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Pediatrics > Pediatric Orthopedics- Nathan Apple > Flashcards

Pediatric Orthopedics- Nathan Apple Flashcards

1
Q

is hip dysplasia more common in boys or girls?

A

girls- 70%

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2
Q

what is the main cause of hip dysplasia

A

breech birth, too small intrauterine space (too much baby not enough space, bc of multiples or large child)

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3
Q

which test is better for testing hip dysplasia

A

ortoloanis, bc u are reducing a hip that is already out instead of dislocating a hip thats in like u do in barlows- causes unnecessary stress on hip ligature

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4
Q

how do babies present with hip displasia

A

leg length differences, galeazzi, uneven thigh folds, waddling gait with lordosis, one limited hip abduction, trendelenburg with circumduction (may not look much diff than normal toddler gait) overpronation

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5
Q

diagnosing hip displasia

A

ultrasound (6-8 wks), radiography wont work til after 4 months bc all bone is still cartilage

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6
Q

when does femoral head ossification begin

A

4-9 months

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7
Q

DDH

A

developmental displasia of hip

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8
Q

shenton’s line

A

inferior neck and infer. border of superior pubic ramus should make a nice arch

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9
Q

hilgenreiner’s line

A

ossification center should be center of horizontal line drawn through the triradiate cartilages

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10
Q

Perkin’s line

A

perpendicular to hilgenreiner’s line

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11
Q

Acetabular angle

A

hilgenreiner’s line at triradiate to acetabular roof, want it to be less than 20 degrees at 24 mo. greater than 40 deg= significant at birth

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12
Q

DDH treatment

A

6-12 months of abduction orthotics…

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13
Q

when is the critical age to catch DDH by?

A

6 months

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14
Q

who is a pavlik brace for. What do u need to watch for?

A

immobile babies, watch for brachial plexus and femoral nerve palsys- look for favoring of one arm/leg and waiter’s tip deformity

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15
Q

when do u stop a pavlik brace

A

if no progress in 3 weeks, or if palsys

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16
Q

what does the success rate drop to if DDH is caught after 6 months

A

drops by 50%

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17
Q

factors for success with treating DDH

A

diagnosed under 6 wks
bilateral
acetabular angle under 35 degrees

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18
Q

who wears a rhino brace

A

older, mobile kids, ortalani positive

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19
Q

PT management of DDH

A

ROM, strength, gross motor skills, during immobilization, after immobilization, after surgery

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20
Q

what if they need surgery

A

12 months or older
mm release and proximal femoral osteotomy
spica cast until stable

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21
Q

Talipes Equinovarus

A

club foot

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22
Q

3 types of club foot

A

equinus, varus, adductus

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23
Q

tx for mild club foot

A

serial casting, weekly progression

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24
Q

tx for severe club foot

A

most likely underlying neuro issues, sx correction at 4-6 months, night splints

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25
Q

PT management of club foot

A

ROM, strength, gross motor

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26
Q

Metatarsus adductus

A

forefoot curves medially

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27
Q

calcaneovalgus

“rocker bottom”

A

forefoot curves laterally, mid foot and hind foot goes valgus, navicular rides the floor

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28
Q

when does a child’s arch devleop?

A

age 3-5

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29
Q

pes planus

A

dont worry too much about it, but… if it’s unilateral use it as a litmus test to look for other issues, is there a leg length discrepancy, are they hemophiliac and a growth plate shut down??

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30
Q

does pes planus need an orthotic

A

no. only if kid is older and its painful, then maybe a SMO or a SURESTEP. most these kids are so ligament laxity they will just roll over whatever u give them

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31
Q

tx for pes planus

A

strengthening, stretching…

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32
Q

what does a positive gowers sign tell u

A

duchenne’s

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33
Q

ask parent’s the tough questions

A

night pain? gnawing pain? does he not want to put wt. on it?

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34
Q

whats a good way to see a kid get down and back up?

A

dead bug!

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35
Q

what do u want to always look for??

