Peds Flashcards
<div>Anatomic/Physiologic differences between Children/Adults in polytrauma</div>
c-spine: large head - use recessed spine board to protect<div>Airway/breathing: large tongue, short airway, anterior larynx, can have lung contusion without rib #</div><div>Circulation: BP reserve - can lose 30% blood volume before HoTN, increased risk of visceral injuries, organ failure ealy (during resus) use IO for access</div><div>Disability: hyperlaxity - SCIWORA risk, delayed neuro injury</div><div>Exposure: hypothermia risklarge body SA:volumre ratio</div><div><br></br></div><div>Trivia:</div><div>cause of death-head injury</div><div>fix fractures early to decrease Vent time/ICU stay</div><div>compartment syndrome - use analgesic requirement</div>
RFs for DDH? not a RC Q
“F’s<div>female</div><div>first born</div><div>frank breech</div><div>FHx up to 30%</div><div>fluid - oligohydramnios</div>”
Associations with DDH? not a RC Q
torticollis<div>foot: Metatarsus adductus (10%), CTEV (6%), calcaneovalgus</div><div>spine-scoliosis</div>
normal US angles for DDH? not a RC Q
“<div>Timing: 6 weeks to 4-6months</div>AAAA = alpha angle, acetabulum, above 60 deg (>60 deg is N)<div>BB = Beta, below 55 (<55 is N)</div><div><br></br></div><div><img></img><br></br></div>”
Defect in SCFE?
“Hypertrophic zone<div>Metaphyseal zone in renal osteodystrophy</div><div><br></br></div><div><img></img><br></br></div>”
Associations with PFFD? Not a RC Q
<ul> <li>Ulnar deficiency</li> <li>Coxa Vara</li> <li>Distal femoral focal defect</li> <li>ACL/PCL deficiency</li> <li>Fibular hemimelia (50-70%)</li> <li>Ball and Socket Ankle</li> <li>Lateral Ray Deficiency</li></ul>
Anteromed bowing - (1) assx anomalies, (2) Classification, (3) general tx?
“(1)<ul> <li>Upper extremity –> syndactyly, to extensive deficiency</li> <ul> <li>More common with bilateral involvement</li> </ul> <li>Hip: PFFD, coxa vara, congenital short femur (add to LLD), distal femoral hypoplasia (up to 93%)</li> <li>Knee: Genu valgum, ACL deficiency (95%), PCL def (60%) patella alta, hypoplastic patella</li> <li>Foot: Equinovalgus more common</li> <ul> <li>missing rays, tarsal coalition, ball in socket ankle, ankle instability</li> </ul></ul><div>(2)</div><div><div><img></img></div> <div></div> <img></img><br></br></div><div>(2) Tx depends on foot function and LLD</div><div>-indications for amputation: non-functional foot, predicted LLD>30%, 5cm discrepancy at birth, prolonged reconstructive course</div><div><img></img><br></br></div>”
Pirani Classification for CTEV?
“<ul> <li>Predictive of need for number of casts and need for TAL</li> <ul> <li>Pirani > 4 = 90% will need more than 3 casts</li> <li>Pirani > 5 = 85% will need TAL</li> </ul> </ul> <ul> <li>0:normal, 0.5 moderately abnormal, 1 severely abnormal</li> <li>Midfoot:</li> <ul> <li>(A) Curved lateral border</li> <li>(B) Medial crease</li> <li>(C) Talar head coverage</li> </ul> <li>Hindfoot</li> <ul> <li>Rigid equinus (D)</li> <li>Empty Heel (E)</li> <li>Posterior crease (F)</li> </ul> </ul> <div><img></img></div>”
Ponsetti technique?
”"”Serial above knee casting +/- TAL followed by abduction foot orthosis”“<div><br></br></div><div>Casts 5-6 weekly: correct supination, abduct foot around lateral talar pivot to 70 deg abduction and correct to hindfoot valgus, then DF to goal of 15 deg (TAL in 90%), then cast for 3/52</div><div><br></br></div><div>Move to foot abduction orthosis (Dennis Brown): 70 deg ER abd 10 DF 23 hr/d X3 month then 12-18hr/day up to 4 years</div><div><div><br></br></div></div>”
Soft tissue surgical Tx for clubfoot? not a RC Q
“Posteromedial release<div>-capsuleX4 - TT, subtalar, TN, CC</div><div>-musclesX4 - Achilles, PT, FHL, FDL (+Abd Hall, PF)</div><div><div> <div> <div><img></img></div> <div><img></img></div> </div></div></div>”
Causes of Cavovarus feet (not a RC)?
