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SD: Peds > Peds: Ortho > Flashcards

Peds: Ortho Flashcards

1
Q

What is developmental dysplasia of the hip?

A

generalized hip laxity

complete hip dislocation

acetabular abnormality

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2
Q

What are some risk factors for developmental dysplasia of the hip?

A

first child

girls > boys

breech presentation

family hx

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3
Q

What are some S/S of developmental dysplasia of the hip?

A

first noticed w/ walking, limp

decreased leg length

assymety of skin folds

loss of motion

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4
Q

What are the two tests used to diagnose developmental dysplasia of the hip?

A

Barlow’s test (dislocation test)

Ortolani test (relocation test)

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5
Q

When is a ultrasound performed for possible developmental dysplasia of the hip?

A

at 6 weeks if female & breech

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6
Q

What are some treatments for developmental dysplasia of the hip?

A

braces/harness (Pavlik) -best used < 6 months old

casting for > 6 months

spica cast for 8-12 weeks

surgical reduction if > 2 yrs

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7
Q

Wahat is the goal of treatment for developmental dysplasia of the hip?

A

to keep the hip located!

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8
Q

What is Legg-Calve-Perthes disease?

A

idiopathic osteonecrosis of the femoral head

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9
Q

What can the progression of Legg-Calve-Perthes disease lead to?

A

loss of blood supply

bone dies (osteonecrosis)

loss of structural rigidity

femoral head collapses

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10
Q

What is the typical child like who has Legg-Calve-Perthes disease?

A

age 2-12

small stature

thing

physically active

rare in blacks

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11
Q

What are some S/S Legg-Calve-Perthes disease?

A

pain & limping (worse w/ activity)

pain radiates to groin/proximal thigh

decreased AROM & ROM

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12
Q

How is Legg-Calve-Perthes disease diagnosed?

A

x ray

initial increased density at femoral head, crescent sign

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13
Q

What is the treatment for Legg-Calve-Perthes disease?

A

observation

femoral head re-vascularizes, usually regenerates in 12-18 months

restrict vigorous activity, NSAIDs, crutches

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14
Q

What is slipped capital femoral epiphysis (SCFE)?

A

slippage of the femoral epiphysis

(usually posteriorly)

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15
Q

What is the most common adolescent hip disorder?

A

SCFE

2-3x more common in boys

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16
Q

What are some S/S of SCFE?

A

onset may be sudden or progressive

pain w/ activity, pain in hip, groin, thigh, knee

limp

decreased hip motion (internal rotation)

possible limb shortening

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17
Q

What are some red flags for SCFE?

A

older child

male

obesity

limp

pain in hip/groin/thigh/knee

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18
Q

How is SCFE diagnosed?

What will be seen?

A

X-ray

‘fuzzy’ irregularities on physis, appears that the epiphysis has slipped/rotated

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19
Q

What is the treatment for SCFE?

A

surgical fixation

NEED to fix this

single cannulated screw into epiphysis

non-weight bearing

slippage WILL progress if left untreated

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20
Q

What is transient synovitis of the hip?

A

sterile effusion of the hip

(inflammation of the hip for no apparent cause)

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21
Q

What are some S/S of transient synovitis of the hip?

A

usually acute onset

worse in AM

limp is initial presentation

pain in groin/thigh

decreased abduction

AFEBRILE

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22
Q

How is transient synovitis of the hip diagnosed?

A

diagnosis of exclusion

joint aspiration if suspecting sepsis

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23
Q

What is the treatment for transient synovitis of the hip?

A

rest

monitor temp

reassurance

full resolution in 3-14 days

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24
Q

What is the most common cause for lower extremity rotational disorders?

A

intrauterine constraint of the fetus

(small uterus, twins, uterine fibroids)

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25
Q

What are some symptoms of lower extremity rotational disorders?

A

usually present by age 2 (walking)

noticed by parents first

rarely pain, limp, or instability

may stumble if severe rotation

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26
Q

What is the most common cause of ‘toeing in’?

A

internal tibial torsion

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27
Q

Is internal tibial torsion exaggerated with weight bearing?

A

yes

28
Q

What is the treatment for internal tibial torsion?

A

no treatment necessary

spontaneous resolution

29
Q

What is the most common cause of ‘toeing in’ after 3 years old?

