Pediatric Orthopedics Flashcards
Condition: arch develops 3-5; compensatory posture; tx [just keep an eye on it unless incredible painful]
Pes Planus
LEARN PEDIATRIC ORTHOPEDIC CONDITIONS TABLE
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Describe what can be determined from the results of a Galleazi Sign
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
List when the epiphyseal plates open and close
Open = Birth-3mo
Close = 16-19 yo
Condition: Complications = compartment syndrome; recurvatum; extension lag; patella baja; fixation complication
Tibial Tubercle Fx (Osgood Schlatter)
Condition: Loss of hip IR, ABD, Flexion
Slipped Capital Femoral Epiphysis (SCFE)
Condition: Contralateral head rotation coupled w/ipsilateral tilt
Congenital Muscular Torticollis
Condition: hypertext injury, fx beneath ACL insertion, 8-12 yo
Tibial Eminence Fx
Condition:
- Emergent situtation requiring sx to maintain vasculature
Slipped Capital Femoral Epiphysis (SCFE)
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.
Galleazi Sign [for LLD]
Instability Test: Dislocates a reduced hip [bad – stretching out tissue]
Barlow
List the 4 stages of Legg-Calve Perthes
- Condensation [femoral head turns necrotic]
- Fragmentation [necrosis fragmentsàreabsorbed; revascularize, deform femoral head/flat acetabulum]
- Reossification [w/return of vascular supply]
- Remodeling [at acetabulum]
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]
Congenital Muscular Torticollis
Condition: violent quad contraction or passive flexion of knee with contracted quad, 12-17 yo
Tibial Tubercle Fx (Osgood Sclatter)
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]
Developmental Dysplasia of the Hip (DDH)
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
Popliteal angle
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
Galleazi Sign [for LLD]
Describe the 2 ways that Slipped Capital Femoral Epiphysis be classified
- By duration (acute < 3 wk; chronic > 3 wk; acute on chronic > 3 wk w/exacerbation)
- Severity: grades 1-3 (1 = 1/3 width of neck; 2 = 1/3-1/2; 3 = > 1/2)
Condition:
Foot in: Equinus, varus, ADD
- Will never be normal foot again
Club Foot or Talipes Equinovarus
Condition: Complications = laxity/instability, arthorfibrosis, extension block/mal/non-union
Tibial Eminence Fx
Condition: Loss of hip IR, ABD, Extension
Legg-Calve-Perthes
Condition:
- Forefoot curves medially
- Will grow out of
Metatarus Adductus
Term: femoral ER
femoral retrotorsion
Condition:
Mild = due to fetal positioning
Severe = underlying neuromuscular dx [sx @ 4-6mo; night splint; PT]
Club Foot or Talipes Equinovarus
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
Adams forward bend test [for scoliosis]
Describe the 5 Salter Harris Classification System for Fractures
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
Term: femoral IR
femoral antetorsion
Describe acetabular angles that are normal and significant for DDH
Norm = < 20 degree at 24 mo
Significant = > 40 degree at birth
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]
Calcaneovalgus
Condition: pain, hemarthrosis, instability, limited ROM
Tibial Eminence Fx
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
Slipped Capital Femoral Epiphysis (SCFE)
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
Legg-Calve Perthes
Condition: plateau in gains after 4-5 mo of tx and/or 7-8 mo of age
Refractory Torticollis
Describe the hip motions that are lost in Legg-Calve-Perthes
IR
ABD
Extension
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.
Hamstring length
Instability Test: reduces a hip that is out, one leg at a time [out]
Ortolani
List 2 features that are unique to pediatric bones
- Increased malleability [more avulsion b/c ligaments stronger than bone; bending fx]
- Increased remodeling [non-union rare]
Condition: pain, hemarthrosis, inability to extend knee
Tibial Tubercle Fx (Osgood Schlatter)