A

laterality
gait
wt. bearing vs. non wt. bearing

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36
Q

torticollis: 3 types

A

> congenital muscular
benign paroxysmal
toticollis spasmodica

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37
Q

congenital mm tort. (CMT)

A

infancy

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38
Q

benign paroxysmal tort. (BPT)

A

childhood

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39
Q

torticollis spasmodica

A

childhood to adulthood, cervical dystonia

40
Q

causes of tort.

A

intrauterine crowding

41
Q

define torticollis

A

shortening of the sternocleidomastoid

42
Q

function of SCM

A

tilts to same side, rotates to oppostite side- causes contralateral head rotation coupled with ipsilateral tilt

43
Q

how is tort. named

A

named to the side of the tilt

44
Q

what does tort. do to the shape of the skull

A

forms it like a parallelogram- plagiocephaly

45
Q

what effect does plagiocephaly have on appearance, etc.

A

ears are uneven, eye on same side of frontal bulge appears larger and more forward

46
Q

what if ears are plum but head looks misshapen?

A

check for premature closing of sutures, this will need plastic surgery and can cause brain damage if not addressed

47
Q

causes of tort.

A

intrauterine crowding, contracture, birth trauma, positional (placed on vent, etc.) , direct mm trauma, compartment syndrome (nerve, mm damage, swelling, fibrosis)

48
Q

Eval of a tort. bebe

A

> history: birth wt., multiples, unplanned events, NICU? vent?
observation: posture, movement?cranial asymmetry, palpate cerv. mm, milestones, development? extremities and spine?
vision- tracking, nystagmus (maybe need a referral)
ROM and strength in spine and extremities
tone?
myotomes
neglect? is it neurological or just visual neglect bc he’s always turned away from it?

49
Q

what is a syndrome that presents like tort.?

A

Sandifers, its a reflux problem that the position of comfort looks a lot like torticollis.

50
Q

when is it best to catch tort?

A

6-8 wks, mostly parent education and instruction, 3-4 visits

51
Q

tort protocol and prognoisis

A

begin ASAP

  • before 3 mo. =0 surgical need
  • after 3 mo= 25% require sx
  • with consistent, timely, therapy, 85-90% CMT should reslove within 4-5 months
52
Q

what can u do to help with AROM for tort.

A

bring toys to other side, make them turn to look at them…

53
Q

orthotics for tort.

A

shaping helmets

54
Q

what is the window for shaping helmets?

A

6-10 mo, after that skull not plastic enough

55
Q

back up tx options for tort.?

A

sx or botox

56
Q

diff. dx of types of tort.

A

BPT: childhood
CMT: infancy
torticollis spasmodica: childhood to adulthood, verv. dystonia

57
Q

refractory tort.

A

torticollis that does not respond to traditional protocol after 4-5 months of PT and the child becomes 7-8 mo. old. Physician needs to be notified and radiographs taken.

58
Q

Legg-Calve-Perthes

A

avascular necrosis of femoral head

59
Q

LCP population

A

boys 3-13, 3x more likely than girls

60
Q

causes of LCP

A

trauma, vascular anomalies, infection, thrombic incidents

61
Q

presentation with LCP

A

pain in groin, knee, thigh, loss of IR, abduction, extension of hip, antalgic gait and trendelenberg gait

62
Q

SCFE

A

femoral head slips off rest of bone

63
Q

causes of SCFE

A

trauma, obesity, development, african americans, inner city kids

64
Q

presentation of SCFE

A

antalgic gait, pain in groin, medial thigh, lack of adduction and flexion tho, this is how u diff. from LCP

65
Q

SCFE pose

A

captain morgan

66
Q

4 stages of LCP

A

1) condensation- femoral head turns necrotic
2) fragmentation- necrotic bone splinters and is reabsorbed, revascularization occurs, deformation of fem. head and flattening of acetabulum
3) reossification with return of vascular supply
4) remodeling at acetabulum

67
Q

diff. diag. btween SCFE and LCP??

A

areas of restriction!
SCFE= captain morgans, loss of adduction and flexion
LCP= loss of abduction, ext, and IR

68
Q

grades of SCFE

A

I- up to 1/3 width of neck
II- 1/3 to 1/2 width of neck
III- greater than 1/2 width of neck

69
Q

PT management of SCFE?

