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Pathophysiology II > Pediatric Orthopedics > Flashcards

Pediatric Orthopedics Flashcards

1
Q

Consider the differences between adults and children regarding the following:
Bone, periosteum, communion, union, remodeling

A

Bone: Flexible in children; Rigid in adults
Periosteum: Thick in children; Thin in adults
Communion: Rare in children; Often in adults
Union: Rapid in children; Slower in adults
Remodeling: More in children; Less in adults

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2
Q

A bone’s remodeling potential is dependent on what 4 factors?

A
  1. Age
  2. Growth plate specific
  3. Growth plate proximity
  4. Plane of joint motion
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3
Q

What is plastic deformation? Is it more common in adults or children?

A

Plastic deformation is the bending of a bone in response to trauma or a large force.

This is more common in children because their bones are more flexible and have less mineral content.

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4
Q

What is a sleeve fracture? Why does this occur?

A

A sleeve fracture occurs when a portion of the periosteum is ripped off the bone in response to trauma.

This occurs because, in children, ligaments are stronger than bone/cartilage. So, a child is more likely to fracture a bone than tear a ligamentous structure in response to trauma.

Example: Fracture to the growth plate more likely to occur than an MCL tear in response to a lateral tackle in a child

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5
Q

What is compartment syndrome? How will a child present with this syndrome? (3 As)

A

Increase in fascia and soft tissue production (in response to injury) increases pressure in the limb which obstructs blood flow to the muscle

Child will complain of pain that is out of proportion to the injury

3 A’s: Anxiety, apprehension and analgesia

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6
Q

What 3 parts of the body grow the fastest in children?

A

Shoulder
Wrist
Knee

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7
Q

What is the fastest growing bone in the body?

A

Distal femur

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8
Q

What is meant by non-accidental trauma?

A

When the MOI does not match the presentation of the injury

RED FLAG FOR ABUSE

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9
Q

What is in toeing? What are 6 potential causes of in toeing?

A

Feet turn inward instead of remain straight when a child is walking or running

  1. Cerebral Palsy
  2. Adducted great toe
  3. Metatarsus adductus
  4. Internal tibial torsion
  5. Internal femoral torsion
  6. Asymmetrical hip rotation
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10
Q

What is a Pavlik Harness? What is it used to treat?

A

A brace used to treat developmental dysplasia (dislocation) of the hip

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11
Q

What is the foot progression angle (FPA)?

A

Documents the angle at which the foot travels during walking

(Angle of deviation of forefoot from midline)

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12
Q

What position is hip rotation tested in? What findings result in femoral anteversion?

A

Tested in prone to stabilize the pelvis

Internal Rotation > External Rotation = Femoral Anteversion

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13
Q

What does the thigh foot angle detect? What finding suggests the presence of a pathology?

A

Detects tibial torsion

The foot should turn out relative to the hip

Abnormal: foot turns in relative to the hip

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14
Q

What is the difference between club foot and metatarsus adductus?

A

Metatarsus adductus will resolve with time

Club foot requires casting and at times surgery

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15
Q

What is the Ponseti Treatment? What does it treat?

A

Ponseti Treatment: uses gentle manipulation, casting and stretching to treat clubfoot

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16
Q

What is miserable malalignment? How is it treated?

A

Characterized by:
Internal rotation of the femur
External rotation of the tibia

Places lateral stress/pull on the patella

Osteotomy required for treatment

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17
Q

What is out toeing? What are three possible causes for this?

A

External rotation of the feet during gait

  1. Infantile external hip rotational contracture
  2. External tibial torsion
  3. External femoral torsion
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18
Q

What are the 3 possible causes of flexible flatfoot?

A
  1. Developmental
  2. Hypermobile
  3. Calcaneovalgus
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19
Q

What are the 8 possible causes of pathological flatfoot?

A
  1. Tight Achilles’ tendon
  2. Tarsal coalition
  3. Neuromuscular (CP)
  4. Accessory Navicular
  5. Skew foot
  6. Vertical talus
  7. Iatrogenic
  8. Obesity
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20
Q

What is the timeline for bow legs/knocked knees?

