated.
What are signs/sx of septic hip?
Won’t bear weight on leg, fever, won’t move hip.
What is something similar to a septic hip?
toxic synovitis. It’s a viral infection of hip. Appears like septic hip but no pus. Goes away in 3-4 days
Treatment for septic hip?
Treat with antibiotics to prevent bone degradation. Draw a need aspiration of hip joint. Clear - follow up, pus - send for culture, start Ab and drain hip
