Pediatrics Flashcards
Brachial plexus palsy typically manifests as what?
Internal shoulder rotation (results in glenoid hypoplasia), flexion of elbow and wrist
90% of cases will resolve without intervention
What carries a poor prognosis in brachial plexus injury?
No biceps function at 6 months
Horner syndrome
What innervates the teres major?
Lower scapular nerve (C5-C7)
What innervates the latissimus muscle?
Thoracodorsal nerve (C6-C8)
What is the name for undescended scapula?
Sprengel deformity
What is the name for unilateral chest wall hypoplasia?
Poland syndrome (Can have hypoplasia of the hand and forearm, hand deformities)
What are the three possible causes of pediatric in-toeing?
- Metatarsus adductus
- Internal tibial torsion
- Femoral anteversion
What exam finding favors tibial torsion?
Thigh foot angle <-10 degrees (normal is 0-20)
How much does each area contribute to growth per year?
Distal femur 9 mm
Proximal tibia 6 mm
Proximal femur 3 mm
How do I treat a LLD of 2 cm?
Shoe lifts if at maturity
What are the risk factors for DDH?
Breech, positive family history, female, firstborn
When can I use ultrasound for DDH?
Up until 4-6 months
What is the normal alpha angle on hip ultrasound for infants?
60 degrees
What is the normal acetabular index on xrays?
Less than 25 degrees
AIN innervates what three muscles?
FPL
PQ
Radial half of the FDP
What nerve is commonly injured with flexion type SCH?
Ulnar nerve
How old should I consider an open reduction for dislocated hips?
18 months to 3 years
How old shoulder I consider an osteotomy for dislocated hips?
3 to 8 years
For dislocated hips, what osteotomy is available for growth plates are closed?
Ganz and Chiari procedures
Excessive flexion in a pavlik harness can cause what palsy?
Femoral nerve palsy
How long should I give a pavlik harness to reduce a hip?
3 weeks tops
What are the treatments for the following Coxa Vara:
1. Hilgenreiner epiphseal angle <45 deg
2. HE 45-60 deg
3. HE>60
- Will resolve
- close observation
- Surgery (subtroch valgus osteotomy)
When do I consider surgery for Perthes disease?
Skeletal maturity (over the age of 8) with lateral pillar groups (B or B/C)
When should I consider an endocrine work up for SCFE?
Patient less than 10 years old
Whats included in Kochers criteria?
T>101.3
Elevated ESR
Refusal to bear weight
WBC > 12
What joints do not have intraarticular metaphysis?
Hip, Knee, Ankle, Elbow
When can I treat osteomyelitis with only atbx?
If there is no subperiosteal abscess or abscess within the bone
genu varum in children turns into genu valgum by what age?
2.5 years
When is surgery indicated for infantile blounts disease? (0-4 years)
Patient over 3 years at stage II or stage III (Langenshlold classification)
Up to what degree of valgum is common in children 2-6 years of age?
15 degrees (maxium valgus is at 3-4 years)
What is the most common cause of bilateral genu valgum thats pathologic?
Renal osteodystrophy
What type of tibia bowing is likely phsiologic?
Posteromedial tibial bowing
What is the most common type of long bone deficency?
Fibular hemimelia
(linked to SHH)
Neurofibromatosis causes what type of tibial bowing?
Anterolateral
Kingaella septic arthritis often has negative cultures, what test can be helpful in its diagnosis?
PCR
Where is OCD most commonly found?
Posterolateral portion of the medial femoral condyle
Congenital dislocation of the knee is associated with what other conditions?
DDH
Clubfoot
Metatarsus adductus
When should I operate for congenital dislocation of the knee?
If there is less than 30 degrees of knee flexion after 3 months of casting
What makes up clubfoot?
CAVE
Cavus
Adduction of forefoot
Varus of hindfoot
Equinus
Clubfoot is associated with what vascular anomly?
Diminished or absent anterior tibial artery
PITX1-TBX4 is associated with what condition?
