pediatric orthopedics Flashcards
What causes developmental dysplasia of the hip?
poor development of the acetabulum in utero
What are risk factors for developmental dysplasia of the hip?
female, firstborn, breech, oligohydramnios
What is Galeazzi sign?
knees at unequal heights when hips and knees are flexed
What are the imaging studies that should be used to assess developmental dysplasia of the hip?
ULTRASOUND. Xrays not useful until after 4 months of age
What is the treatment for developmental dysplasia of the hip?
- 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
What is SCFE?
separation of the growth plate of the femoral epiphysis from the metaphesis
How would hypothyroidism change the management of SCFE?
-If pt has hypothyroidism (risk factor for SCFE), they should have prophylactic pinning of the normal contralateral side
What are the complications of untreated SCFE?
increased risk of avascular necrosis and premature OA
What are the labs seen in rickets?
- 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
What is the treatment for rickets?
phosphorus supplements, vitamin D supplements for poor intake, 1,25 dihydroxycholecalciferol for impaired vitamin absorption/metabolism
What is Osgood-schlatter diseaes?
inflammation of the bone-cartilage interface of the tibial tubercle, esp in young boys during their growth spurts
-treatment is stretching and NSAIDs
What is the tx for clavicular fracture in neonates?
no treatment (in older kids need a figure of eight sling)
What is JIA?
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
Pauciarticular JIA: joints involved, age, extraosseous sx, labs
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
Pauciarticular JIA: treatment , prognosis, complications
-NSAIDs and maybe methotrexate. usually resolves in
What is polyarticular JIA? joints involved, age, extraosseous sx, labs
- 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
What is the tx, prognosis and complications of polyarticular JIA?
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
What is systemic JIA: what joints, age, extraosseus sx, labs?
- 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
What is Legg-Calve-Perth disease? When does it present?
avascular necrosis of the femoral epiphysis usually seen between the ages of 3-8
What is the H/P for Legg-calve-perth disease?
gradual progressive limp with insidious onset of pain and decreased ROM
What is the treatment for legg-calve perth disease?
containment of the hip within the acetabulum via bracing or surgery; acetabular reconstruction performed in cases of permanent hip dysplasia
What are the complications of legg-calve-perth disease?
50% recover fully, but there is an incr. risk of OA, progressive AVN, and deed for early arthroplasty
