Pediatric Orthopedics

Question 1

Talipes equinovarus

• what is it
• mild vs. severe & treatments

Answer 1

aka club foot - equinas + varus + adduction

Mild - due to fetal positioning (decreased space)
- treatment = serial cast, weekly progression

Severe - due to underlying neuromuscular diagnosis

• treatment = surgical correction at 4-6months, night splint and PT
• PROM, strength and gross motor skills

Question 2

Developmental Dysplasia of the hip (DDH)

• etiology
• testing
• treatment

Answer 2

affects 70% female; usually first born, heriditary or breech birth

Etiology: mechanical (positional), cultural (cradle boards –> Iatrogenic disorder), increased incidence w/ torticollis

Testing: Barlow and Ortolana tests, Galeazzi sign, asymmetric gluteal folds

Question 3

Congenital Muscular Torticollis

• what is it
• etiology
• treatment

Answer 3

shortened STM that causes lateral flexion to the shortened side and rotation to the OPPOSITE side

Etiology: intrauterine positioning, deliver trauma, post-birth positioning

Treatment: stretching; botox and surgery if 12 months or older

Question 4

Legg-Calve Perthes Disease

• what is it & 4 stages
• who does it affect & etiology
• symptoms
• treatment

Answer 4

AVN of femoral head; 4 stages
condensation –> fragmentation –> reossification –> remodeling

Typically affects boys 3-13 due to trauma, obesity, vascular abnormalities, infection or clots

Symptoms: vague pain in groin, knee & hip

• *LOSS of IR, ABD and EXT
• *antalgic gait w/ trendelenburg sign

Treatment: decrease pain, casting and/or orthitics, if 9+ the surgery w/ varus osteotomy
- PT: PROM and strengthening especially core stability, gait training w/ limited WB, activity modification and parent education

Question 5

Slipped Capital Femoral Epiphysis (SCFE)

• what is it
• symptoms
• treatment

Answer 5

Displacement from normal position on femoral neck due to increase in mechanical stress (rapid growth, trauma or obesity)
-classified by duration or severity

Symptoms: antalgic gait w/ decreased WB

• *limited IR, ADD and FLEXION
• *halmark sign - ER the hip when trying to flex hip while sitting on the edge of the table

Treatment: immediate surgical intervetion

PT - gait training w/ assistive device, strength and PROM and core stability

Question 6

Blount’s Disease

• what is it
• radiologic results
• treatment

Answer 6

asymmetric compression and shear forces at medial tibia presenting w/ bow-legged stance

Radiographs:

• sharp varus angulation of metaphysis
• wedging of medial epiphysis
• widening of growth plate
• breaking of medial tibia metaphysis w/ cartilage islands

Treatment: gait training w/ restricted WB, infection control, strength, ROM

Question 7

Salter-Harris Growth Plate Fractures

Answer 7

I - fracture along the physis but unaffected; excellent prognosis
II - fracture through metaphysis and along GP (not into); good prognosis
III - fracture along GP, through and down into epiphysis; good if blood supply intact
IV - fracture through metaphysis, physis and epiphysis; surgery requred; fair prognosis
V - compression fracture of GP; poor prognosis b/c often not recognized at time of injury

Question 8

Limb shortening vs. Limb lengthening

Answer 8

Shortening is preferred if difference is less than 5cm;
MAX shortening of femur = 5-6cm and MAX shortening of tibia = 2-4cm

Lengthening is preferred if difference >5cm