“<ul> <li>2/3 of pts with CV feet have neuro issue</li><li>unilateral - rule out tethered spinal cord or spinal cord tumor</li> </ul> <ul> <li>CNS:</li> <ul> <li>Cerebral palsy</li> <li>Freidrich’s Ataxia</li> </ul> <li>Spinal Abnormalities:</li> <ul> <li>Myelodysplasia</li> <li>Diastematomyelia</li> <li>Syringomyelia</li> <li>Poliomyelitis</li><ul><ul> </ul> </ul> <li>Spinal cord tumors, intrathecal lipoma, tethered cord syndrome, Guillain-Barre Syndrome</li> </ul> <li>Peripheral Nerves:</li> <ul> <li>Hereditary Sensorimotor Neuropathy (HSMN) - CMT</li><li><br></br></li><li>Other: polyneuritis, small muscular atrophy, atypical polyneuritis, neuromuscular choristoma</li> </ul></ul>”
Difference b/t oblique and vertical talus? not a RC Q
<div><div>Reduction of talocalcaneal angle and reduction of navicular on talus with forced PF view</div></div>
<ul> <li>Oblique talus </li> <ul> <li>Similar to true vertical talus but is passively correctable/reducible</li> <li>Plantarflexion lateral radiographs show talus aligns with 1st MT</li><li>Some need treatment</li> <ul> <li>< 10o dorsiflexion passively (tight Achilles)</li> <ul> <li>Will become symptomatic over time</li> </ul> </ul> </ul></ul>
Ortho and Non-ortho manifestations of DS?
“<div> <div> <div> <div>MSK Manifestations</div> <ul> <li>General: </li> <ul> <li>Joint hypermobility/ligamentous laxity</li> <li>Shorter than average stature</li> <li>Polyarticular arthropathy NYD</li> <li>Delayed ambulation with walking at age 2 or 3, wide-based waddling gait</li> </ul> <li>Spine</li> <ul> <li>Odontoid hypoplasia</li> <li>Atlantoaxial instability</li> <li>Occipito-cervical instability</li> <li>Subaxial instability/cervical stenosis</li> <li>Scoliosis</li> </ul> <li>U/E: Clinodactyly (usually 5th digit)</li> <li>Pelvis</li> <ul> <li>Flared iliac wings</li> <li>Flat acetabulae</li> <li>Hip instability</li> <li>Hip dysplasia (acquired) with dislocation late in life</li> <li>High rates of SCFE</li> </ul> <li>Knee</li> <ul> <li>Genu valgum</li> <li>Subluxed/dislocated patellae</li> </ul> <li>Feet</li> <ul> <li>Flexible pes planovalgus</li> <li>Hallux valgus</li> </ul> </ul><div><div> <div> <div><img></img></div> </div></div></div> </div> </div></div>”
“<div>Friedreich Ataxia: (1) def’n, (2) triad, (3) ortho manifestations</div>”
“(1) spinocerebellar degen dz<div>(2) ataxia, absent patellar/achilles reflexes, upgoing toes</div><div>(3) scoliosis (AIS, SSEPs don’t work), rigid cavus foot (achilles tenotomy, TT, fusions)</div>”
Peri-op considerations for DMD? Not a RC Q
“<ul> <li>MALIGNANT HYPERTHERMIA common</li> <ul> <li>Avoid succinylcholine</li> <li>Can lead to lethal hyperkalemia even if frank MH doesn’t occur</li> </ul> <li>Cardiac evaluation (cardiomyopathy, late CHF, risk of intra-op cardiac arrythmias)</li> <li>Pulmonary function</li> <ul> <li>Decreased FVC starts around age 10 (Weakness/contractures of intracostal muscles)</li> </ul> <li>Increased intra-operative bleeding</li> <ul> <li>Lack of vasoconstriction from weak smooth muscle</li> <li>Consider TXA use</li> </ul> <li>Post-op wound complications and infections</li> <li>Stress dose steroids</li> <li>Curve progression</li> <li>Late pseudo-arthrosis</li></ul>”
MED vs LCDP hips?
