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Skin MS: Week 7 > Pediatric Top 10 > Flashcards

Pediatric Top 10 Flashcards

1
Q

Hip Dysplasia - When to Refer (peds ortho)

A

Abnormal exam

Abnormal Ultrasound

Abnormal xray

Breech position- ultrasound?

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2
Q

Perthes Disease age

A

4-8 (3-12)

Boys>>Girls

Family hx

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3
Q

Perthes pathogenesis

A

Vascular insult to femoral epiphysis

Repetitive trauma ?

Hormonal ?

Thrombophilia?

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4
Q

Radiographic stages Perthes

A

Initial, fragmentation, reossification, remodeling

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5
Q

Poor prognostic factors Perthes

A

–Age greater than 7-8

–Decreased ROM

–Deformity of head

–% of head involvement ( no lateral pillar)

–Protracted disease course

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6
Q

Clinical presentation Perthes

A

Insidious limp

Mild to moderate pain

Hip, thigh, or knee pain

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7
Q

Physical Exam Perthes

A

Limited abduction

Synovitis

Muscle spasm

Thigh atrophy

Leg length discrepancy

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8
Q

Imaging Perthes

A

Radiographs- AP and Frog lateral- pelvis xray better than hip

Tc bone scan- pinhole

MRI- can help with early diagnosis but not with staging

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9
Q

Treatment Perthes

A

Rest (reduce load)

NSAIDs

PT

Bracing?

Casts

Surgical muscle releases

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10
Q

When to Refer Perthes

A

School children with

–Hip, thigh, knee pain

–Decreased ROM

–Atrophy

–Abnormal imaging

–Labs important if xray normal to rule out other causes

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11
Q

Slipped Capital Femoral Epiphysis

A

Males>Females

B 12-15

G 10-13

Obesity

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12
Q

Etiology Slipped epiphysis

A

Mechanical Factors

Renal Osteodystrophy

Radiation therapy

Endocrine

–Hypothyroidism

–GH deficiency

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13
Q

Clinical features Slipped Epiphysis

A

Pain in thigh or knee

Limp- external rotated gait

Limited internal rotation and flexion

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14
Q

Types Slipped Epiphysis

A

Acute- less than 3 weeks symptoms

Chronic- greater than 3 weeks

Stable- can walk

Unstable- can’t walk

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15
Q

Treatment slipped epiphysis

A

In situ fixation

Osteotomy for deformity

Epiphysiodesis

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16
Q

Prophylactic pinning slipped epiphysis (one side slipped, pin otherside?)

A

Hypothyroidism

Renal Osteodystrophy

Endocrinopathies

Younger Children less than 10 years

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17
Q

Complications slipped epiphysis

A

Osteoarthritis

Chondrolysis

Osteonecrosis- MRI helpful to screen out, should be done at 1 month out

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18
Q

When to refer slipped epiphysis

A

Any SCFE needs to referred immediately

Strict nonweight bearing (send them in a wheelchair)

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19
Q

Intoeing Outtoeing assessment

A

Rotational Variation Assessment

Static (prone, look at flexion)

Dynamic- with walking

20
Q

Causes of intoeing, outtoeing

A

Increased femoral anteversion, internal tibial torsion

21
Q

When to refer intoe/outtoe

A

Recent specific change in gait

Functional problem

Persistent problem in older children

Family wants referral

22
Q

Genu varum

A

bowed legs

23
Q

Physiologic bowing (characteristics)

A

Early walkers

Family history common

Usually agile walkers

Usually bilateral

24
Q

Treatment Physiological bowing

A

Spontaneous correction is the rule

Bracing not effective

Serial photos helpful

25
Q

Diff Dx Bowing

A

Blounts disease

Skeletal dysplasia

Neoplastic disease

Metabolic bone disease

Hypophoshatemic rickets

Nutritional rickets

**If short stature, worry about these

26
Q

Blounts Ds

A

Osteochondrosis

Deformity proximal medial tibia epiphysis

Fragmentation medial tibial plateau

Ultimate physeal bar formation

Progressive condition

27
Q

If see _______ bowing, not physiological

A

unilateral

28
Q

Physiological bowing usually distributed between ________

A

Femur and tibia

29
Q

Blounts ds tx

A

Brace treatment- less than 2 and ½ years old

Valgus Proximal tibial osteotomy in children over 2

30
Q

Bowing when to refer

A

Height less than 5%

Positive family history

Asymmetry

Progressive condition

Localized varus deformity

31
Q

Genu valgum

A

Physiologic

Usually apparent after 2 years

Typically symmetric

Knockkneed

32
Q

Diff Dx knockkneed

A

Rickets

Post-traumatic

Skeletal dysplasia

33
Q

Tx valgum

A

Predictably remodels to normal by age 7

No effective bracing

If after 8 –

Hemiepiphysiodesis (minimal surgery)

Stapling

8 plates

Ostetomy

34
Q

Genu valgum when to refer

A

Less than 10% for height

Asymmetry

Deformity increasing after age 7-8

History of metabolic disease

History skeletal dysplasia

35
Q

Metatarsus adducts

A

MEdial deviation of forefoot on hind foot

36
Q

Tx metatarsus adductus

A

Spontaneous resolution

Prognosis excellent

Stretching- be sure is not over zealous

Casting in children 6-12 months- especially rigid cases

Flexible sometimes can be treated with bebax bootie brace

37
Q

Clubfoot tx

A

After birth- serial casts

Should be seen each week

75% plus successful

Bracing needed to prevent recurrence

Often require percutaneous achilles tenotomy

38
Q

Rigid flatfoot cause

A

Tarsal Coalition

Congenital synostosis or failure of segmentation between 2 or more tarsal bones

Types

–Calcaneonavicular

–Talocalcaneal

–Talonavicular

–Calcaneocuboid

–Cubonavicular

39
Q

Dx hip dysplasia

A

Ortolani (reduction) Barlows (Dislocation) - early *clunk*

Galeazzi - leg length discrepancy (later)

Imaging (Ultrasound, xrays)

40
Q

Tx Hip dysplasia

A

Some untreated positive ortolani - heal on own

Pavlik harness (Full time 6-12 wks), otherwise closed reduction/spica casting

41
Q

Clinical features metatarsus adductus

A

Forefoot adductus

Hindfoot neutral

Medial crease

Forefoot slightly supinated

Full dorsiflexion

Supple vs. rigid

42
Q

MEtatarsus adductus when to refer

A

Stiff foot

No correction at 6 months

Shoe problems

Hindfoot in valgus( skewfoot) or equinus(clubfoot)

43
Q

Clubfoot when to refer

A

All patients

Hopefully within first week or two of life

44
Q

Symptoms rigid flatfood

A

Lack of subtalar motion

Frequent ankle sprains

Tendon spasms (tight achilles tendon)

45
Q

WHen to refer Flatfeet

A

All rigid flatfeet

Flexible flatfeet with tight achilles

Swelling or synovitis

Painful feet

Family wants referral

Skin MS: Week 7 (5 decks)

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