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Orthopedics > Pediatric Orthopedics > Flashcards

Pediatric Orthopedics Flashcards

1
Q

Legg-Calve-Perthes Disease

  1. What is it?
  2. Sequenced how?
  3. Age range?
  4. Gender?
  5. Unilateral or BI?
A
  1. Idiopathic osteonecrosis of the femoral head in children
  2. Sequence of femoral head fragmentation and repair.
    • Age range is 4 to 8 commonly.
    • Age 2 to 12.
  4. Four to five times more common in boys than girls.
  5. 10% of cases are bilateral.
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2
Q

Legg-Calve-Perthes Disease
Clinical Presentation
4

A
  1. Prolonged limp or waddling gait with
  2. pain in the thigh, groin, or knee.
  3. 90% have delay in bone age and short stature.
  4. Bilateral L.C.P.D. both hips usually do not become symptomatic at the same time.
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3
Q

Legg-Calve-Perthes Disease
Diagnostics?
5

A
  1. AP and lateral view of the hip.
  2. Wrist and hand films for bone age.
  3. AP pelvis with hips abducted to determine containment.
  4. Technetium-99m bone scan with pinhole collimation.
  5. MRI.
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4
Q

Legg-Calve-Perthes Disease
Etiology
3 components

A
  1. Anterolateral portion of the head is commonly involved.
  2. The ascending lateral cervical vessels from the medial femoral circumflex artery.
  3. Circulation is less developed in 3 to 10 year old boys.
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5
Q 
Legg-Calve-Perthes Disease
Prognosis:
1. Dx and tx before when is best?
2. function?
3. Risks?
A
  1. The disease begins before 6 years of age and treatment begins before 8 years of age.
  2. Adolescents function well in spite of poor radiographs.
  3. 70-80% develop arthritis in long term studies.
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6
Q

Legg-Calve-Perthes Disease

  1. Tx goals? 3
  2. Tx? 4
A
  1. Goals are to
    - reduce pain,
    - improve function, and
    - minimize femoral head deformity.
    • Revascularization of the femoral head
    • Traction, bed rest.
    • Bracing – not proven to alter natural history.
    • Surgery
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7
Q

SLIPPED CAPITAL FEMORAL EPIPHYSIS

What is it?

A

Disorder in which the epiphysis becomes posterior displaced on the femoral neck. This may lead to osteoarthritis in adults or result in chondrolysis or avascular necrosis in the adolescent.

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8
Q

Epidemiology - SCFE

  1. Ages?
  2. Gender?
  3. Risk factor?
  4. Bilateral?
A
  1. This tends to occur in boys 10 to 17 years of age,
  2. girls 8 to 15 years of age. Male to female ratio is 2:1.
  3. Obesity-50% weigh more than 90% of the children in their age group.
  4. Bilaterality-37% for the symptomatic slips.
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9
Q
  1. Signs of acute and then chronic? 2

2. What makes it acute or chronic?

A
    • Abrupt onset of groin pain.
    • Longer duration of symptoms, medial thigh and knee pain.
    • Acute – symptoms for less than 3 weeks.
    • Chronic – symptoms for longer than 3 weeks.
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10
Q

Clinical Findings - SCFE?

3

A

Clinical Findings:

  1. Pain is localized to the anterior hip, groin, or medial thigh and knee.
  2. Child walks with antalgic gait with leg in external rotation.
  3. Passive hip flexion results in obligatory external rotation.
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11
Q

Describe stable and unstable SCFE dx differences?

A

Stable – no independent movement on fluoroscopy.

Unstable – independent movement on fluoroscopy.

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12
Q

Imaging Studies - SCFE? 2

What do each say?

A

AP and lateral radiographs are the most important imaging studies.

