Pediatrics: Orthopedic Conditions Flashcards
Torsional Conditions: Toeing in/Toeing out: Foot Progression Angle
- Angle made by the foot with respect to a straight line progression in the direction of gait.
Torsional Conditions: Toeing in/Toeing out: Foot Progression Angle
- Can be normal
- sign=toe out
- sign=toe in
Torsional Conditions: Toeing in/Toeing out: Thigh-foot angle
- Angle between axis of thigh and axis of foot.
- Measured with child prone and knees at 90 degrees.
- The angle describes the degree of Tibial torsion.
Torsional Conditions: Toeing in/Toeing out
- Toeing in is common among children who W sit.
Torsional Conditions: Toeing in/Toeing out: Deformities: Metatarsus Adductus
- Congenital foot deformity
- More common in females
- More common on the left side
Torsional Conditions: Toeing in/Toeing out: Deformities: Metatarsus Adductus: Cause
- Most common cause is intrauterine packing
Torsional Conditions: Toeing in/Toeing out: Deformities: Metatarsus Adductus: Types
- Rigid
- Flexible
Torsional Conditions: Toeing in/Toeing out: Deformities: Metatarsus Adductus: Rigid
- Medial subluxation of Tarsometatarsal Joints
- Hindfoot slightly in valgus with navicular lateral to head of talus.
Torsional Conditions: Toeing in/Toeing out: Deformities: Metatarsus Adductus: Flexible
- Adduction of all five metatarsals at the tarsometatarsal joints.
Torsional Conditions: Toeing in/Toeing out: Deformities: Metatarsus Adductus: Flexible: Diagnosis and Treatment
- Diagnosed through clinical exam.
- Treatment includes stretching and casting.
- Surgical option to release of abductor hallucis tendon.
- Strengthening and regaining proper alignment of the foot
- 85-90% of cases identified at birth resolve by 1 year.
Torsional Conditions: Toeing in/Toeing out: Internal Tibial Torsion
- Most common cause of toeing in
- High complication rate for osteotomy of Tibia
- Associated with W sitting
Torsional Conditions: Toeing in/Toeing out: Increased Femoral Anteversion
- Femoral angle of greater than 25-30 degrees from the frontal plane
- Associated with W sitting
- Causes toeing in.
Torsional Conditions: Toeing in/Toeing out: Increased Femoral Retroversion
- Femoral angle of less than 10 degrees from the frontal plane.
- Causes toeing out.
Torsional Conditions: Toeing in/Toeing out: Other Causes of Toeing-Out
- External Tibial Torsion
- Flat feet
Torsional Conditions: Toeing in/Toeing out: Other Causes of Toeing-Out: External Tibial Torsion Correction
- High complication rate with surgery.
Talipes Equinovarus/Clubfoot: Etiology
- Intrauterine malposition causing
- Abnormal development of the head and neck of thetas due to hereditary or neuromuscular disorders.
Talipes Equinovarus/Clubfoot: Observation
- Foot will be
- Plantar flexed
- Adducted
- Inverted
Talipes Equinovarus/Clubfoot: Anatomical changes
- Planterflexion=Talocrural Joint
- Inversion=Subtalar, Talocalcaneal, Talonavicular, and calcaneocuboid joints
- Supination=Midtarsal Joints
Talipes Equinovarus/Clubfoot: Diagnosis
- Prenatal ultrasound
- Lower quarter exam.
- Affected foot will be. half size smaller and less movie.
- Calf muscles will be smaller.
- Bilateral 50% of the time.
Talipes Equinovarus/Clubfoot: Physical Therapy
- Manipulation followed by casting
- Stretching following casting
- Orthosis throughout the day for up to 3 months
- Orthosis at night for up to three years
Talipes Equinovarus/Clubfoot: Non-Postural Treatment
- Surgery
- Casting and Splinting
- Possible Achilles tenotomy
Angular Conditions: Genu Valgum
- Excessive Lateral Tibial Torison
- Referred to as knock knees
- Accompanied by excessive LATERAL patellar position
Angular Conditions: Genu Varum
- Excessive Medial Tibial Torsion
- Referred to as Bowlegged.
- Accompanied by excessive MEDIAL patellar position
Angular Conditions: Other
- Excessive medial patellar tracking
- Pigeon toed
Angular Conditions: Age Norms
- Genu varum=normal in newborn and infants
- Maximum varum at 6-12 months of age
- 0 Tibiofemoral angle by 18-24 months.
- Knees drift into valgus by 3-4 years
- Valgus corrects at age 7 to an adult alignment.
- 8 degrees in female and 7 degrees in males.
Angular Conditions: Diagnosis
- Imaging
- Clinical examination
Angular Conditions: Physical Therapy
- Decreased loading on the knee
- Maintenance of strength
Hip Dysplasia: Etiology
- Abnormality of the femoral head, acetabulum, or both.
- Can result in subluxations, dislocations or both
Hip Dysplasia: Risk Factors
- Females more often than males
- Breech position
- History
- Low levels of amniotic fluid
- Swaddling an infant too tightly
Hip Dysplasia: Diagnosis
- Ultrasound after 4 weeks.
- Radiographs for infants 4-6 months.