A

Children are born bow legged
Straighten at 18 months
Age 3-4 (knock kneed)
Normalize over time

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21
Q

What are the 6 pathological causes of malalignment?

A
  1. Trauma
  2. Metabolic
  3. Infection
  4. Developmental
  5. Bone Dysplasia
  6. Tumors
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22
Q

When are radiographs required for knock knees?

A
  1. Sever deformity
  2. Asymmetric
  3. Short stature
  4. Dysmorphic features
23
Q

What are the 8 risk factors for development dysplasia of the hip (DDH)?

A
  1. First Born
  2. Female (6:1)
  3. Family History
  4. Breech
  5. Intrauterine Crowding
  6. Torticollis
  7. Ethnicity
  8. Post natal positioning
24
Q

What is the relationship between treatment and age?

A

Treatment becomes more invasive as the child ages.

EARLY TREATMENT IS OPTIMAL

25
Q

What is the Barlow test? When is this test typically performed?

A

Barlow test screens for congenital hip dysplasia
(audible clunk of exit)

DISLOCATION MANEUVER

Provocative test where hip is flexed and adducted. Posterior pressure applied to dislocate femoral head?

Performed between 0-6 months of age.

26
Q

What is the Ortolani test? When is this test typically performed?

A

Ortolani test used to detect hip instability/dysplasia
(Audible clunk of entry)

RELOCATION MANEUVER

Hip is flexed and abducted. Hand is used to posteriorly dislocate femoral head and then relocate femur back in acetabulum

Performed between 0-6 months of age

27
Q

What is the typical treatment for hip instability in children <6 months of age?

A

Usually closed reduction (AVOID forced reduction)

Pavlik Harness/Abduction brace

  1. Place child in human position (100 degrees of flexion; 50 degrees of abduction)
  2. To be worn for 6-12 weeks after achieving stability
28
Q

What is the typical treatment for hip instability in children 6-18 months of age? (6 options)

A
  1. Arthrogram
  2. Gentle Closed Reduction
  3. Spica Cast
  4. Adductor Tenotomy
  5. Follow up CT/MRI in cast
  6. Open reduction if closed reduction fails
29
Q

What is the typical treatment for hip instability in children >18 months of age?

A

Usually open reduction (anterior approach)

Capsulorraphy: thermal capsular shrinkage

30
Q

What are the characteristics of a Trendelenberg gait? What is a common compensation for this gait pattern?

A

Trendelenberg: Contralateral pelvis to weakness will drop

Compensation: Trunk lean to affected side

31
Q

What is a slipper capital femoral epiphysis (SCFE)? What population of children is it most often seen in?

A

SCFE is a fracture through the growth plate resulting in slippage of the overlying end of the femur (epiphysis)

Most often seen in OBESE children

32
Q

What is Perthes disease?
How many stages does it have?
What age range does it affect?
Is it more common in males or females?

A

Idiopathic ischemic necrosis of femoral head

4 stages
Ages 4-10 yrs
M>F

33
Q

What are the treatment principles for Perthes Disease?

What 2 factors does the prognosis of Perthes disease depend on?

A

Treatment Principles: CONTAINMENT & MOBILITY

PROGNOSIS:

  1. Amount of femoral head involvement
  2. Age of onset
34
Q

What is the normal ratio of stance to swing?

A

Stance 60% (maintain stability)

Swing 40% (maintain clearance)

35
Q

What is cerebral palsy? What 3 functions does it affect?

A

Group of permanent NON PROGRESSIVE disorders of development and posture

Affect developing fetal/infant brain

Affects:

  1. Cognition
  2. Behavior
  3. Musculoskeletal system
36
Q

What is the difference between hemiplegia, diplegia, and quadriplegia?

A

Hemiplegia: paralysis of one side of the body

Diplegia: paralysis on both sides of the body, affects legs MORE than arms

Quadriplegia: paralysis of all four limbs

37
Q

Aside from PT, what are 5 other ways CP can be treated?

