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Musculoskeletal > Pediatric Orthopedics > Flashcards

Pediatric Orthopedics Flashcards

1
Q

What dx is the MC injury of the elbow in children under 5?

A

Nursemaid’s Elbow

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2
Q

What degree of curve is dx of scoliosis?

A

> 10˚

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3
Q

What test can be done to dx scoliosis?

A

Forward Bending Test

Flank Crease & Scapular Prominence may also be seen when standing upright

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4
Q

What disease uses the Cobb angle on x-ray for screening & dx?

A

Scoliosis

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5
Q

What 2 PE tests can be used to dx Developmental Dysplasia of Hip (DDH)?

A

Ortolani

Barlow

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6
Q

What is the Ortolani Test?

A

O FOR OUT:
Evaluates for already dislocated hip.
The infant is on their back and you flex their hips, then abduct to their full capacity while applying gentle pressure to push the greater trochanter anteriorly. This reduces the hip if it was dislocated & “pop” or “clunk” will be felt
Limited value after 3 mo

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7
Q

What is the Barlow Test?

A

B FOR BACK:
Evaluates if hip is dislocatable
From abduction, adduct the hip back into normal position while applying pressure to push the femur posteriorly. “Clunk” felt if dislocation occurs

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8
Q

What type of splint is most commonly used to tx DDH? When does the success rate decrease?

A

Pavlik Harness

Decreases after 3 mo, not attempted after 18 mo

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9
Q

What are the 8 predisposing factors for DDH?

A
  1. Inherited joint laxity/ FH DDH
  2. Increased or extended levels of progesterone or relaxin in 3rd trimester
  3. Female
  4. 1st born
  5. Breech presentation at birth
  6. Oligohydraminios
  7. Custom of binding infants (restricting hip mvmt)
  8. Associated deformity- foot or knee
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10
Q

A mom calls and says that her 4 y/o son is unwilling to use his arm and will not supinate his hand. He does not seem to be in a lot of pain though. What is the most likely dx?

A

Nursemaid’s Elbow- Very Good

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11
Q

How is Nursemaid’s Elbow Tx?

A

Have child extend elbow with arm hanging downward in natural position
Turn their palm forward (supinate)
Then flex elbow keeping the palm in the supinate position
If the elbow has full flexion & supination=success

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12
Q

Describe the Forward bending test and what disease it is used for?

A

Have pt stand up and bend forward, keeping their knees straight & hanging arms loosely toward the floor
Assess pt from behind for thoracic/lumbar prominence or “rib hump”
Scoliosis

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13
Q

This is a term used to describe a spectrum of disorders usually seen in infancy that all result in a femur/acetabulum jt that is dislocatable or subluxable

A

Developmental Dysplasia of Hip (DDH)

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14
Q

What is the most common cause of acute hip pain in children?

A

Transient Synovitis

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15
Q

What disease is similar to transient synovitis?

A

Legg-Calve-Perthes Disease (LCPD)

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16
Q

What disease is defined as an idiopathic osteonecrosis of the femoral head in children?

A

Legg-Calve-Perthes Disease (LCPD)

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17
Q

Is scoliosis painful?

A

Usually not painful

If it is painful may suggest inflammatory or neoplastic basis

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18
Q

At what curvature of the spine does scoliosis require a full time brace?

A

20-40˚

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19
Q

At what curvature of the spine does scoliosis require surgery?

A

≥40˚

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20
Q

This disease is uncommon in African Americans?

A

Legg-Calve-Perthes Disease (LCPD)

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21
Q

Being African American is a predisposing factor for this disease?

A

Slipped Capital Femoral Epiphysis (SCFE)

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22
Q

What are the diseases of the Hips found in children?

A
  1. Developmental Dysplasia of Hip (DDH)
  2. Slipped Capital Femoral Epiphysis (SCFE)
  3. Legg-Calve-Perthes Disease (LCPD)
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23
Q

What are the diseases of the Lower limb in children?

A
  1. Osgood Schlatter
  2. Genu Varus & Valgus
  3. Inturning/Intoeing:
    Metatarsus Adductus: flexible & inflexible (Metatarsus Varus)
    Tibial Torsion
    Femoral Anteversion
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24
Q

Subluxation of radial head?

A

Nursemaid’s Elbow

25
Q

Disease? Femoral epiphysis becomes displaced from metaphysics through physeal plate

A

Slipped Capital Femoral Epiphysis (SCFE)

26
Q

Bowlegged

A

Genu Varum

27
Q

Knock-Kneed

A

Genu Valgum

28
Q

Disease? An outgrowing of bone, inflammation & possible separation of the apophysis of tibial tubercle due to repetitive microtrauma

A

Osgood Schlatter’s

29
Q

Disease? Medial deviation of forefoot commonly seen in infants

A 
Metatarsus Adductus (MTA) 
Can be flexible or inflexible
30
Q

What is the most common cause of intoeing?

