Peds Ortho Flashcards
Talipes equinovarus- Eti
- Clubfoot deformity
- 1:1000 births
- Congenital fixed foot deformity
- Idiopathic, neuro, other syndromes
Talipes equinovarus- Sx
- Plantar flexion with varus deformity
Talipes equinovarus- Dx
Clinical
Talipes equinovarus- Tx
- Plaster casting to surgery, if severe
- Refer to ortho
Genu varum- Eti
- Bowleg
- Normal from 0-2 yrs
- Seek tx if pain, unilateral
Genu valgum- Eti
- Knock-kneed
- Normal from 2-8 yrs
- Seek tx if pain, unilateral
Congenital dysplasia of hip- Eti
- Dislocated: 1: 1000
- Dislocatable: 1:1000
- Subluxable: 9:1000
Congenital dysplasia of hip- Risk
- Fam hx
- Breech position
- Female 2-3x
- Risk factors are additive
Congenital dysplasia of hip- Dx
- Hip ABduction
- Asymmetry
Congenital dysplasia of hip- Tx
- Maintain hip in reduced position, reverses if tx early on
- Prolonged traction, casting and surgical repair if > 18 months
Scoliosis- Eti
> 10 degree curvature measured by Cobb angle
- 3D deformity: curvature, kyphosis, lordosis and rotation of axial plane
- Idiopathic most common
- 9-10 yo female
Scoliosis- Tx
- Observation 40 degrees
- Determine based on risk of progression and cobb angle
Scoliosis- Sx
- Asymptomatic and painless
- Discrepancy in shoulder ht, scapulae, waist line and arm distance
Scoliosis- Dx
- Adams forward bend test
- Rib & muscle prominence
- Looking at rotation only
- Standing x-rays- measure Cobb angle for severity
- Eval skeletal maturity- Risser sign
Scoliosis- Tx
- Observation 40 degrees
- Determine based on risk of progression & cobb angle
Torticollis- Eti
- Fibrosis & shortening of SCM
- Traumatic birth or positioning
- 20% also have hip dysplasia
Torticollis- Sx
- Head tilt to affect side with rotation of chin
- Swelling/ mass in SCM
- Limited lateral bending away from affected side
Torticollis- Tx
PT & stretching
Legg-calve-perthes- Eto
- Unknown etiology
- 4-11 yo male
- Small for age, delayed skeletal maturation
- Unilateral
- Painless, limp & fatigue
Slipped capital femoral epiphysis- Eti
- Separation of proximal femoral epiphysis through growth plate
- Displaced medially and posterior
- During growth spurt: 10-17 male, 8-15 female
- Obese
Slipped capital femoral epiphysis- Sx
- Progressive pain and limp
- Referred pain to thigh, knee or groin
- Bilateral involvement within 2 years
Slipped capital femoral epiphysis- Dx
- Xray: Klein’s line- doesn’t intersect formal head
- Affected limp positioned in external rotation, shorter
- Gait externally rotates
- Loss of internal rotation
Slipped capital femoral epiphysis- Tx
- Surgery- fixation of femoral head
- Leads to avascular necrosis
Legg-calve-perthes- Eto
- Unknown etiology
- 4-11 yo male
- Small for age, delayed skeletal maturation
- Unilateral
- Painless, limp and fatigue
Legg-calve-perthes- Sx
- Impairment to blood supply leads to avasc. necrosis,spontaneously regenerates
- Limp
- Pain &; limitation of internal rotation
- Flexion contracture of involved hip
Legg-calve-perthes- Dx
- X-ray- late: failure of development of femoral head
Septic arthritis- Eti
- Infection of synovium
- S. aureus most common, N gonorrhea in adolescence
- First 2 yrs of life
Septic arthritis- Sx
- Ill appearing child with fever
- Local swelling, effusion, pain, erythema & warmth
Septic arthritis- Dx
- Joint aspiration for gram stain
- X-ray to RO occult fx
- Bone scan RO osteomyelitis
Septic arthritis- Tx
- IV abx x 2-4 wks
- I and D if abscess suspected
Nursemaids elbow- Eti
- Most common elbow injury in children
- Sudden traction on extended arm
- 1 - 4 YO
Nursemaids elbow- Sx
- Sudden pain that subsides
- Pain increases with arm movement
- Holds elbow flexed and pronated
- Refusal to move/ bend
- Tenderness over radial head
- Normal x-ray
Nursemaids elbow- Tx
- Reduction by extension, supination then flexion, feel clunk
- Relief almost immediately
Tibial torsion- Eti
- Toeing in
- Rotation of leg between knee and ankle
- Should be neutral by 16 mo.
- Self limited and self resolves
Femoral anteversion
- Toeing in beyond age 2-3 due to internal rotation of hip
- Tx with active external rotation exercises
Juvenile Rheumatoid arthritis- Eti
- Chronic arthritis in 1+ joint x 6 wks
- Autoimmune
Juvenile Rheumatoid arthritis- Sx
- Arthritis: pain, swelling, warmth, AM stiffness and decreased ROM
- Systemic manifestations: fever, rash, uveitis, serositis, anemia & fatigue
Juvenile Rheumatoid arthritis- Eti
- Chronic arthritis in 1+ joint x 6 wks
- Autoimmune
- Oligoarticular most common
Juvenile Rheumatoid arthritis- Dx
- Elevated inflammation markers- CRP, WBC, ESR
- Xray- degeneration, increased joint space, soft tissue swelling
Juvenile Rheumatoid arthritis- Tx
- NSAIDs
- Methotrexate
- Triamcinalone injections