Club foot
What is the first casting method for clubfoot?
Go after the Cavus
Supinate forefoot and dorsiflex the first ray
No impairment in athletic ability after treatment
What is a common deformity after clubfoot treatment?
Dynamic supination (15-20%)
The heel bisector shoulder be between what toes?
2nd and 3rd (useful to evaluate for metatarsus adductus)
What protein is affected in Charcot-Marie-Tooth?
PMP-22 (helps with myelination)
-Think cavus feet
What muscles overpower what muscles in CMT?
Peroneus longus and the posterior tibialis overpower the peroneus brevis and tibialis anterior
How is the forefoot in vertical talus?
Abducted and dorsiflexed
When should I perform a subtalar arthrodesis for talocalcaneal coalition?
If more than 50% of the facet is involved
calcaneovalgus foot is associated with what tibia abnormality?
Posteromedial bowing of the tibia
If you see bilateral perthes, what must you do first?
Rule out MED, bone survey to examine other physes
On Adams forward bending test, what degrees is associated with a 20 degree coronal curve?
7 degrees
When to get MRI for scoliosis?
Left sided curve
Rapidly progressing
Apical kyphosis
Onset before 10
Neurologic signs or symptoms
Congenital abnormalities (e.g. cavus feet)
What determines rate of progression in infantile idiopathic scoliosis?
Medial rib relative to the apical vertebra (RVAD), more than 20 degrees high risk for progression (80%)
Rib overlap is also a high risk for progression
When is surgery for scoliosis indicated for ducheene muscular dystrophy?q
Curve more than 25-30 degrees or progressive with FVC >40%
What is the chromosome in NF-1?
17
Autosomal dominant
(Protein is a tumor suppressor that inhibits ras activity via stimulating GTPase)
What else is seen with Klippel Fiel syndrome?
Sprengel deformity
Auditory issues
Heart issues
Renal disease
When should I do a fusion in a patient with atlantoaxial instability?
Neurologic symptoms or ADI>10 mm
When does halo, reduction come into play for atlantoaxial rotatory displacement?
Greater than 1 month of symptoms
What is the most important determinant for nonunion and pain in spondylolisthesis?
Slip angle
For CP patients, the ability to do what independently is highly prognostic of ability of walk?
Sit independently
Syndrome with multiple joint dislocations?
Larsen syndrome
Dominant form - filamin B
Recessive form - carbodhydrate slfotransferase 3 deficency
Watch out for cervical kyphosis
What is increased in utero in myelodysplasia?
Alpha fetoprotein
Commonly associated with Type II Arnold Chiari Malformation
What is the first muscle group typically affected in Duchennes?
Hip extensors
DMD associated with low IQ, megacolon, volvulus, and malabsorption
What disease is due to a GAA repeat?
Friedreich ataxia (recessive)
Wide base gait, nystagmus, cardiomyopathy, cavus foot, scoliosis
What is the most common cause of pes cavus?
CMT
Plantar flexion of the first ray is the first foot deformity because TA is weak
What causes destruction of the anterior horn cells in the spinal cord?
Polio
muscle weakness WITHOUT sensory deficity
What gene with achondorplasia?
FGFR3 gain of function
What disease has a genetic defect with cAMP?
McCune Albright
What differentiates spondyloepiphyseal dysplasia (type II collagen defect) from MED?
Involved of the spine: scoliosis with sharp curve over small number of vertebra
Also common are retinal detachment and respiratory problems
Morquio syndrome (AR) may have dwarfism, cloudy corneas, but what orthopedic issue am I worried about?
C1-C2 instability due to odontoid hypoplasia
Urinary excretion of keratan sulfate
What is the inheritance for Hunter syndrome?
X linked
No cloudy corneas
What is the protein involved for cleidocranial dysplasia?
CBFA-1 (osteocalcin)
Delayed closure of the skull sutures and frontal bossing
Describe bone healing in osteopetrosis?
Healing is normal but may be prolonged
