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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
PT management of club foot
ROM, strength, gross motor
26
Metatarsus adductus
forefoot curves medially
27
calcaneovalgus | "rocker bottom"
forefoot curves laterally, mid foot and hind foot goes valgus, navicular rides the floor
28
when does a child's arch devleop?
age 3-5
29
pes planus
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??
30
does pes planus need an orthotic
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
31
tx for pes planus
strengthening, stretching...
32
what does a positive gowers sign tell u
duchenne's
33
ask parent's the tough questions
night pain? gnawing pain? does he not want to put wt. on it?
34
whats a good way to see a kid get down and back up?
dead bug!
35
what do u want to always look for??
laterality gait wt. bearing vs. non wt. bearing
36
torticollis: 3 types
>congenital muscular >benign paroxysmal >toticollis spasmodica
37
congenital mm tort. (CMT)
infancy
38
benign paroxysmal tort. (BPT)
childhood
39
torticollis spasmodica
childhood to adulthood, cervical dystonia
40
causes of tort.
intrauterine crowding
41
define torticollis
shortening of the sternocleidomastoid
42
function of SCM
tilts to same side, rotates to oppostite side- causes contralateral head rotation coupled with ipsilateral tilt
43
how is tort. named
named to the side of the tilt
44
what does tort. do to the shape of the skull
forms it like a parallelogram- plagiocephaly
45
what effect does plagiocephaly have on appearance, etc.
ears are uneven, eye on same side of frontal bulge appears larger and more forward
46
what if ears are plum but head looks misshapen?
check for premature closing of sutures, this will need plastic surgery and can cause brain damage if not addressed
47
causes of tort.
intrauterine crowding, contracture, birth trauma, positional (placed on vent, etc.) , direct mm trauma, compartment syndrome (nerve, mm damage, swelling, fibrosis)
48
Eval of a tort. bebe
>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
what is a syndrome that presents like tort.?
Sandifers, its a reflux problem that the position of comfort looks a lot like torticollis.
50
when is it best to catch tort?
6-8 wks, mostly parent education and instruction, 3-4 visits
51
tort protocol and prognoisis
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
what can u do to help with AROM for tort.
bring toys to other side, make them turn to look at them...
53
orthotics for tort.
shaping helmets
54
what is the window for shaping helmets?
6-10 mo, after that skull not plastic enough
55
back up tx options for tort.?
sx or botox
56
diff. dx of types of tort.
BPT: childhood CMT: infancy torticollis spasmodica: childhood to adulthood, verv. dystonia
57
refractory tort.
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
Legg-Calve-Perthes
avascular necrosis of femoral head
59
LCP population
boys 3-13, 3x more likely than girls
60
causes of LCP
trauma, vascular anomalies, infection, thrombic incidents
61
presentation with LCP
pain in groin, knee, thigh, loss of IR, abduction, extension of hip, antalgic gait and trendelenberg gait
62
SCFE
femoral head slips off rest of bone
63
causes of SCFE
trauma, obesity, development, african americans, inner city kids
64
presentation of SCFE
antalgic gait, pain in groin, medial thigh, lack of adduction and flexion tho, this is how u diff. from LCP
65
SCFE pose
captain morgan
66
4 stages of LCP
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
diff. diag. btween SCFE and LCP??
areas of restriction! SCFE= captain morgans, loss of adduction and flexion LCP= loss of abduction, ext, and IR
68
grades of SCFE
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
PT management of SCFE?
core work, make sure they get sx first...
70
healing rates of ped. fractures
infants: 2-3 wks preschool: 4 wks 7-10 years: 6 wks adolescent: 8-10 wks
71
Salter Harris classifications of Physeal injuries
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
which growth plates get most growth?
distal femur, prox tibia close last and get most growth
73
why would u want to hinder growth plates
to correct imbalance deformities, stop growth for prosthetics, etc.
74
Tibial Eminence (spine) fracture
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
tibial eminence fractures only occur if...
growth plate is still open! otherwise the ACL just tears.
76
presentation of tibial eminence fx
presents just like ACL tear, pain swelling, hemarthrosis, instability, lack of ROM
77
types of TEFx
I- physis only II- physis and bone flap up III- physis and bone completely disassociated
78
if a kid has sx to fix a TEfx where they use the IT band to bandaid it, what does this mean for PT
CONSERVATIVE! be careful, most likely TTWB for awhile
79
tx of TEfx
I- cast in flight flexion II- evaluate in operating room, confirm reduction with CT scan III- operative tx using IT band
80
tibial tuberacle fx
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
when does the tib. tub. physis close in kids?
males-15-19 | females- 13-15
82
causes of tib tub. fx
trauma, sports injuries, violent stop to progression of leg while violent quadriceps contraction is occurring "think blocked punt"
83
which types of tib. tub. fxs require ORIF?
types II, III= ORIF
84
complications of tib. tub. fx
compartment syndrome, recurvatum deformity, extension lag, patella baja fixation complications
85
epiphysitis vs. Apophysitis
epiphysitis involves growth plates, apophysis involves a projection of a bone, an outcropping or swelling of a bony prominence
86
osgood schlatter
tibial tub. epiphysis
87
sinding-larsen-johansson
inferior patella epiphysis
88
sever's disease
calcaneal epiphysis
89
little leaguer's shoulder
prox. humeral epiphysis
90
what do u HAVE to HAVE to diagnose little leaguer's shoulder?
bilateral A/P radiographs!
91
Little league elbow
medial humeral epicondyle apophysitis
92
treatment of apophysitis or epiphysitis
>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
in the state of KS, can a PT legally clear a kid for back to sport?
no, need physician clearance
94
treatment for refractory torticollis if radiographs are normal
continue PROM, AROM PT program, botox,
95
tx of refractory torticollis if radiographs are abnormal
STOP PROM! continue AROM and positioning, refer to orthopedic surgery, consider botox
96
pediatric fractures
``` >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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