<div>MED distinguished from LCPD by itssymmetric and bilateral presentation, early acetabular changes, and lack of metaphyseal cysts</div>
<div><br></br></div>
<div>MED always bilateral and symmetric</div>
<div>Only 13% of perthes are bilateral and 31% of these at same stage<br></br></div>
<div><br></br></div>
<div>MED will have other joint involvement - skeletal survey!</div>
Ortho manifestations of sickle cell? not a RC q
<div>-sickle cell crisis: hydroxyurea, hydration, analgesia</div>
-osteomyelitis<div>-AVN</div><div>-septic arthritis</div><div>-pathologic fracture</div>
RU Synostosis:<div>(1) position</div><div>(2) Investigations</div><div>(3) Tx and complications</div>
(1) presents at 2-5 years with fixed PRONATION (>60 deg is fxnally limiting)<div>(2) Xray, but MRI to r/o cartilaginous synostosis</div><div>(3) osteotomy through synostosis; injuries to PIN and high risk of CS if >85 deg correction</div>
EDS diagnostic criteria
<ul> <li>Major</li> <ul> <li>Beighton score >4</li> <li>Arthralgia for >3mo in 4 or more joints</li> </ul> <li>Minor</li> <ul> <li>Beighton score of 1, 2, or 3</li> <li>Arthralgia >3mo in 1,2,or 3 joints or back pain >3mo or spondylosis/spondylolysis/spondylolisthesis</li> <li>Dislocation or subluxation of more than one joint, or in one joint on more than one occasion</li> <li>Three or more soft tissue lesions (i.e. epicondylitis, tenosynovitis, bursitis)</li> <li>Marfanoid habitus</li> <li>Skin striae, hyperextensibility, thin skin, or abnormal scarring</li> <li>Occular signs (drooping eyelids, myopia, antimongoloid slant)</li> <li>Varicose veins, hernia, rectal or vaginal prolapse</li> <li>Mitral valve prolapse</li> </ul> <li>Positive if any of:</li> <ul> <li>2 major criteria</li> <li>1 major and 2 minor</li> <li>4 minor</li> <li>2 minor and unequivocally affected 1st degree relative</li> </ul></ul>
Alignment parameters for BBFA #s? Not A RCQ
<div> <div></div> <div>Angle</div> <div>Malrotation (°)</div> <div>Bayonet Apposition</div> <div>0-10 years</div> <div><15</div> <div><45</div> <div>Yes, if <1cm short</div> <div>≥10 years</div> <div><10</div> <div><30</div> <div>No</div> <div>Approaching skeletal maturity (<2y growth remaining)</div> <div>0</div> <div>0</div> <div>No</div> </div>
Etiologies of Physeal Arrest? not a RC Q
<ul> <li>Trauma</li> <ul> <li>Salter Harris Type I and II fractures travel through hypertrophic zone so very little risk of arrest (1-7%)</li> <ul> <li>Risk factors</li> <ul> <li>Repeated, forceful manipulation/reduction</li> <li>Remanipulation >10d after injury</li> </ul> </ul> <li>Salter Harris Type III and IV fractures traverse reserve zone</li> <ul> <li>Increased risk of growth distrubance</li> <li>Malunion can bridge epiphysis to metaphysis</li> </ul> <li>Salter Harris Type V injuries have high energy and can affect all zones, high rate of arrest</li> <li>Usually injury not identified until arrest has occurred</li> </ul> <li>Vascular ischemia 20 to compartment syndrome</li> <ul> <li>Frostbite</li> <li>Both lead to cell death in reserve and proliferative zone</li> </ul> <li>Occlusion</li> <ul> <li>Can occur in hematological deraignment</li> <ul> <li>Sickle-cell disease</li> <li>Thalassemia</li> <li>Purpura fulminans</li> </ul> </ul> <li>Infection</li> <ul> <li>Usually more in the metaphysis and hypertrophic zone, as that is where blood flow slows in young bones</li> <ul> <li>Advanced infection can progress across physis to reserve zone and lead to growth arrest</li> </ul> <li>Subperiosteal abscess or septic arthritis can compress epiphyseal vessels -> secondary ischemic insult</li> </ul> <li>External beam radiation</li> <ul> <li>Direct death to chondrocytes in rapidly proliferating areas</li> <li>Also can have ischemic effects</li> </ul> <li>Tumors</li> <ul> <li>Can invade physis and destroy chondrocytes</li> <li>Can be damaged iatrogenicly during tumor resection</li> </ul> <li>Repetitive Stress</li> <ul> <li>Especially in gynmasts</li> <ul> <li>Can bear 10x body weight through their wrists</li> <li>Have increased incidence of positive ulnar variance compared to non-gymnasts</li> </ul> <li>Heuter-Volkman principle = compression across physis impairs growth, tension will increase growth</li> </ul></ul>
DDX for Vertebroplana
“<ul> <li>DDX for vertebroplana:</li> <ul> <li>F:fracture (trauma)</li> <li>E:eosinophilic granuloma</li> <li>T:tumor (e.g. metastases, myeloma, leukemia)</li> <li>I:infection</li> <li>S:steroids (<a>avascular necrosis</a>)</li> <li>H:hemangioma</li> </ul></ul>”
DDx for Kyphosis? Not a RC Q.