A

Internal Tibial Torsion (ITT) a rotational deformity

31
Q

This is a rotational deformity associated with sitting in on feet in a “W” position & awkward running style (Like a girl)?

A

Femoral anteversion “Kissing Patella”

32
Q

Disease? Subchondral bone develops lesion, which can eventually result in cartilage & associated bone detaching from an articular surface

A

Osteochondritis Dissecans

33
Q

Who should be evaluated for DDH?

A

All infants on PE
The earlier the Dx the better the prognosis
Does NOT cause pain in neonate

34
Q

This disease will cause an out-toeing gait with a limp & loss of internal rotation!

A

Slipped Capital Femoral Ephiphysis

35
Q

What is Blount’s Disease?

A

Inherited form of extreme bowleggedness (Genu Varum)

36
Q

What is usually the main complaint in LCPD? Other S/S

A

Insidious onset of a limp is main complaint. Antalgic Gait: limp from pain not weakness
Pain is often worsened with activity & temporarily relieved with rest
Usually in thigh or groin, sometimes knee
90% unilateral
No recent infix
Leg length discrepancy possible

37
Q

What ROM will be limited on PE in pts with LCPD?

A

both passive & active

abduction & internal rotation

38
Q

Who gets LCPD?

A

MC in boys ages 4-6 but can range from 2-18 y/o

39
Q

What dx tests are used for LCPD

A

X-ray: AP & Frog lateral views required

If x-ray normal but S/S suggest LCPD do an MRI

40
Q

What are some tx options for LCPD?

A 
Vary
Observation with activity restriction
Bed rest with traction
Bracing 
Surgery 
Often slow recovery up to 18 mo
41
Q

What are the predisposing factors for SCFE?

A

Male
Black
Various anatomic anomalies

42
Q

What are the complications of SCFE?

A

MC-Osteonecrosis
Cartilage Necrosis
Osteoarthritis

43
Q

This disease occurs in adolescence when orientation of physeal plate ∆’s from horizontal to oblique

A

SCFE

44
Q

When SCFE is dx what must be done immediately?

A

Immediately non weight bearing to avoid additional slippage- Do not delay! Refer and wheelchair out of office

45
Q

What PE test is done on all adolescents with lower extremity pain especially if suspecting Slipped Capital Femoral Epiphysis (SCFE)?

A

Examine for reduction in rotation of hip:
Flex hip 90˚, internally rotate or place pt in prone position with knees bent & feet in the air
Normal rotation will be symmetrical on L & R

46
Q

Genu Varum is common up to what age and how large can the gap be b/t legs?

A

Common up to 18 mo

Gap normal up to 2 in

47
Q

Genu Valgum is common in what age group and usually resolves by when?

A

Common b/t 3-4 and resolves by 5-8 y/o

48
Q

What type of disorder should you look for if SCFE is seen outside of adolescents?

A

Endocrine

49
Q

Who is Osgood-Schlatter’s most common in?

A

Athletic boys, but also seen in girls ages 10-14

50
Q

What are the main tx’s of Osgood-Schlatter’s?

A

NSAIDs & decreased activity

51
Q

What condition uses the Thigh-Foot-Angle to help in dx and PE?

A

Tibial Torsion

52
Q

What is the normal thigh foot angle?

A

At maturity avg 15˚

53
Q

What thigh-foot-angle indicates internal tibial torsion?

A

TFA >15˚ medially

54
Q

What is Sinding-Larson-Johansson Disease?

A

Pain at the inferior patella

55
Q

What disease is very similar to Osgood Schlatter’s?

A

Sinding-Larson-Johansson Disease

56
Q

What is the difference b/t Osgood Schlatter’s Disease and Sinding-Larson-Johansson Disease?

A

Osgood Schlatter’s=Pain at tibial tuberosity

SLJD=Pain at inferior patella

57
Q

What will be seen on PE if child has Femoral Anteversion?

A

Exam of child standing shows patella medially rotated

Internal hip rotation >65˚ (normal ≤45˚)

58
Q

How is Femoral Anteversion Treated?

A

None usually required
90% resolve by age 10
Persistent or severe deformity after age 8 should be referred for possible surgical correction

59
Q

What types of joints are usually involved in Osteochondritis Dissecans?

A

Joints subjected to frequent microtrauma

MC in knee joint

Musculoskeletal (2 decks)

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