Peds Flashcards
4-year-old girl who is being evaluated for genu varum. She has a family history of bowed legs and short stature. She has a mutation in the PHEX gene. Identify the laboratory studies most consistent with this diagnosis.
Decreased phosphorus, increased serum alkaline phosphatase, normal calcium and vitamin D 25-OH
Thoracolumbar kyphosis is a characteristic feature of achondroplasia and thought to be a result of
Thoracolumbar kyphosis is a characteristic feature of achondroplasia and thought to be a result of developmental motor delay and hypotonia and disproportionate head size relative to a small chest size.
most common complication after unstable scfe
avn…not contralateral disease
most common type of pediatric brachial plexus lesion
upper trunk- ERB’s C5-C6
GMFCS level-what is more active 1 or 5
Level one is more active, “one can run”
five is wheelchair bound and totally dependent on caretakers
angle formed by Hilgenreiner’s line and a line from a point on the lateral triradiate cartilage to a point on lateral margin of acetabulum
acetabular index, should be less than 25 degrees
DDH-angle created by lines along the bony acetabulum and the ilium
alpha angle should be > 60
normal alpha angle
> 60 deg
DDH-angle created by lines along the labrum and the ilium
normal is < 55
normal beta angle
< 55 deg
DDH tx birth-6 months
pavlik
- contraindicated if SpinaBifida, spasticity, teratologic hip
- must have normal muscle function to pavlik
DDH tx 6-18 months
Closed reduction and spica
*or for failure of pavlik
DDH tx >18 months
open reduction spica casting
*of failure of closed reduction
avn in DDH treated with pavlik is due to what?
due to impingement of the posterosuperior retinacular branch of the medial femoral circumflex artery
seen with extreme abduction (> 60°)
DDH- single transverse cut above the acetabulum through the ilium to sciatic notch
Salter- acetabulum hinges thru the pubic symphisis
20-25 deg anterior coverage, lengthen leg up to 1 cm
DDH- Salter osteotomy plus additional cuts through superior and inferior pubic rami
Steele- Triple
acetabular re-orientation procedure
*open tri0radiate, pubic symphisis doesnt rotatate too well, little bit older child than dega or salter
ddh-• involves multiple osteotomies in the pubis, ilium, and ischium near the acetabulum
•allows for improved 3D correction of the acetabulum configuration
PAO- GANZ, Burnese
*Older child, closed Tri-radiate
DDH-osteotomy starts approximately 10-15mm above the AIIS and proceeds posteriorly to end at the level of the ilioischial limb of the triradiate cartilage (halfway between the sciatic notch and the posterior acetabular rim)
Pemberton-reduces acetabular volume
)
• acetabulum hinges through the triradiate cartilage
• does not enter the sciatic notch and is therefore stable and does not need internal fixation
• improves anterior, central, or posterior coverage
• reduces the acetabular volume
DDH salvage osteotomy-
add bone to the lateral weight-bearing aspect of the acetabulum by placing an extra-articular buttress of bone over the subluxed femoral head
Shelf
• depends on fibrocartilage metaplasia for successful results
DDH salvage-
• osteotomy starts above the acetabulum to the sciatic notch and ileum is shifted lateral beyond the edge of the acetabulum
• depends on fibrocartilge metaplasia for successful results
• medializes the acetabulum via iliac osteotomy
chiari
when do you start to use XR to monitor DDH
4-6 months, before this the femoral head isnt ossified enough, so use USG
how long until 94% of elbow ROM returns after CRPP of SCH fx
6 months
