Pediatric orthopedics

Question 1

What is the ortolani maneuver?

Answer 1

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

Question 2

What is the barlow maneuver?

Answer 2

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.

Question 3

What is the galeazzi sign?

Answer 3

unequal leg lengths associated with asymmetric gluteal skin folds. Seen at 4-6 months with dislocated hip.

Question 4

What is the treatment for hip dysplasia in an infant up to 6 months?

Answer 4

Use a pavlik harness that flexes hips above 90% and abducted slightly. Weekly check with ultrasound to make sure there is reduction

Question 5

What is club foot? Epidemiology

Answer 5

occurs at birth when foot is down and rotated in (walking on ankle). 1/800 births.

Question 6

How do you treat club foot?

Answer 6

Conservatively! Put in new cast each week, slowly remodeling foot. Can take a year. If not making progress, use surgical intervention.

Question 7

What is the epidemiology of Adolescent idiopathic scoliosis?

Answer 7

25/1000 children

More females than males

Question 8

What is adolescent idiopathic scoliosis?

Answer 8

Scoliosis is a curvature of the spine greater than 10 degrees. It causes no pain but curves increase during growth spurts.

Question 9

What is the treatment for adolescent idiopathic scoliosis based on curvature?

Answer 9

10-20 degrees, monitor.
20-40 degrees, brace.
Over 40 degrees, surgery.

Question 10

What is the key degree for stabilization of curvature over a lifetime in scoliosis.

Answer 10

If the curve is less than 40 degrees, stable curve throughout adulthood. If curve is greater than 40 degrees, curve worsens over time.

Question 11

How often should kids be followed up with scoliosis?

Answer 11

Every 3 months during growth spurts. Right before menarchy for girls.

Question 12

Does bracing improve a curve?

Answer 12

No, stabilizes curve.

Question 13

What are the treatment options for scoliosis today?

Answer 13

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.

Question 14

What is non-accidental trauma?

Answer 14

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.

Question 15

What are the Salter Harris Fractures?

Answer 15

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.

Question 16

What types of Salter Harris Fractures affect growth?

Answer 16

Type III and IV because growth plate fractured.

Question 17

How should you treat fractures in children?

Answer 17

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.

Question 18

What is osteomyeltis

Answer 18

infection of the bone, causes primarily by staph aureus or pseudomonas (puncture through tennis shoe)

Question 19

What are the signs/sx of osteomyelitis?

Answer 19

Fever, lots of swelling, very painful and tender

Question 20

How do you treat osteomyelitis

Answer 20

3-4 weeks of antibiotics. Check C-reactive protein for improvement. High = infection

Question 21

What is a septic hip?

Answer 21

bacterial infection of the hip, find a joint filled with pus. Hip will be flexed and externally rotated.

Question 22

What are signs/sx of septic hip?

Answer 22

Won’t bear weight on leg, fever, won’t move hip.

Question 23

What is something similar to a septic hip?

Answer 23

toxic synovitis. It’s a viral infection of hip. Appears like septic hip but no pus. Goes away in 3-4 days

Question 24

Treatment for septic hip?

Answer 24

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

Question 25

Why do peds patients have few musculoskeletal tumors?

Answer 25

Younger so fewer mutation. Bone turns over very slowly.

Question 26

What is the number one symptom of malignancy (osteosarcoma) that patients complain of?

Answer 26

Unremitting pain at night for malignant tumor. Tumor is eating away at the bone all the time.

Question 27

What is the epidemiology if osteosarcomas in peds patients.

Answer 27

Normal age 11-20. Around knee, distal femur. Labs show increased alkaline phosphatase. Survival ~70% (before chemo 15-20%)

Question 28

What is Ewings sarcoma?

Answer 28

3x more common that osteosarcoma. Moth eaten appearance in diaphyses of bones or flat bones.