- Clinical Exam
Hip Dysplasia: Gold Standard Treatment
- Pavlik Harness
Hip Dysplasia: Other Treatment
- Maintain hip in flexion and abduction to maintain femoral head in acetabulum for newborns and 6 month olds
- Closed reduction and anesthesia followed by spica castor 12 weeks for children 6 months to 2 years
- Open reduction + spica cast for 6-12 weeks for children older than two years.
Hip Dysplasia: Physical Therapy
- Moderate exercise
- Maximize function
Transient Synovitis: Etiology
- Acute onset of sudden hip pain in children ages 3-10
- Transient inflammation of the synovium of the hip
Transient Synovitis: Diagnosis
- Clinical exam showing decreased hip abduction and and internal rotation
- Biopsy that shows effusion that causes bulging of the anterior joint capsule
Transient Synovitis: Signs and Symptoms
- Hip or groin pain that is unilateral
- Less common is medial thigh or knee pain
- Crying at night
- Antalgic limp
- Child does not commonly have hip pain.
- Recent history of upper respiratory infection.
Transient Synovitis: Treatment
- NSAIDS and rest while healing.
Legg-Calve-Perthes Disease: Etiology
- Blood supply interrupted to the femoral head
- Age of onset between 2-13 years of age
- Higher likelihood in males than females
Legg-Calve-Perthes Disease: Diagnosis
- MRI showing positive bony crescent sign
Legg-Calve-Perthes Disease: Clinical exam
- Psoatic limp due to weakness of poses major
- Moves in external rotation, flexion, adduction
- Gradual onset of aching in hip, thigh, or knee
- AROM limited in abduction and extension
Legg-Calve-Perthes Disease: Treatment
- Acetominophin
- NSAIDS
- Casting
- Surgery
Legg-Calve-Perthes Disease: Physical Therapy
- Joint/bone protection
- Maintain/improve joint mechanics/connective tissue function
- Implementation of conditioning activities
- Post surgical interventions, regaining functional flexibility, improving strength, endurance, coordination, and gait
Slipped Capital Femoral Epiphysis: Etiology
- Unknown etiology
- Most common hip disorder in adolescents
Slipped Capital Femoral Epiphysis: Etiology
- Femoral head is displaced posteriorly and inferiorly in relation to the femoral neck and within the acetabulum
Slipped Capital Femoral Epiphysis: Etiology: Age of Onset
- Onset in males is 10-17 years with average onset of 13 years
- Onset in females 8-15 years with average onset at 11 years
- More common in males than females
Slipped Capital Femoral Epiphysis: Diagnosis
- AROM restricted in abduction, flexion, and internal rotation
- Patient described pain as vague at knee thigh and hip
- Trendelemberg Gait
- Imaging shows positive displacement of upper femoral epiphysis.
Slipped Capital Femoral Epiphysis: Treatment
- Operative internal fixation
Slipped Capital Femoral Epiphysis: Physical Therapy
- Joint/bone protection strategies
- Maintain/improve joint mechanics and connective tissue functions
- Implementation of conditioning programs
- Flexibility
- Improving strength
- Endurance
- Coordination
- Gait
Tendon Lengthening Conditions: Osgood-Schlatter Disease: Etiology
- Mechanical dysfunction resulting in apophysitis of the Tibial Tubercle at the patellar tendon insertion.
Tendon Lengthening Conditions: Osgood-Schlatter Disease: Diagnosis
- Radiograph
- Clinical examination
Tendon Lengthening Conditions: Osgood-Schlatter Disease: Treatment
- Occasionally surgery
Tendon Lengthening Conditions: Osgood-Schlatter Disease: Physical Therapy
- Modify activities to prevent excessive stress to irritated site
- Flexibility
Tendon Lengthening Conditions: Sever’s Disease: Etiology
- Most common cause of heel pain in children occurs before or during peak growth spurt
- Caused by repetitive micro trauma due to increased traction by the achilles tendon on the insertion site
- Bilateral 60% of the cases
Tendon Lengthening Conditions: Sever’s Disease: Diagnosis
- Imaging
Tendon Lengthening Conditions: Sever’s Disease: Treatment
- Temporary cessation of running/jumping activities
- Heel lifts/heel cups
Tendon Lengthening Conditions: Sever’s Disease: Physical Therapy
- Stretching
- Strengthening
Tendon Lengthening Conditions: Sinding-Larsen-Johannson’s Disease: Etiology
- Traction apophysists at the patella/patellar tendon junction.
- Overuse injury due to repeated stresses can occur after significant growth spurt or increased activities.
Tendon Lengthening Conditions: Sinding-Larsen-Johannson’s Disease: Diagnosis
- Radiographs
- Clinical examination
Tendon Lengthening Conditions: Sinding-Larsen-Johannson’s Disease: Treatment
- Temporary cessation of activities
Tendon Lengthening Conditions: Sinding-Larsen-Johannson’s Disease: Physical Therapy
- Stretching and strengthening
- Activity modifications
Growing Pains/Benign Nocturnal pains of childhood: Etiology
- Unknown etiology
- Possibly muscular fatigue
- Poor posture
- Stress
Growing Pains/Benign Nocturnal pains of childhood: Etiology
- No evidence linking growing pains to growing
- Most likely between the ages of 3-5 and 8-11
Growing Pains/Benign Nocturnal pains of childhood: Diagnosis
- Clinical exam
- Increased pain at night
- Typically bilateral leg pain
- Not associated with redness, temperature, swelling and tenderness
Growing Pains/Benign Nocturnal pains of childhood: Treatment
- Pain management
