![]()Rest (reduce load) ![]()NSAIDs ![]()PT ![]()Bracing? ![]()Casts ![]()Surgical muscle releases

Pediatric Top 10 Flashcards by Elaina JoAnn

Hip Dysplasia - When to Refer (peds ortho)

Abnormal exam

Abnormal Ultrasound

Abnormal xray

Breech position- ultrasound?

How well did you know this?

Not at all

Perfectly

Perthes Disease age

4-8 (3-12)

Boys>>Girls

Family hx

How well did you know this?

Not at all

Perfectly

Perthes pathogenesis

Vascular insult to femoral epiphysis

Repetitive trauma ?

Hormonal ?

Thrombophilia?

How well did you know this?

Not at all

Perfectly

Radiographic stages Perthes

Initial, fragmentation, reossification, remodeling

How well did you know this?

Not at all

Perfectly

Poor prognostic factors Perthes

–Age greater than 7-8

–Decreased ROM

–Deformity of head

–% of head involvement ( no lateral pillar)

–Protracted disease course

How well did you know this?

Not at all

Perfectly

Clinical presentation Perthes

Insidious limp

Mild to moderate pain

Hip, thigh, or knee pain

How well did you know this?

Not at all

Perfectly

Physical Exam Perthes

Limited abduction

Synovitis

Muscle spasm

Thigh atrophy

Leg length discrepancy

How well did you know this?

Not at all

Perfectly

Imaging Perthes

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

Tc bone scan- pinhole

MRI- can help with early diagnosis but not with staging

How well did you know this?

Not at all

Perfectly

Treatment Perthes

Rest (reduce load)

NSAIDs

Bracing?

Casts

Surgical muscle releases

How well did you know this?

Not at all

Perfectly

When to Refer Perthes

School children with

–Hip, thigh, knee pain

–Decreased ROM

–Atrophy

–Abnormal imaging

–Labs important if xray normal to rule out other causes

How well did you know this?

Not at all

Perfectly

Slipped Capital Femoral Epiphysis

Males>Females

B 12-15

G 10-13

Obesity

How well did you know this?

Not at all

Perfectly

Etiology Slipped epiphysis

Mechanical Factors

Renal Osteodystrophy

Radiation therapy

Endocrine

–Hypothyroidism

–GH deficiency

How well did you know this?

Not at all

Perfectly

Clinical features Slipped Epiphysis

Pain in thigh or knee

Limp- external rotated gait

Limited internal rotation and flexion

How well did you know this?

Not at all

Perfectly

Types Slipped Epiphysis

Acute- less than 3 weeks symptoms

Chronic- greater than 3 weeks

Stable- can walk

Unstable- can’t walk

How well did you know this?

Not at all

Perfectly

Treatment slipped epiphysis

In situ fixation

Osteotomy for deformity

Epiphysiodesis

How well did you know this?

Not at all

Perfectly

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

Hypothyroidism

Renal Osteodystrophy

Endocrinopathies

Younger Children less than 10 years

How well did you know this?

Not at all

Perfectly

Complications slipped epiphysis

Osteoarthritis

Chondrolysis

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

How well did you know this?

Not at all

Perfectly

When to refer slipped epiphysis

Any SCFE needs to referred immediately

Strict nonweight bearing (send them in a wheelchair)

How well did you know this?

Not at all

Perfectly

Intoeing Outtoeing assessment

Rotational Variation Assessment

Static (prone, look at flexion)

Dynamic- with walking

Causes of intoeing, outtoeing

Increased femoral anteversion, internal tibial torsion

When to refer intoe/outtoe

Recent specific change in gait

Functional problem

Persistent problem in older children

Family wants referral

Genu varum

bowed legs

Physiologic bowing (characteristics)

Early walkers

Family history common

Usually agile walkers

Usually bilateral

Treatment Physiological bowing

Spontaneous correction is the rule

Bracing not effective

Serial photos helpful

Diff Dx Bowing

![]()Blounts disease ![]()Skeletal dysplasia ![]()Neoplastic disease ![]()Metabolic bone disease ![]()Hypophoshatemic rickets ![]()Nutritional rickets \*\*If short stature, worry about these

Blounts Ds

![]()Osteochondrosis ![]()Deformity proximal medial tibia epiphysis ![]()Fragmentation medial tibial plateau ![]()Ultimate physeal bar formation ![]()Progressive condition

If see _______ bowing, not physiological

unilateral

Physiological bowing usually distributed between \_\_\_\_\_\_\_\_

Femur and tibia

Blounts ds tx

![]()Brace treatment- less than 2 and ½ years old ![]()Valgus Proximal tibial osteotomy in children over 2

Bowing when to refer

![]()Height less than 5% ![]()Positive family history ![]()Asymmetry ![]()Progressive condition ![]()Localized varus deformity

Genu valgum

![]()Physiologic ![]()Usually apparent after 2 years ![]()Typically symmetric Knockkneed

Diff Dx knockkneed

![]()Rickets ![]()Post-traumatic ![]()Skeletal dysplasia

Tx valgum

![]()Predictably remodels to normal by age 7 ![]()No effective bracing If after 8 -- ![]()Hemiepiphysiodesis (minimal surgery) ![]()Stapling ![]()8 plates ![]()Ostetomy

Genu valgum when to refer

![]()Less than 10% for height ![]()Asymmetry ![]()Deformity increasing after age 7-8 ![]()History of metabolic disease ![]()History skeletal dysplasia

Metatarsus adducts

MEdial deviation of forefoot on hind foot

Tx metatarsus adductus

![]()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

Clubfoot tx

![]()After birth- serial casts ![]()Should be seen each week ![]()75% plus successful ![]()Bracing needed to prevent recurrence ![]()Often require percutaneous achilles tenotomy

Rigid flatfoot cause

![]()Tarsal Coalition ![]()Congenital synostosis or failure of segmentation between 2 or more tarsal bones ![]()Types –Calcaneonavicular –Talocalcaneal –Talonavicular –Calcaneocuboid –Cubonavicular

Dx hip dysplasia

Ortolani (reduction) Barlows (Dislocation) - early \*clunk\* Galeazzi - leg length discrepancy (later) Imaging (Ultrasound, xrays)

Tx Hip dysplasia

Some untreated positive ortolani - heal on own Pavlik harness (Full time 6-12 wks), otherwise closed reduction/spica casting

Clinical features metatarsus adductus

Forefoot adductus Hindfoot neutral Medial crease Forefoot slightly supinated Full dorsiflexion Supple vs. rigid

MEtatarsus adductus when to refer

Stiff foot No correction at 6 months Shoe problems Hindfoot in valgus( skewfoot) or equinus(clubfoot)

Clubfoot when to refer

All patients Hopefully within first week or two of life

Symptoms rigid flatfood

Lack of subtalar motion Frequent ankle sprains Tendon spasms (tight achilles tendon)

WHen to refer Flatfeet

All rigid flatfeet Flexible flatfeet with tight achilles Swelling or synovitis Painful feet Family wants referral