A
  1. Water Therapy
  2. Hippo Therapy
  3. Botox
  4. Baclofen pump (GABA agonist to combat spasticity)
  5. Selective Dorsal Rhizotomy (dorsal roots of SC are cut to break reflex arc and minimize spasticity)
38
Q

What are the 6 causes of limb length discrepancy (LLD)/Deformity?

A
  1. Congenital
  2. Trauma
  3. Developmental
  4. Infection
  5. Bone Dysplasia
  6. Metabolic
39
Q

What is the difference between a true vs apparent limb length discrepancy (LLD)?

A

True: STRUCTURAL bony malalignment

Apparent: soft tissue CONTRACTURE that appears as malalignment

40
Q

What is meant by congenital shortening of the femur?

A

FIXED GROWTH INHIBITION –> the LLD DOES NOT change with age

As you grow, both legs will grow, but one leg (with discrepancy) will grow at a lower percentage as compared to the other

41
Q

Management of LLD is based on what 6 factors?

A
  1. Predicted LLD
  2. Predicted height
  3. Joint instability
  4. Foot/ankle: form and function
  5. Psychosocial factors
  6. Surgeon bias
42
Q

What is epiphysiodesis?

A

Surgical procedure in which the epiphyseal (growth) plate of a bone is fused either temporarily or permanently to delay growth of a long bone.

Used to slow or halt the growth of a morphologically normal leg to allow a shorter leg to grow to a matching length.

43
Q

What is fibular hemimelia?

A

Birth defect where part or all of the fibular bone is missing

Associated with limb length discrepancy

44
Q

What is Ilizarov-Distraction Osteogenesis?

A

Technique that relies on the normal healing process that occurs between controlled, surgically osteotomized bone segments.

Gradual controlled distraction is done using an external fixator (ilizarov apparatus)

45
Q

What are the 3 lengthening phases of distraction osteogenesis?

A
  1. Latency
  2. Distraction
  3. Consolidation
46
Q

How long does distraction osteogenesis take? (rate, rhythm, time)

A 
Rate: ~1 mm/day
Rhythm: ~.25 mm x 4
Fixator Time: ~1 month/cm
	1/3 Distraction
	2/3 Consolidation
47
Q

What is Blount’s disease? How is this typically treated?

A

Growth disorder of the tibia (shin bone) that causes the lower leg to angle inward, resembling a bowleg

Tx: tibial osteotomy

48
Q

What are the WB precautions for a circular external fixator vs an internal fixator?

A

Circular external fixator: no pxns, FWB

Internal fixator: toe touch weight bearing (TTWB)

49
Q

What 2 tools are used to screen for scoliosis? What age is it typically detected in children?

A

School Screening: Forward Bend (ATR)

Scoliometer (7 deg)

10-16 yrs

50
Q

What is the cobb angle? How big does this angle have to be to diagnose scoliosis?

A

Measure of the curvature of the spine

Cobb angle of a minimum of 10 degrees indicates scoliosis

51
Q

The risk of progression of a scoliotic curve is dependent on what 4 factors?

A
  1. Growth Remaining
  2. Curve magnitude
  3. Gender (F>M)
  4. Curve Pattern
    Thoracic > lumbar
    Double >single
52
Q

In patients with scoliosis, what are the 5 indications for an MRI?

A
  1. Atypical symptoms
  2. Neurological findings
  3. Atypical curve pattern
  4. Rigid curve
  5. Rapid progression
53
Q

What are the 3 management options for scoliosis?

A
  1. Observation (monitor the curve)
  2. Bracing (indicated with 25-40 degree curve with growth remaining)
  3. Surgery (curve > 45 degrees)
54
Q

What 3 treatments have shown NO substantial effect in treating scoliosis?

A
  1. E-Stim
  2. Exercise (lol okay… sure)
  3. Chiropractic manipulation

Pathophysiology II (24 decks)

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