pediatric orthopedics

Question 1

What causes developmental dysplasia of the hip?

Answer 1

poor development of the acetabulum in utero

Question 2

What are risk factors for developmental dysplasia of the hip?

Answer 2

female, firstborn, breech, oligohydramnios

Question 3

What is Galeazzi sign?

Answer 3

knees at unequal heights when hips and knees are flexed

Question 4

What are the imaging studies that should be used to assess developmental dysplasia of the hip?

Answer 4

ULTRASOUND. Xrays not useful until after 4 months of age

Question 5

What is the treatment for developmental dysplasia of the hip?

Answer 5

• less than 6 mo: Pavlik harness
• 6mo-2 yrs: closed or open reduction and spica casting
• 2-8 yrs: open reduction
• Don’t fix after 8 yrs- limited benefit

Question 6

What is SCFE?

Answer 6

separation of the growth plate of the femoral epiphysis from the metaphesis

Question 7

How would hypothyroidism change the management of SCFE?

Answer 7

-If pt has hypothyroidism (risk factor for SCFE), they should have prophylactic pinning of the normal contralateral side

Question 8

What are the complications of untreated SCFE?

Answer 8

increased risk of avascular necrosis and premature OA

Question 9

What are the labs seen in rickets?

Answer 9

• increased ALP, decr phosphorus
• If due to low calcium, low calcium and decreased vitamin D, increase PTH
• If due to impaired phosphate absorption, increased vitamin D

Question 10

What is the treatment for rickets?

Answer 10

phosphorus supplements, vitamin D supplements for poor intake, 1,25 dihydroxycholecalciferol for impaired vitamin absorption/metabolism

Question 11

What is Osgood-schlatter diseaes?

Answer 11

inflammation of the bone-cartilage interface of the tibial tubercle, esp in young boys during their growth spurts
-treatment is stretching and NSAIDs

Question 12

What is the tx for clavicular fracture in neonates?

Answer 12

no treatment (in older kids need a figure of eight sling)

Question 13

What is JIA?

Answer 13

Juvenile idiopathic arthritis- defined as nonmigratory arthropathy of 1 or more joints for >3 months
all involve arthralgias and fevers
may have osteopenia and subchondral sclerosis around involved joints

Question 14

Pauciarticular JIA: joints involved, age, extraosseous sx, labs

Answer 14

fewer than 4 joints, often large joints except the hips with swelling and decr ROM
presents age 2-3
30% have uveitis or iridocyclitis
weakly positive ANA

Question 15

Pauciarticular JIA: treatment , prognosis, complications

Answer 15

-NSAIDs and maybe methotrexate. usually resolves in

Question 16

What is polyarticular JIA? joints involved, age, extraosseous sx, labs

Answer 16

• 5 or more joints, hips less common. Joint involvment usually symmetric and can involve hands and spine.
• presents at many ages (2-5, 10-14)
• can cause growth retardation, iridocyclitis is rare
• Possibly positive ANA or RF

Question 17

What is the tx, prognosis and complications of polyarticular JIA?

Answer 17

NSAIDs, methotrexate, sulfasalazine, etanercept

• 60% have remission by age 15 but some have chronic arthritis. worse prognosis with older age of onset
• can lead to chronic arthritis and leg length discrepancies

Question 18

What is systemic JIA: what joints, age, extraosseus sx, labs?

Answer 18

• any number of joints, any age under 17
• kids have acute significant pain, may have fevers, jaw/neck involvment
• may have a maculopapular rash, LAD, pericardiits
• negative ANA

Question 19

What is Legg-Calve-Perth disease? When does it present?

Answer 19

avascular necrosis of the femoral epiphysis usually seen between the ages of 3-8

Question 20

What is the H/P for Legg-calve-perth disease?

Answer 20

gradual progressive limp with insidious onset of pain and decreased ROM

Question 21

What is the treatment for legg-calve perth disease?

Answer 21

containment of the hip within the acetabulum via bracing or surgery; acetabular reconstruction performed in cases of permanent hip dysplasia

Question 22

What are the complications of legg-calve-perth disease?

Answer 22

50% recover fully, but there is an incr. risk of OA, progressive AVN, and deed for early arthroplasty