Peds - Facts Flashcards
To control most spontaneous bleeding into the knee in children with hemophilia, factor VIII must be
replaced to what percentage of normal?
40% to 50% of normal
For surgery, the replacement should be
to 100%
? correct pelvic osteotomy ?
Chiari or Shelf (salvage for unreducible head)
both depends on fibrocartilge metaplasia for successful results
Most prognostic sign for the ability of a young child with cerebral palsy to walk?
Ability to sit independently by age 2 years
test of choice for dx
- Lateral radiograph of the foot in maximum plantar flexion
treatment algorithm
< 3 yo try KAFO
surgery:
> 3 yo
stage IV-V (bony bar)
failed brace
overcorrect into 10-15° of valgus +/- bar excision
natural history leg bowing
genu varum (bowed legs) is normal in children less than 2 years
genu varum migrates to a neutral at ~ 14 months
continues on to a peak genu valgum (knocked knees) at ~ 3 years of age
genu valgum then migrates back to normal physiologic valgus at ~ 4 years of age
MTP arthrodesis
Femur fracture treatment by age
< 6 mo
- Pavlik or spica
7 mo - 5 yo
- Spica
6 - 11 yo
- Flexible nail or sub-m bridge plate (by fx pattern)
12 and up (approaching maturity)
- Flexible nail (<100 lb, length stable)
- lateral entry nail (> 100 lb, length unstable)
- Sub-m bridge plate (> 100 lb, length unstable, very proximal or distal)
normal alpha angle
greater than 60 deg
(pic is abnormal)
DDH treatment by age
< 6 mo
- Pavlik
6-18 mo (or failed Pavlik younger)
- Closed reduction + spica
>2 yo
- open reduction + osteotomies (by side of pathology)
> 4 yo
- open reduction and pelvic osteotomy common
quadrant of the femoral head with highest complications after in situ pinning of a chronic slipped capital femoral epiphysis
anterior superior
Duchenne Scoliosis
early PSF with instrumentation (rare need for anterior)
- curve > 20° in nonambulatory patient (treat early, < 30° curve, before pulmonary function declines)
- can wait slightly longer (Cobb ~ 40°) if patient is responding well to corticosteroids
- FVC drops below 35%
- rapidly progressive curve
extension to pelvis is controversial
remember malignant hyperthermia and dantrolene
Kocher criteria septic hip
weight bearing
fever
ESR > 40
WBC > 12,000
Perthes treatment
Surgery is for > 8 yo with B or B/C (50%) lateral pillar
- less than 8 yo do fine regarless of treatment
- Pillar C greater than 8 you can’t help with surgery
CP hip treatment
Soft tissue release 8yo >60% or 40% Remember dega osteotomy ai > 25deg
surgical indications in scheuermann’s
kyphosis > 75 degrees that is rigid in nature in skeletally mature patient
neurologic deficit
spinal cord compression
severe pain in adults
unacceptable closed reduction BBFA fx
children <10
angulation >20 degrees, rotation >45 degrees
children >10
angulation >10 degrees, rotation >30 degrees
bayonette apposition
Starting 13-14 begin to treat like adult
BBFA fx:
apex volar = __________ injury
apex dorsal = _________ injury
supination
pronation
treat accordingly with closed reduction of deforming force
OI scoliosis treatment numbers
bracing ineffective and side effects
PSF for curves
>45 milder forms (better bone)
> 35 severe forms
*use allograft not autograft
* ASF if very young to prevent crankshaft
curly toe treatment age
> 3 yo if pain/severe deformity (FDL release)
typically self corrects, observation before then
age and indications for surgical releases for clubfoot
9-10 months of age so the child can be ambulatory at one year
resistant feet in young children
“rocker bottom” feet that develop as a result of serial casting
syndrome-associated clubfoot
delayed presentation >1-2 years of age
++ casting always
abduction/ER # to remember for Ponseti FAO
70° in clubfoot and 40° in normal foot
usually achieve 70° week 8, heel in valgus –> achilles tenotomy (80%)
indication for surgery in femoral anteversion
- < 10° of external rotation on exam in an older child (>8-10 yrs)
- rarely needed
amount correction needed can be calculated by (IR-ER)/2
Bones with an intra-articular metaphyses (4)
proximal humerus, proximal radius, proximal femur, and distal fibula/tibia.
NOT KNEE
Growth rates mm/yr for lower extremity
proximal femur-4
distal femur-9
proximal tibia-6
distal tibia-5
LLD treatment based on length
< 2 cm observation
2-5 cm shortening long
>5 cm lengthen short side (often shorten long)
excise bar < 50% and 2 yr growth left
Kocher criteria septic hip
WBC > 12,000 cells/µl inability to bear weight fever > 101.3° F (38.5° C) ESR > 40 mm/h Added later CRP > 2.0 (mg/dl) temperature > 101.3° (38.5° C) is the best predictor of septic arthritis followed by CRP of >2.0 (mg/dl)
Fibular deficiency = hemimelia
no known inheritance pattern
linked to sonic hedge-hog gene
anteromedial tibial bowing
ball and socket ankle, instability
equinovalgus foot deformity tarsal coalition (50%) absent lateral rays
LLD
convex hemiepiphysiodesis/arthrodesis indications
- young age (<5)
- concave growth potential
- short curves (<5 segments)
- smaller curves (< 70)
- NO KYPHOSIS
- NOT RIGID
lysosomal storage diseases last minute facts
MPS I H Hurler á-L-iduronidase
MPS II Hunter Iduronate-2-sulfatase
MPS IIIA Sanfillipo Heparan-N-sulfatase
MPS IVA Morquio N-acetylglucosamine -6-sulfatase
MPS IVB Morquio â-galactosidase
B-glucocerebrosidase- Gauchers (not MPS, sphingolipids)
