Pediatric Orthopedics Flashcards
Q: Growth abnormailites are most commonly due to what 2 things?
- They are congential in nature
- Due to lack of space in utero
Q: When does gestation development really take off?
5 weeks
Q: Gestationally, when do the majority of PT/Ortho problems arise?
20-40 wks
Q: What is the most rapid time of growth?
Birth to 2 years
T/F: If anatomical variations are symmetrical, things are most likely going to be okay.
True
Q: By what age are you 1/2 of your adult height?
2
T/F: LE grow earlier than UE.
False: flip it
T/F: The foot grows before the rest of the LE.
True
Q: When does the Trunk grow more?
In children
Q: When does the LE grow more?
In adolescents
Q: What is the most common time for the development of scoliosis and slipped capital femoral epiphysis?
Adolescents
Q: What fraction of MSK defects are congenital?
1/3
Q: 50% of MSK defects are comprised of what two conditions?
- Development dysplasia of the hip
- Club feet
Q: What are the 4 major reasons for abnormal growth?
- Environment (external and intrauterine)
- Nutrition
- Infection
- Trauma
Q: What is the important about the “fetal position”?
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.
Q: What are 3 important factors of a ped eval?
- Birth history - timing and type
- Developmental milestones
- Parent intuition
Q: We are ________ in rating our pain but ___________ with ourselves.
unique, consistent
Q: What are 3 important factors of a ped phsyical exam?
- Trust - pt. and parent
- Observation of spontaneous movements - kids like to perform
- Age appropiate verbal commands
Q: What is Gower’s sign associated with?
Muscular dystrophy (walking hands up legs to stand)
T/F: We are least mobile in infancy
False
Q: What is the difference between growing pain and pain due to growing?
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
T/F: MMT is appropriate at all ages.
False, not under the age of 5(ish)
Content: Talipes Equionvarus (Club Foot) (3)
- Equinus, varus, adductus
- Mild = serial cast
- Severe = sx correction at 4-6 mo
Q: What are 4 tests for developmental dysplasia of the hip?
- Barlow - distraction in ABD/ER/Flex
- Ortolani - distraction in ABD/ER/Flex
- Galeazzi sign - knee unlevel in supine hook lying
- Asymmetry of thigh folds
Content: Congenital Muscular Torticollis (5)
- Shortened SCM
- Lateral flexion on short side with rotation on opposite side
- Can cause cranial/facial deformity
- DDX = vision deficits
- Primarily treated with botox and PT when < 1 yo
Content: Legg-Calve-Perthes (5)
- Locailzed
- Boys (> girls), 3-13 yo
- Loss of IR, ABD, Ext
- Antalgic and trendelenberg gait
- PT = core stab, limited WB, activity modification, compliance
Q: What is the motion limitation in Legg-Calve-Perthes?
Lack, ER, ABD, Ext of hip
Content: Slipped capital femoral epiphysis (SCFE) (6)
- Due to mechanical stress
- Onset at puberty
- Limited IR, ADD, Flex
- Hallmark: ER with attempts of increased hip flexion
- Sx w/in 24 hrs to protect against AVN
- PT = Core stab, progressive WB
Q: What is the motion limitation in SCFE?
Lack, IR, ADD, Flex of hip
Content: Tibia vara (Blount’s) - asymmetric (3)
- Bow legged stance of one leg
- Sharp varus of metaphysis, wedging of medial epiphysis, widening growth plate, beakin of medial metaphysis
- Depending on age: HKAFO, tibial osteotomy, external fixation
Q: What 2 types of fx are more common in peds?
- Avulsion
- Bending
Defn: Buckle or Torus Fx
Compression fx resulting in a bulge in the cortex
Q: Which Epiphyseal injury is most alarming?
Type 5 - will not show up on x-ray but rather years later when growth arrest is noticeable
Content: Limb shortening (5)
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
Q: When would you lengthen the short limb?
When the discrepancy is greater than 5 cm
Q: How do you lengthen a bone?
distract the fx .25 mm 3-4xday, do not exceed 1 mm/day of lengthening
Q: When do the arches of the foot develop?
3-5 yo
