Pediatric Orthopedics

Question 1

Q: Growth abnormailites are most commonly due to what 2 things?

Answer 1

1. They are congential in nature
2. Due to lack of space in utero

Question 2

Q: When does gestation development really take off?

Answer 2

5 weeks

Question 3

Q: Gestationally, when do the majority of PT/Ortho problems arise?

Answer 3

20-40 wks

Question 4

Q: What is the most rapid time of growth?

Answer 4

Birth to 2 years

Question 5

T/F: If anatomical variations are symmetrical, things are most likely going to be okay.

Answer 5

True

Question 6

Q: By what age are you 1/2 of your adult height?

Answer 6

2

Question 7

T/F: LE grow earlier than UE.

Answer 7

False: flip it

Question 8

T/F: The foot grows before the rest of the LE.

Answer 8

True

Question 9

Q: When does the Trunk grow more?

Answer 9

In children

Question 10

Q: When does the LE grow more?

Answer 10

In adolescents

Question 11

Q: What is the most common time for the development of scoliosis and slipped capital femoral epiphysis?

Answer 11

Adolescents

Question 12

Q: What fraction of MSK defects are congenital?

Answer 12

1/3

Question 13

Q: 50% of MSK defects are comprised of what two conditions?

Answer 13

1. Development dysplasia of the hip
2. Club feet

Question 14

Q: What are the 4 major reasons for abnormal growth?

Answer 14

1. Environment (external and intrauterine)
2. Nutrition
3. Infection
4. Trauma

Question 15

Q: What is the important about the “fetal position”?

Answer 15

The fetal position is important of the development of the acetabulum. A cradle board (common in native american culture) or extended positions results in shallow acetabulums and a higher risk of hip dysplasia.

Question 16

Q: What are 3 important factors of a ped eval?

Answer 16

1. Birth history - timing and type
2. Developmental milestones
3. Parent intuition

Question 17

Q: We are ________ in rating our pain but ___________ with ourselves.

Answer 17

unique, consistent

Question 18

Q: What are 3 important factors of a ped phsyical exam?

Answer 18

1. Trust - pt. and parent
2. Observation of spontaneous movements - kids like to perform
3. Age appropiate verbal commands

Question 19

Q: What is Gower’s sign associated with?

Answer 19

Muscular dystrophy (walking hands up legs to stand)

Question 20

T/F: We are least mobile in infancy

Answer 20

False

Question 21

Q: What is the difference between growing pain and pain due to growing?

Answer 21

Growing pain = poorly localized, at night, no altered function, spontaneously resolves

Pain due to growing

ex. bones grow faster than mm, which results in tightness followed by compensations that cause pain
ex. overuse of developing structures results in pain

Question 22

T/F: MMT is appropriate at all ages.

Answer 22

False, not under the age of 5(ish)

Question 23

Content: Talipes Equionvarus (Club Foot) (3)

Answer 23

1. Equinus, varus, adductus
2. Mild = serial cast
3. Severe = sx correction at 4-6 mo

Question 24

Q: What are 4 tests for developmental dysplasia of the hip?

Answer 24

1. Barlow - distraction in ABD/ER/Flex
2. Ortolani - distraction in ABD/ER/Flex
3. Galeazzi sign - knee unlevel in supine hook lying
4. Asymmetry of thigh folds

Question 25

Content: Congenital Muscular Torticollis (5)

Answer 25

1. Shortened SCM 2. Lateral flexion on short side with rotation on opposite side 3. Can cause cranial/facial deformity 4. DDX = vision deficits 5. Primarily treated with botox and PT when \< 1 yo

Question 26

Content: Legg-Calve-Perthes (5)

Answer 26

1. Locailzed 2. Boys (\> girls), 3-13 yo 3. Loss of IR, ABD, Ext 4. Antalgic and trendelenberg gait 5. PT = core stab, limited WB, activity modification, compliance

Question 27

Q: What is the motion limitation in Legg-Calve-Perthes?

Answer 27

Lack, ER, ABD, Ext of hip

Question 28

Content: Slipped capital femoral epiphysis (SCFE) (6)

Answer 28

1. Due to mechanical stress 2. Onset at puberty 3. Limited IR, ADD, Flex 4. Hallmark: ER with attempts of increased hip flexion 5. Sx w/in 24 hrs to protect against AVN 6. PT = Core stab, progressive WB

Question 29

Q: What is the motion limitation in SCFE?

Answer 29

Lack, IR, ADD, Flex of hip

Question 30

Content: Tibia vara (Blount's) - asymmetric (3)

Answer 30

1. Bow legged stance of one leg 2. Sharp varus of metaphysis, wedging of medial epiphysis, widening growth plate, beakin of medial metaphysis 3. Depending on age: HKAFO, tibial osteotomy, external fixation

Question 31

Q: What 2 types of fx are more common in peds?

Answer 31

1. Avulsion 2. Bending

Question 32

Defn: Buckle or Torus Fx

Answer 32

Compression fx resulting in a bulge in the cortex

Question 33

Q: Which Epiphyseal injury is most alarming?

Answer 33

Type 5 - will not show up on x-ray but rather years later when growth arrest is noticeable

Question 34

Content: Limb shortening (5)

Answer 34

Best practice is the arrest growth of the long limb Options - Physeal arrest: 2-5 cm - Shorten femur: 5-6 cm - Shorten tibia: 2-4 cm Caution - Can affect proportion/changes knee center

Question 35

Q: When would you lengthen the short limb?

Answer 35

When the discrepancy is greater than 5 cm

Question 36

Q: How do you lengthen a bone?

Answer 36

distract the fx .25 mm 3-4xday, do not exceed 1 mm/day of lengthening

Question 37

Q: When do the arches of the foot develop?

Answer 37

3-5 yo