Pediatric Orthopedics Lecture Powerpoint

Question 1

Pediatric bones vs adult bones (4)

Answer 1

• higher water content and lower mineral so less brittle, more elastic
• physis is cartilaginous in children
• children do not get sprains, they break bones
• growth plates more vulnerable than bone or ligaments

Question 2

Growing pains

Answer 2

-recurrent, self limiting extremity pains (most commonly lower extremities and have no correlation with growth spurts) often with no explanation benign and usually resolve with 1 -2 years, must rule out pathologic causes thru thorough H&P, can give NSAIDS/acetaminophen, if persistent pain or constitutional symptoms then further investigation

Question 3

Accessory navicular

Answer 3

Extra bone or cartilage on navicular bone in foot, anatomic variant seen prominently in females and during adolescence, usually results in point tenderness right over the navicular, can often cause pain or swelling, diagnosed via x ray and treat with modifications, may see grow out of it, or refer if persistent pain

Question 4

Calcaneal apophysitis (Sever’s disease)

Answer 4

Inflammation of calcaneal physis (achilles tendon pulling away slightly at the growth plate) resulting in localized point tenderness on the retrocalcaneal area, often self resolving as matures, heel lifts, activity restriction, casting in severe cases can help, only refer if not improving

Question 5

Osgood schlatter disease

Answer 5

Traction apophysitis of proximal tibial tubercle at insertion of the patellar tendon due to overuse injury, sees pain and swelling at tibial tubercle, seen typically ages 9-11 when they undergo rapid growth sport, more common in adolescents active in sports, can limit sports involvement as tolerated, self limiting most of time

Question 6

Osteogenesis imperfecta (brittle bone dz)

Answer 6

Connective tissue disorder, if not identified at birth due to trauma with delivery then can see excess or atypical fractures, short stature, scoliosis, blue sclera, increased laxity of ligaments and skin as well as easy bruisability

Question 7

Osteogenesis imperfecta treatment options (3)

Answer 7

• bisphosphonate therapy
• fracture management
• PT/OT

Question 8

Coxa vara deformity

Answer 8

Congenital acquired decrease in neck shaft angle of the femur

Question 9

Congenital dislocation of knee

Answer 9

Hyperextension of knee at birth

Question 10

Congenital vertical talus

Answer 10

Rocker bottom of flat foot

Question 11

Congenital curly toe

Answer 11

Congenital flexion and medial rotation of toes

Question 12

Polydactyly

Answer 12

Accessory toes

Question 13

Syndactyly

Answer 13

Common fusion of skin or bone either partial or complete at birth

Question 14

Congenital radial ulnar synostosis

Answer 14

Fusions of radius and ulna where they fail to separate, cannot supinate or pronate as result

Question 15

Fibular hemimelia

Answer 15

Congenital absence of a fibula

Question 16

Developmental dysplasia of the hip (DDH) definition

Answer 16

When the acetabulum does not fully cover the femoral head, increasing risk of dislocation, can be associated with ligamentous laxity detectable at birth, neonates asymptomatic but by walking age may see manifestations

Question 17

Developmental dysplasia of the hip (DDH) treatment options (2)

Answer 17

• within first 3 months pavlik harness

- later on closed or open reduction

Question 18

Adverse outcomes of fracture healing in pediatrics (3)

Answer 18

• malunion
• physeal arrest
• neurovascular compromise

Question 19

Night stick fracture definition

Answer 19

Isolated ulna fracture

Question 20

Supracondylar fractures of the humerus in kids should be splints as….

Answer 20

….as they lie (no reduction)

Question 21

Genu valgum/varum treatment options (3)

Answer 21

• observation
• no braces or shoes, spontaneousy corrects most of time
• refer if severe

Question 22

Intoeing and outtoing

Answer 22

-Foot turns in or out more than expected, if stumbling or falling can consider casting, but as long as no underlying pathology typically don’t need to do anything (shoes and braces don’t help)

Question 23

Leg calve-perthes disease

Answer 23

Idiopathic osteonecrosis of the femoral head children age 2-12 mostly unilateral, worse prognosis in longer it goes without being detected, bone dies and may collapse with deformity and degenerative joint disease early, often need surgery, will present often as limping, aching in groin and thigh, check on x ray (AP and frog leg lateral), no consistent treatment works all the time,

Question 24

Transient synovitis of the hip

Answer 24

Sterile effusion of the joint which resolves without therapy or sequale in children 2-5 years, unknown etiology but mild trauma possible, not infectious (no fever - rule out septic arthritis) and normal x ray, will present as limping, diagnosis of exclusion, treated with bed rest or activity modification with temp tchecks

Question 25

Toe walking differential diagnosis (4)

Answer 25

• cerebral palsy
• intraspinal abnormality
• muscular dystrophy
• unilateral limb length discrepancy