Pediatric Orthopedics

Question 1

Condition: arch develops 3-5; compensatory posture; tx [just keep an eye on it unless incredible painful]

Answer 1

Pes Planus

Question 2

LEARN PEDIATRIC ORTHOPEDIC CONDITIONS TABLE

Answer 2

YOU’LL DO IT!!

Question 3

Describe what can be determined from the results of a Galleazi Sign

Answer 3

If knee centers are even ant/post but not sup/inf = short femur and tibia

If knee center off anterior = short tibia

If knee centerio off posterior = short femur

Question 4

List when the epiphyseal plates open and close

Answer 4

Open = Birth-3mo

Close = 16-19 yo

Question 5

Condition: Complications = compartment syndrome; recurvatum; extension lag; patella baja; fixation complication

Answer 5

Tibial Tubercle Fx (Osgood Schlatter)

Question 6

Condition: Loss of hip IR, ABD, Flexion

Answer 6

Slipped Capital Femoral Epiphysis (SCFE)

Question 7

Condition: Contralateral head rotation coupled w/ipsilateral tilt

Answer 7

Congenital Muscular Torticollis

Question 8

Condition: hypertext injury, fx beneath ACL insertion, 8-12 yo

Answer 8

Tibial Eminence Fx

Question 9

Condition:

• Emergent situtation requiring sx to maintain vasculature

Answer 9

Slipped Capital Femoral Epiphysis (SCFE)

Question 10

Test: Child is supine with knees bent and feet flat on the table or floor. ASIS’s are held level. Look to see if one knee is higher than the other. If so, leg length may need to be measured.

Answer 10

Galleazi Sign [for LLD]

Question 11

Instability Test: Dislocates a reduced hip [bad – stretching out tissue]

Answer 11

Barlow

Question 12

List the 4 stages of Legg-Calve Perthes

Answer 12

1. Condensation [femoral head turns necrotic]
2. Fragmentation [necrosis fragmentsàreabsorbed; revascularize, deform femoral head/flat acetabulum]
3. Reossification [w/return of vascular supply]
4. Remodeling [at acetabulum]

Question 13

Condition:

• Abnormal intrauterine posture or injury to SCM w/delivery [direct mm trauma; compartment syndrome]
• Named for the side of the tilt [R > L; dx mean age 4 mo]

Answer 13

Congenital Muscular Torticollis

Question 14

Condition: violent quad contraction or passive flexion of knee with contracted quad, 12-17 yo

Answer 14

Tibial Tubercle Fx (Osgood Sclatter)

Question 15

Condition: Appearance

• LLD, Galeazzi, uneven thigh folds
• Waddling gat w/lordosis [Trendelenburg to affected side]
• Limited hip ABD [unilateral late dx diff of 10 deg; bilateral < 60 deg]

Answer 15

Developmental Dysplasia of the Hip (DDH)

Question 16

Test: Infant is supine with hip and knee of measured lower extremity flexed to 90 degrees. The other hip is stabilized against the surface while the knee of the testing leg is extended. Measure the angle between the thigh and leg when the knee is maximally extended

Answer 16

Popliteal angle

Question 17

Test: May also be an indication of hip joint integrity—if a child has a dislocated hip, the femur will slide backward and the knee on that side will be lower

Answer 17

Galleazi Sign [for LLD]

Question 18

Describe the 2 ways that Slipped Capital Femoral Epiphysis be classified

Answer 18

1. By duration (acute < 3 wk; chronic > 3 wk; acute on chronic > 3 wk w/exacerbation)
2. Severity: grades 1-3 (1 = 1/3 width of neck; 2 = 1/3-1/2; 3 = > 1/2)

Question 19

Condition:

Foot in: Equinus, varus, ADD

• Will never be normal foot again

Answer 19

Club Foot or Talipes Equinovarus

Question 20

Condition: Complications = laxity/instability, arthorfibrosis, extension block/mal/non-union

Answer 20

Tibial Eminence Fx

Question 21

Condition: Loss of hip IR, ABD, Extension

Answer 21

Legg-Calve-Perthes

Question 22

Condition:

• Forefoot curves medially
• Will grow out of

Answer 22

Metatarus Adductus

Question 23

Term: femoral ER

Answer 23

femoral retrotorsion

Question 24

Condition:

Mild = due to fetal positioning

Severe = underlying neuromuscular dx [sx @ 4-6mo; night splint; PT]

Answer 24

Club Foot or Talipes Equinovarus

Question 25

Test: The child bends forward with his/her arms hanging in front and knees straight. The therapist stands behind and then in front of the child to assess spine symmetry. This is a screening procedure and is not a definitive diagnosis of spine curvature

Answer 25

Adams forward bend test [for scoliosis]

Question 26

Describe the 5 Salter Harris Classification System for Fractures

Answer 26

Only used in those with mature bones 1 = closed reduction; good px 2 = closed reduction; good px 3 = open/closed reduction; good px if vasculature intact 4 = open reduction; growth plate disturbd 5 = not detected until growth disturbed; growth arrest/angular deformity

Question 27

Term: femoral IR

Answer 27

femoral antetorsion

Question 28

Describe acetabular angles that are normal and significant for DDH

Answer 28

Norm = \< 20 degree at 24 mo Significant = \> 40 degree at birth

Question 29

Condition: - Forefoot curves laterally, hindfoot valgus, navicular on the floor - Foot appears DF; Vertical talus or “rocker bottom” deformity - Needs to be protected [orthotic or sx]

Answer 29

Calcaneovalgus

Question 30

Condition: pain, hemarthrosis, instability, limited ROM

Answer 30

Tibial Eminence Fx

Question 31

Condition: - Displacement from normal position on femoral neck; B \> G - Presents w/pain in medial thigh, groin, knee, antalgic gait w/decreased WB, ER w/attempted flexion

Answer 31

Slipped Capital Femoral Epiphysis (SCFE)

Question 32

Condition: - Self-limiting avascular necrosis of the femoral head; B 3-13 yo [3x more likely than G] - Presents w/pain in groin, knee, thigh, antalgic gait w/Trendelenburg

Answer 32

Legg-Calve Perthes

Question 33

Condition: plateau in gains after 4-5 mo of tx and/or 7-8 mo of age

Answer 33

Refractory Torticollis

Question 34

Describe the hip motions that are lost in Legg-Calve-Perthes

Answer 34

IR ABD Extension

Question 35

Test: Infant is supine with hip and knee of measured lower extremity flexed to 90 degrees. The other hip is stabilized against the surface while the knee of the testing leg is extended. Measure the amount of ROM that is missing or lacking from full knee extension.

Answer 35

Hamstring length

Question 36

Instability Test: reduces a hip that is out, one leg at a time [out]

Answer 36

Ortolani

Question 37

List 2 features that are unique to pediatric bones

Answer 37

1. Increased malleability [more avulsion b/c ligaments stronger than bone; bending fx] 2. Increased remodeling [non-union rare]

Question 38

Condition: pain, hemarthrosis, inability to extend knee

Answer 38

Tibial Tubercle Fx (Osgood Schlatter)