“<img></img>”
most common soft tissue mass in kids?
hemangioma<div><br></br></div><div><div>Hemangioma < 3 months of age, vascular malformation > 3months of age</div></div>
- ""Pavlik Harness Disease""
- Damage to the femoral head despite failure of reduction
- Injury to acetabular cartilage
- Impaired bone growth
- Inferior dislocation resulting from the hyperflexion
- Femoral nerve compression from hyperflexion
- Brachial plexus palsy from shoulder straps
- Skin breakdown
- Principles:
- Approach
- Identify acetabulum (cut psoas)
- Remove Obstacles
- Reduction
- Capsulorraphy
- blocks
- Extra-articular
- Iliopsoas tendon
- Contracted adductor longus
- Inferomedial hip capsule
- Intra-articular
- Pulvinar (fibro-fatty tissue that fills the acetabulum)
- Transverse acetabular ligament
- Inverted labrum (neolimbus)
- Hypertrophied ligamentum teres
- Southwick Angle Classification - determines severity of slip
- Measurement of the difference on the Frog leg lateral of the epiphyseal-shaft angle
- Mild = <30°
- Moderate = 30-50°
- Severe = > 50°
- Orthobullets
- Can also be done on AP If bilateral involvement, assume normal is 145 deg for AP and 10 deg for lateral
- gentle transfer to OR table
- In-situ Single-screw fixation - 6.3mm screw into centre of the femoral head with >5 threads engaged, but >5mm from subchondral bone, staying perpendicular to physis
- Confirm screw not intra-articular with near-far method
- ideally keep screw head lateral to intertroch line
- Deformity: apex anterior, ER, varus - present with impingement
- Imhauser Osteotomy:
- Creates flexion, abduction, IR of distal fragment
- Fixation with blade plate
- Associated factors:
- Unstable SCFE
- Over reduction of unstable SCFE
- Attempted reduction of unstable SCFE
- Placement of pins in posterosuperior quadrant of epiphysis
- Cuneiform osteotomy
- Risk factors for AVN:
- Sankar (JPO, 2010)
- Younger patients (11.7 vs 12.8 years)
- Shorter duration of prodromal symptoms (17.5 vs 65.9 days).
- (Tokomakova KP JBJS 2003, Palocaren T JPO 2010, Boyer DW JBJS 1981, Rattey T JBJS 1996)
- Severity of slip
- Complete or partial reduction
- Multiple pins
- Female sex
- Klein's line - does not intersect with femoral head
- or is asymmetric between sides
- epiphysiolysis (growth plate widening or lucency)
- an early radiographic finding
- blurring of proximal femoral metaphysis (metaphyseal blanch sign of Steel)
- seen on AP due to overlapping of the metaphysis and posteriorly displaced epiphysis
- identify subtle slip
- Physiologic
- Blount's
- Metabolic Bone Dz: Ricket's
- Dysplasia: achondroplasia, pseudoachon
- Neoplastic
- Differentiating from physiological bowing
- Proximal tibial location of bowing
- Sharply angular deformity
- Asymmetric bowing of the two legs
- Progressive deformity on serial exams
- Lateral thrust during gait
- Very severe deformity
- General Algorithm
- MDA <9 - physiologic varus, no tx
- MDA 9-16 - observation
- MDA >16 - treat
- Brace
- Stage I and II in kids <3 years
- Operative
- Stage I and II in kids>3 years
- Stage >II
- Age>4
- Failure of bracing
- Fixation Principles:
- Resection of pseudoarthrosis
- Circumferential resection with periosteum
- Shorten for boney apposition
- Resect fibular pseudoarthrosis if present
- Correction of Angular Deformity
- Stabilize fibula
- Biologic bone bridging of defect
- Stable Fixation
- Surgery when curve>20deg
- Front / back surgery if curve > 50o
- Complications
- Both dystrophic and non dystrophic curves have higher rates of complication compared to AIS.