  1. AP x-ray on a pre-slip will show slight widening and fuzzy irregularity of the physis.
  2. Lateral view gives the most information, the percent epiphyseal displacement and the lateral head/shaft angle.
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13
Q

Etiology - SCFE? 3

A
  1. Hypothyroidism.
  2. Hypogonadism.
  3. Parathyroid adenoma with growth hormone abnormality.
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14
Q

Treatment - SCFE

2

A
  1. Stabilize slipping process and achieve premature closure of the physis.
  2. Single screw fixation under fluoroscopic control.
    - Screw generally needs to be placed anteriorly on the femoral neck.
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15
Q

Club Foot

Congenital foot deformity characterized by four components? 4

A
  1. Plantar Flexion of the ankle
  2. Inversion of the Heel
  3. High Arch at the midfoot
  4. Adduction of the forefoot
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16
Q

Club foot:

  1. Cause?
  2. Gender?
  3. Genetic?
A
  1. Idiopathic
  2. Males twice that of females
  3. Familial
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17
Q

Club foot
Clinical Presentation
4

A
  1. Look like they could walk on the top of the foot
  2. Plantar flexion is most severe, drawn up position of the heel and inability to pull the calcaneus down
  3. High arch difficult to see
  4. Forefoot adduction
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18
Q

Club foot tests? 2

A
  1. Rule out neuromuscular disorders

2. Xrays not needed unless dx unclear

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19
Q

CLub foot tx?

5

A
  1. Manipulation and casting should be started immediately
  2. 2-4 months of manipulation and casting are required to correct the clubfoot
  3. Surgery if conservative fails
  4. Surgery lengthens tendons and ligaments so that the bones can be positioned in normal alignment
  5. Child can run and play after
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20
Q

Metatarsus adductus

  1. What is it?
  2. Common in who?
  3. Prognosis?
A
  1. Common congenital deformity characterized by medial deviation of the forefoot
  2. 25% preterm infants
    13% term infants
  3. Often resolves spontaneously
21
Q

Metatarsus adductus

Exam findings? 4

A
  1. Convex lateral border of the foot with a palpable prominence at the base of the fifth metatarsal
  2. Hindfoot is in neutral or increased valgus
  3. Normal ankle dorsiflexion (metatarsal bones deviated inward)
  4. “pigeon toe”
22
Q

Metatarsus adductus Diagnostics? 2

A
  1. Serial photocopies
  2. Heel bisector line
    Kind of subjective….
23
Q

Metatarsus adductus

Tx? 3

A
  1. Supine sleeping position
  2. Delay tx until 6 months old
  3. Serial casting
24
Q

Genu varum and valgus
Characteristics for Varum?
4

A
  1. Tibia adducted in relation to the femur
  2. 10-15 degrees is normal
  3. Straightens by 12-18 months of age
  4. After age 30-36 months, bracing or surgery
25
Q

Genu varum and valgus

Characteristics of Valgus? 3

A
  1. alignment of the knee with the tibia abducted in relation to the femur
  2. “Knock-knees”
  3. Observation is the treatment of choice
26
Q

DEVELOPMENTAL DYSPLASIA OF THE HIP
Variants of Developmental
Dysplasia of the Hip? 5

Describe them?

A

Teratologic – fixed dislocation, occurs prenatally, usually associated with neuromuscular disorders.

Unstable hip – femoral head is reduced, can be fully dislocated or partially subluxated.

Dislocated hip – femoral head does not articulate and may not be reducible.

Subluxated hip – femoral head contacts a portion of the true acetabulum.

Acetabular dysplasia – acetabulum is shallow, femoral head is subluxated or normal.

27
Q

Developmental Dysplasia of the Hip

Etiology? 2

A

Physiology:

  1. Ligamentous laxity.
  2. Hormonal and familial.
28
Q

Mechanical Factors

for hip dysplasia? 7

A
  1. Prenatal.
  2. Breech.
  3. Oligohydramnios.
  4. Primigravida.
  5. Congenital knee recurvatum with dislocation.
  6. Congenital muscular torticollis.
  7. Metatarsus adductus.
29
Q

Post-Natal Factors

for hip dysplasia? 2

A
  1. Swaddling.

2. Strapping.

30
Q

Genetic Factors

for hip dysplasia? 2

A
  1. Gender is female.

2. Left hip 3:1

31
Q

Diagnosis
for hip dysplasia
PE? 2
Imaging? 4

A

Neonate.

  1. Barlow Test is a hip that is reduced but is dislocateable.
  2. Ortolani’s Test is a hip that is dislocated but reduceable.
  3. X-ray is difficult to interpret in the very young child.
  4. Ultrasound is useful in children under 6 months of age and can be effective up to 1 year of age.
  5. Arthrogram demonstrates soft tissue impediments to reduction and concentricity and stabillity of reduction.
  6. CT is not for routine screening but can be useful in reconstruction.
32
Q

Hip Dysplasia tx? 2

A
  1. Closed reduction.

