Pediatrics orthopaedics Flashcards
Scoliosis: Description
lateral curvature greater than 10 deg, often associated with rotational deformity. M:F = 1:1 of curves less than 20, but girls are 7 times more likely to progress
Scoliosis: Sx
no pain. Ill fitting clothes
Scoliosis: Exam
forward bend test. Scoliometer.
Scoliosis Tests
Full length x rays measure vertebral angle
Scoliosis: tx
brace if angle > 30. surgery if > 40-50
Club foot Description
idiopathic congenital foot deformity, characterized by plantar flexion of ankle; adduction of the heel; high arch; adduction of the fore foot
Club foot: sx
none
Club foot: tests
none
Club foot TX
manipuation and casting immediately. surgery if still rigid at 3 years
Osgood schlatter: description
overuse injury causing apophyseal injury at tibial tubercule
Osgood schlatter: sx
pain over tibial tuberculev
Osgood schlatter: exam
pain over tibial tubercle
Osgood schlatter: tests
xrays show gramentation of tubercle
Osgood schlatter: tx
NSAIDS, rest, PT
hip dysplasia: description
malformed hip socket and femoral head, asscoiated with ligamentous laxity, left hip, female gender, breech presentation. Xray will show dislocation.
hip dysplasia: SX
limp
hip dysplasia: Exam
barlow and ortolani exam. Dislocation test then relocate it.
hip dysplasia: tests
ultrasound can help with difficult cases
hip dysplasia: tx
pavlik harness to force relocation of hip. mimic ortalani maneuver
perthes disease: description
idiopathic osteonecrosis of femoral head, between 4-8 years old
Good blood supply to lateral side can help with good prognosis. Femoral head is medial crcumflex and pulvinar artery.
perthes disease: sx
limp and stiffness
perthes disease: exam
decreased internal rotation and abduction
perthes disease: tests
x rays show sclerosis, coxa magna. MRI can help with diagnosis
perthes disease: tx
ROM and bracing. No good treatment
SLipped capital femoral epiphysis: description
displacement of the femoral head through the physis usually during growth spurt, associated with obesity, maes, sports, endocrine disorders
SLipped capital femoral epiphysis: SX
pain with activity
SLipped capital femoral epiphysis: exam
loss of internal rotation with hip flexed
SLipped capital femoral epiphysis: tests
AP and lateral X rays show slip. Workup for endocrine abnormality if bilateral
SLipped capital femoral epiphysis: tx
surgical fixation in situ
pin it and let it heal
Genu varum/valgum: description
normally the knee starts at birth in varum 10-15 deg, and by 18 months straightes out to 0. Maximum valgum of 15 degree at age 4, then 5-10 deg in adolescence
Genu varum/valgum: SX
worried parents
Genu varum/valgum: exam
measure knee angle
Genu varum/valgum: tests
weight bearing x rays if outside normal
Genu varum/valgum: tx
observation, bracing, occasional epiphyseal stapling osteotomy
tarsal coalition: description
abonrmal connection between tarsal bones
tarsal coalition: SX
pain, limp, frequent, ankle sprain
tarsal coalition: exam
restricted hindfoot movement
tarsal coalition: tests
x rays will show calcaneal navicular coaltion. CT scan can confirm
tarsal coalition: TX
casting then surgery if needed.
transient synovitis of the hip: description
sterile effusions of the hip causing pain.
transient synovitis of the hip: SX
limp, refuses to walk, groin pain. History of viral infection elsewhere.
transient synovitis of the hip: exam
limp, stiffness, afebrile
transient synovitis of the hip: tests
x rays effusion. CBC, esr, crp are not elevated. Joint aspirate < 50000 WBC. Gets better with NSAIDS
transient synovitis of the hip: TX
Supportive care
Supracondylar humerus fracture description
affects 2-12 years old, most common elbow fracture
Supracondylar humerus fracture: SX
fall of trampoline, elbow deformity, pain
Supracondylar humerus fracture exam
neurovascular exam important
Supracondylar humerus fracture tests
x rays show supracondylar fracture, positive posterior sail sign
Supracondylar humerus fracture tx
casting vs surgical reduction
Rickets: description
error in Vit D metabolism causes failure of mineralization
Large hypertrophic zone.
Rickets: SX
pain in legs
Rickets: exam
bowed lgs
Rickets: xray
looser lines (osteoid seam). Widened growth plates
Rickets: labs
low normal serum Ca, phos low
Rickets: tx
nutritional supplementation. treat for underlying cause (meds)
Non-accidental trauma incidence:
42/10000 children were victims of abuse or neglect
15-20% presents with fractures
humerus is the most common bone then femur
Non-accidental trauma: risk factors
low income, first born, premature, stepchildren, handicapped, single parent, drug use, unemployed parents, abused parents
fractures in non amulatory children
Non-accidental trauma: injuries to be aware of
posterior rib fractures
spiral fractures
metaphyseal corner fractures
Spiral fractures. Rib fractures (shaking baby syndrome)
Corner fracture: distal fracture.
Bucket fracture.
Salter harris classification of growth factors: Damage of growth plate.
Non-accidental trauma : TX
contact CPS
rule out other causes (OI, caffey’s disease, leukemia, accidental trauma)
treat fracture
Acute joint effusion
mono articular
oligoarticular
systemic sx: JIA, lyme, septic. Ophtalmology consult.
Sometimes painless
Cerebral palsy
permanent non progressive brain injury in the peripartum period
upper motor neurons affected with spasticity
hemiplegia; diplegia
keeping mobile is key
be suspicious for cerebral palsy in a paitnet with delayed motor development, history of prematurity, prolonged NICU stay, toe walking
Achondroplasia
disproportionate short stature
FGFR3 mutation
autosomal dominant
hypertrophic zone in growth plate is narrow
problems involve the spine
Marfan syndrome
defect in collagen 1 from osteoblast
fibrillin mutation
hyper mobile thumb. really long fingers and narrow bone.
SX:
tx no treatment