- Increased rate of pseudoarthrosis, particularly with dystrophic curves.
- Risk is 40% in a dystrophic curve with PSF only, and 10% with combined ASF and PSF.
- Spastic (65-80%) --> involves the cortex; pyramidal
- Increased tone or rigidity with rapid stretch
- Pyramidal dysfunction
- Associated with periventricular leucomalacia (PVL) on MRI
- Most often benefit from surgery
- Dyskinetic - Athetoid/dystonic (10%) --> basal ganglia
- Involuntary movements, athetosis, dystonia
- Extrapyramidal dysfunction
- Poor candidates for Tendon transfers
- Associated with Rh issues, less common in modern medicine
- Ataxia (5%) --> cerebellum
- Cerebellar dysfunction
- Balance and coordination disturbance
- Usually part of another syndrome, rare for isolated CP
- Mixed (12%)
- Spastic children may not have athetoid or ataxic manifestations as they are masked by the spasticity
- Does not provide any useful information about functional abilities
- Hemiplegia
- Upper and lower extremities on same side, usually spastic
- Develop handedness early
- ALWAYS able to walk eventually
- Commonly have seizures (33%), 50% intellectual disability
- Diplegia:
- Lower extremity > upper extremity
- Most eventually walk
- May have normal IQ, often have strabismus
- Quadriplegia:
- Extensive involvement, low IQ, high mortality rate
- Usually unable to walk
- Whole Body:
- Quadriplegia + bulbar symptoms
- physical therapy, bracing/orthotics, medications for spasticity
- spasticity meds: botox, baclofen (intrathecal has less somnolence)
- soft tissue procedures/releases
- techniques
- tenotomies for continuously active muscles (e.g. hip adductor)
- tendon lengthening for continuously active muscles (e.g. achilles tendon or hamstring)
- tendon transfers for muscles firing out of phase (e.g. rectus tendon or tibialis posterior)
- selective dorsal rhizotomy
- indications
- ages 4 to 8, ambulatory spastic diplegia, and a stable gait pattern that is limited by lower extremity spasticity
- neurosurgical resection of dorsal rootlets that do not show a myographic or clinical response to stimulation
- contraindications
- athetoid CP
- bony procedures/deformity correction
- indications
- usually performed in later childhood / adolescence
- static contractures, progressive joint breakdown, and certain patterned gait-deterioration can be treated with combinations of myotendonous unit lengthening, tendon transfers, and osteotomies
- SEMLS surgery (Single-Event, Multi-Level Surgery)
- indications
- Hoffer Modification of L'Episcopo Procedure:
- Cosmetic axillary incision
- Release pectoralis major
- Transfer combined tendons of teres major and latissimus to posterior rotator cuff
- Average gain of 64o abduction and 45o external rotation at 2 year follow up
- Does not improve glenohumeral deformity
- Large for gestational age
- multiparous pregnancy
- prolonged labor
- difficult delivery
- fetal distress
- Shoulder dystocia
- breech position
- Pre-ganglionic (CNS)
- Horners syndrome (typically at C7)
- Miosis (pupil constriction); Anhidrosis (lack of sweat), Ptosis (drooping eyelid)
- Diaphragm paralysis (phrenic nerve) - RC EXAM
- Winged scapula (long thoracic nerve)
- Rhomboid absent (dorsal scapular nerve)
- Rotator cuff absent (suprascapular nerve)
- Latissimus dorsi absent (thoracodorsal nerve)
- More common in lower root (C8-T1)
- pre-ganglionic requires nerve transfer (neurotization)
- oberlin works - ulnar nerve to biceps
- Orthopaedic manifestations
- bone fragility and fractures
- fractures heal in normal fashion initially but the bone does not remodel
- can lead to progressive bowing
- ligamentous laxity
- short stature
- scoliosis
- codfish vertebrae (compression fx)
- basilar invagination
- olecranon apophyseal avulsion fx
- coxa vara (10%)
- congenital anterolateral radial head dislocations
- bone fragility and fractures
- Non-Orthopaedic manifestations
- blue sclera
- dysmorphic, triangle shaped facies
- hearing loss
- 50% of adults with OI
- may be conductive, sensorial and mixed
- brownish opalescent teeth (dentinogenesis imperfecta)
- alteration in dentin
- brown/blue teeth, soft, translucent, prone to cavities
- affects primary teeth > secondary teeth
- wormian skull bones (puzzle piece intrasutural skull bones)
- hypermetabolism
- increased risk of malignant hyperthermia
- hyperhidrosis, tachycardia, tachypnoea, heat intolerance
- thin skin prone to subcutaneous hemorrhage
- cardiovascular
- mitral valve prolapse
- aortic regurgitation
- 90% have a mutation in COL 1A1 (chromosome 7q) and COL1A2 (17q)
- Abnormal collagen cross-linking via glycine substitution in pro-collagen molecule
- Prevents proper formation of collagen triple helix
- Treatment
- <2 years: trial recasting
- >2 years: trial recasting with higher chance of need TA transfer
- Even in adolescents with severe deformity, serial casting can reduce the extent of surgery so it's reasonable to try
- Forms of relapse
- Equinus relapse
- Correct by applying serial long-leg casts with the foot abducted and knee flexed.