A

core work, make sure they get sx first…

70
Q

healing rates of ped. fractures

A

infants: 2-3 wks
preschool: 4 wks
7-10 years: 6 wks
adolescent: 8-10 wks

71
Q

Salter Harris classifications of Physeal injuries

A

I-through growth plate only
II- through growth plate and metaphysis
III- through growth plate and epiphysis
IV- through growth plate, metaphysis and epiphysis
V- compression crushes growth plate and damages eiphysis and metaphysis

72
Q

which growth plates get most growth?

A

distal femur, prox tibia close last and get most growth

73
Q

why would u want to hinder growth plates

A

to correct imbalance deformities, stop growth for prosthetics, etc.

74
Q

Tibial Eminence (spine) fracture

A

result of hyperextension injury with fracture through subchondral bone beneath ACL insertion. The ACL should’ve torn but it was stronger than the bone so the tibial eminence avulsed instead…

75
Q

tibial eminence fractures only occur if…

A

growth plate is still open! otherwise the ACL just tears.

76
Q

presentation of tibial eminence fx

A

presents just like ACL tear, pain swelling, hemarthrosis, instability, lack of ROM

77
Q

types of TEFx

A

I- physis only
II- physis and bone flap up
III- physis and bone completely disassociated

78
Q

if a kid has sx to fix a TEfx where they use the IT band to bandaid it, what does this mean for PT

A

CONSERVATIVE! be careful, most likely TTWB for awhile

79
Q

tx of TEfx

A

I- cast in flight flexion
II- evaluate in operating room, confirm reduction with CT scan
III- operative tx using IT band

80
Q

tibial tuberacle fx

A

still have lots of pain, just like in TEfx, but pt can’t extend knee, too much pain, maybe slight wiggle in ant. tibia, in adult it would be a patellar tendon rupture

81
Q

when does the tib. tub. physis close in kids?

A

males-15-19

females- 13-15

82
Q

causes of tib tub. fx

A

trauma, sports injuries, violent stop to progression of leg while violent quadriceps contraction is occurring “think blocked punt”

83
Q

which types of tib. tub. fxs require ORIF?

A

types II, III= ORIF

84
Q

complications of tib. tub. fx

A

compartment syndrome, recurvatum deformity,
extension lag,
patella baja
fixation complications

85
Q

epiphysitis vs. Apophysitis

A

epiphysitis involves growth plates, apophysis involves a projection of a bone, an outcropping or swelling of a bony prominence

86
Q

osgood schlatter

A

tibial tub. epiphysis

87
Q

sinding-larsen-johansson

A

inferior patella epiphysis

88
Q

sever’s disease

A

calcaneal epiphysis

89
Q

little leaguer’s shoulder

A

prox. humeral epiphysis

90
Q

what do u HAVE to HAVE to diagnose little leaguer’s shoulder?

A

bilateral A/P radiographs!

91
Q

Little league elbow

A

medial humeral epicondyle apophysitis

92
Q

treatment of apophysitis or epiphysitis

A

> modalities and rest for acute symptoms
address underlying causes, strengthen whats weak and stretch whats tight
education on activity modification
don’t forget about the breaks- eccentric control! kids always have the gas pedal (concentric)

93
Q

in the state of KS, can a PT legally clear a kid for back to sport?

A

no, need physician clearance

94
Q

treatment for refractory torticollis if radiographs are normal

A

continue PROM, AROM PT program, botox,

95
Q

tx of refractory torticollis if radiographs are abnormal

A

STOP PROM! continue AROM and positioning, refer to orthopedic surgery, consider botox

96
Q

pediatric fractures

A 
>Avulsion- ligament stronger than bone, ORIF
>Bend- deformation without fx
>buckle- compression, equal bulge in cortex
>greenstick- fx on tension side only
>transverse- horizontal fx
>oblique- angled fx
>spiral- pre-made biscuit tube
>communited- mult. fragments

Pediatrics (13 decks)

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