2. Pavlik Harness can be used up to 6 months of age.

33
Q

Pavlik Harness can be used up to 6 months of age.

  1. When can you use this?
  2. reduction of the hip should be confirmed by?
  3. How often is this effective?
  4. AVN rate?
A
  1. Hip is dislocateable or dislocated and capable of being reduced.
  2. Reduction of the hip should be confirmed by 3 weeks.
  3. This is effective 90% of the time.
  4. AVN rate is low, less than 5%.
34
Q

Hip Dysplasia

  1. preferred method of tx?
  2. What is needed with this?
  3. What is worn with this? and for how long?
A
  1. Closed Reduction
    Preferred method of treatment up to 24 months of age.
  2. This needs general anesthesia and arthrogram guidance.
  3. Spica cast is worn for 3 months.
35
Q

Complications of hip dysplasia:

Most common?

A

Osteonecrosis is the most common complication.

36
Q

HD: Osteonecrosis is the most common complication: What are the signs of this?
4

A
  1. There is a failure of appearance of the ossific nucleus for a period of > 1 year following reduction.
  2. Broadening of the femoral neck over a similar period.
  3. Residual deformity of the femoral head and neck.
  4. There is increased radiographic density followed by fragmentation.
37
Q

Hip Dysplasia: If reduction fails?

A

Failed reduction.

One needs to repeat reduction.

38
Q
  1. Osgood-Schlatter disease
    is what?
  2. Odten caused by?
  3. Gender?
A
  1. Condition results from repetitive injury and small avulsion injuries at the bone-tendon junction where the patellar tendon inserts into the secondary ossification center of the tibial tuberosity.
  2. Sports
  3. Males
39
Q

OSD: Clinical Symptoms

2

A
  1. Pain exacerbated by running, jumping, and kneeling

2. Most continue all activities

40
Q

OSD: Exam/Dx

5

A
  1. Exam reveals tenderness and swelling at the insertion of the patellar tendon into the tibial tubercle
  2. Often bilateral
  3. Joint stable
  4. No restriction
  5. Xrays
41
Q

What do xrays show for OSD?

2

A

show

  1. soft-tissue swelling,
  2. maybe small spicules of heterotopic ossification anterior to the tibial tuberosity
42
Q

OSD: TX?

3

A
  1. Ice, NSAIDS,
  2. protective knee pad
  3. Decreased activity…2-3 months
43
Q

Septic Arthritis

  1. Joint infections most commonly affect which joints? 3
  2. Spread how? 3
A
  1. Joint infections most commonly affect children at the
    - hip,
    - knee
    - ankle
    • Hematogenous spread
    • Contiguous spread
    • Direct inoculation
44
Q

Septic arthritis symptoms? 5

A
  1. Pain, malaise, loss of appetite,
  2. failure to use affected joint
  3. Toddler refuses to walk
  4. Temp above 102, but neonates may not have a fever
  5. Hip most common in kids younger than 2
45
Q

Septic arthritis Exam? 4
Dx? 1
Labs? 4

A
  1. Swelling, tender, warmth
  2. Hip held in flexion, abduction, and external rotation
  3. Knee and Elbow in flexion
  4. Pseudoparalysis (flacid limb) shoulder
  5. AP/Lat Xrays, takes 8-14 days to show up

Labs:

  1. CBC with diff,
  2. Sed rate, CRP
  3. blood cultures
  4. Joint Aspiration
46
Q

What should the Joint Aspiration show? 4

A
  1. WBC greater than 50,000 mm^3
  2. PMNs 90%
  3. They eat the sugar and protein would be increased
  4. Lower WBCs with N. gonorrhoeae
47
Q

Septic arthritis
Complications? 4

Prognosis?

A
  1. Can lead to destruction of the joint surface,
  2. secondary arthritis,
  3. scarring of the capsule
  4. Osteonecrosis of the femoral head

Prognosis is good if surgical drainage and abx within 4 days of symptoms

48
Q

Septic Arthritis Bugs:

  1. Most common?
  2. Infants younger than 1?
  3. 6 mo to 4 yrs?
  4. 12-18 yrs?
A
  1. Staph aureus most common
  2. Group B strep infants younger than 1
  3. H. flu 6 months to 4 years
  4. N. gonorrhoeae 12-18 years

Refer early….ID and Ortho need to be involved.

Orthopedics (27 decks)

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