- Continue weekly casting until the foot can be brought to about 10 ̊ of dorsiflexion
- If this is not achieved in 4–5 casts in children under 4 years of age repeat the percutaneous heel-cord tenotomy and resume the nighttime bracing program
- Varus relapse
- Varus heel relapses are more common than equinus relapses
- Should be treated by re-casting in the child between age 12 and 24 months, followed by resuming of a strict bracing program.
- Dynamic supination
- Usually between ages 3 and 4 years
- Supination deformity will benefit from an anterior tibialis tendon transfer if the deformity is dynamic and not fixed
- Need to have 10 degrees of DF
- Delay the procedure until after 30 months of age when the lateral cuneiform becomes ossified
- Bracing is not required after the transfer
- The tendon transfer PREVENTS recurrence due to muscle imbalance and does not TREAT recurrence.
- Operation goals
- Lateral border of foot is straight.
- Heel is in slight valgus with the foot at 90 degrees to the tibia.
- Prior to repair of the tendons, the ankle range of motion should be 20+ degrees of dorsiflexion and 30+ degrees of plantarflexion.
- After repair of the tendons, the ankle dorsiflexion should be to neutral or 0 degrees.
- The talar head is reduced under the forefoot, with the navicular palpated to be slightly proud medially.
- The TN joint should be flush dorsally and plantarly.
- The first metatarsal should be in line with the talus on the lateral radiograph and should be in 0 to 30 degrees valgus relative to the talar axis on the anteroposterior (AP) radiograph.
- The talocalcaneal angle should be >25 degrees on the lateral and AP radiographs.
- Long axis of the talus and the long axis of the first metatarsal
- Usually 0-5o
- Increased in cavovarus feet
- Angle between undersurface of calcaneus and floor
- Normally about 30o
- Decreased pitch indicates forefoot equinus
- Increased pitch indicates calcaneocavus
- Marked dorsiflexion of the calcaneus with normal medial forefoot
- Calcaneus and axis of first MT
- Normally <45o
- Increased in cavus foot
- Idiopathic (50% - Kiefer says less than 20%)
- 20% of idiopathic have family history (AD)
- similar to CTEV: arthrogryposis, myelomeningocele
- CNS (NTD) Defect:
- Myelomeningocele (10% of myelo patients)
- Diastematomyelia
- Sacral Agenesis
- Neuromuscular Disorders - 36%
- Arthrogryposis
- Neurofibromatosis
- Spinal muscular atrophy
- Genetic Disorder
- Trisomy 13, 15, 18
- NF, Prune-Belly Syndrome, Rasmussen Syndrome
- HOXD10 single gene mutation
- Rare Syndromes --> De Barsy, Costello, Rasmussen
- Oblique talus
- Calcaneovalgus foot --> calcaneus is also dorsiflexed (break is in the ankle, not midfoot)
- Usually passively correctable
- Usually normal by age 6-8 months
- Posteromedial bowing of tibia
- Apex of deformity is in distal tibia
- Can result in limb length discrepancy
- tarsal coalition, pes planus valgus
- Tarsal Coalition
- Inflammatory Arthritis
- Accessory Navicular
- Post-traumatic
- Neoplastic lesions
- Talar beaking
- Broadening of lateral process of anterior facet of calc (ant-eater sign)
- Narrowing/irregularity of the subtalar joint (esp on Harris heel view)
- Concave undersurface of the talus
- C-sign
- Local Deformity
- Lumbosacral kyphosis has worse HRQoL
- Global Sagittal Balance:
- C7 plumb line should be posterior to hip joints
- Relates to PI in that people with low (?) PI are able to compensate more with their pelvis
- Consider reduction if:
- High local lumbosacral kyphosis
- Global imbalance of spine
