pediatrics orthropedics

Question 1

Classification of Newborn hips 5 classes (mubarak)

Answer 1

• Normal
• Subluxatable
• Dislocatable
• Dislocated but reducible
• Dislocated and not reducible

Question 2

clinical examination of hip

Answer 2

• Check hip abd in flexion; should have 75-90 deg
• Asymmetry of 5-10 degrees may indicate hip dysplasia-most reliable finding
• leg fold asymmetry
• apparent femoral shortening and uneven knee heights
  
  • Galeazzi Sign +/-
• barlow or ortolini signs
  
  • clunking during maneuvers
• between the ages of 18-24 months child with hip dislocation will have abnormal gait, pos trendelenburg sign

Question 3

pressure epiphysis

Answer 3

contribute to longitudinal growth and forms articulating surface

Question 4

apophysis

Answer 4

traction epiphysis is located on the bony prominence at the site of muscle or tendon attachment; are not articular and are not associated with logitudinal growth

Question 5

Osteochondrosis

Answer 5

disorders that affects the growing skeleton and characterized by AVN. Result from abnormal growth, injury or overuse of the developing endplate and ossification centers. Primarily during rapid growth followed by a period of slow regeneration

Question 6

four phases of osteochondrosis

Answer 6

1. necrosis or avascularity phase (AVN)
2. revascularization with bone deposition and reabsorption
3. bone healing
4. residual deformity

Question 7

what are 4 complications of of osteochondrosis

Answer 7

subchondral patholgical fx in epiphysis
subluxation of the involved joint
deformity of the epiphysis
severe cases; DJD

Question 8

What are common causes of limp 1-5 yo

Answer 8

• trauma
• transient hip synovitis
• osteomyelitis +/or septic arthritis
• discitis
• kohler syndrome
• juvenile arthritis
• malignancy

Question 9

What are common causes of limp 5-10 yo

Answer 9

• trauma
• transient hip synovitis
• osteomyelitis +/or septic arthritis
• legg calve perthe’s disease
• osteochondritis dissecans (OCD)
  
  • sever
• juvenile Arthritis
• malignancy

Question 10

Whar are common causes of limp 10-15 yo

Answer 10

• trauma
• septic arthritis
• osteochondritis dissecans (OCD)
  
  • frieberg disease
  • little league elbow
  • osgood-schlatter’s disease (OSD)
  • sinding-larsen johansson syndrome
• slipped capital femoral epiphyses
• juvenile Arthritis
• malignancy

Question 11

history of limping child

Answer 11

Age
Onset of pain and limp; sudden insidious; time of day
Any history of trauma including non-accidental injury
Association with pain and its location including referred pain
Preceding viral illness
Aggravating factors
Functional limitations
Constitutional symptoms such as fever, wt. loss or malaise

Question 12

examination of limping child

Answer 12

General examination inspection looking for symmetry, looking for rashes, redness, temperature of skin
Observation of child’s gait
-Trendelenburg
-Limp
-Stance time
-Roll off
Observation of child’s posture
Test mm strength with squat, Trendelenburg test, and heel to toe walk
Palpate bones and joints
-tenderness, masses, effusion, warmth
Observe PROM and AROM of spine and LE
Measure leg length and calf circumferences; symmetry of folds
Neurological screen: sensation, reflexes

Question 13

examination of limping child complete (what body parts?)

Answer 13

Complete examination of spine, hip, knees, lower leg, ankle and feet

Question 14

examination of limping child fuctional

Answer 14

Function

Crawling, sitting, sit to stand, stand to floor, gait