A

femoral anteversion

30
Q

What might pes planus be evident in?

A

external tibial torsion

31
Q

What is the treatment for external tibial torsion?

A

no treatment necessary

surgery for extreme cases

32
Q

What are some of the diagnostics used to assess lower extremity rotational disorders?

A

rotational profile

foot progression angle

measurement of thigh-foot angle

measurement of femoral ante/retroversion

assessment of foot adductus

33
Q

What is the treatment (in general) for lower extremity rotational disorders?

A

careful monitoring of rotational measure

reassurances

referral if no change/improvement

34
Q

What is Osgood-Schlatter disease?

What causes it?

A

inflammation at the tibial tubercle apophysis

caused from reptitive trauma/overuse, jumping, repetitive quadriceps contraction pulling on the tibial tubercle

35
Q

What kids does Osgood-Schlatter disease affect?

A

early adolescence

5x more common in athletic children

2-3x more common in males

36
Q

What are the S/S of Osgood-Schlatter disease?

A

usually a gradual onset

pain worsens w/ jumping, running, kneeling

point tender at tibial tubercles, most often bilaterally

37
Q

What is the treatment for Osgood-Schlatter disease?

A

treat symptoms

ice, heat, NSAIDs, active rest, knee pads

may take several months for results

38
Q

What is metatarsus adductus?

A

medially rotated forefoot

39
Q

What is the etiology of metatarsus adductus?

A

most likely due to position of fetus in utero

40
Q

What are some S/S of metatarsus adductus?

A

hindfoot & midfoot have no deformity

adducted forefoot, may have medial skin crease at TMT joint

forefoot is flexible (can be brought back into normal alignment)

41
Q

How is metatarsus adductus diagnosed?

A

serial weight-bearing photocopies

(measures amount of deviation)

42
Q

What is the treatment or metatarsus adductus?

A

treatment usually not necessary

will spontaneously resolve by age 6 months

if not, serial casting

43
Q

What is Talipes equinovarus?

A

club foot

congenital deformity of foot

44
Q

What are some S/S of Talipes equinovarus?

A

noticeable deformity at birth

plantarflexion is usually most severe (inability to dorsiflex heel)

45
Q

How is Talipes equinovarus diagnosed?

A

physical exam (you can see the deformity)

must also assess muscle & nerve function

46
Q

What is the treatment for Talipes equinovarus?

A

immediate casting (before leaving hospital)

surgery indicated if no results after 4 months

47
Q

What is scoliosis?

A

lateral curvature of the spine greater than 10 degrees

48
Q

Which parts of the spine does scoliosis usually affect?

A

thoracic or lumbar

49
Q

What are some S/S of scoliosis?

A

usually asymptomatic

may notice postural changes/asymmetry

50
Q

How is scoliosis diagnosed?

A

physical exam- Adam’s forward bend test

X rays if greater than 5-7 degrees

51
Q

What is the treatment for scoliosis?

A

must monitor progression while growing

20-40 degrees = brace

> 50 degrees = surgical intervention (fusion or rodding)

52
Q

What is torticolis?

A

unilateral contraction of the sternocleidomastoid muscle

53
Q

What are some S/S of torticolis?

A

first noticed at 4-6 weeks old

‘cock robin’ position- tilted toward affected side & rotated away from affected side

possible palpable ‘tumor’ in muscle belly

decreased cervical motion

54
Q

What is the treatment for torticolis?

A

passive stretching exercises (usually performed by parents)

usually resolves within a year

surgical intervention- longer than 18 months, release of SC

55
Q

What is a Type I salter harris fracture?

A

transverse through the physis

56
Q

What is a Type II salter-harris fracture?

A

transverse through the physics into the metaphysis

57
Q

What is a Type II salter-harris fracture?

A

transverse through the physis into the epiphysis

58
Q

What is a Type IV salter-harris fracture?

A

fracture through the metaphysis, physis, & epiphysis

59
Q

What is a Type V salter-harris fracture?

A

compression/crush injury to the physis

60
Q

What is something important to remember about X rays?

A

always get at least 2 views

61
Q

What is the treatment for salter-harris fractures?

A

conservative, cast for 2-3 weeks & repeat X-rays

observe for radiographic signs of healing

most type I fractures will heal in 4 weeks

surgical- displaced fracture, unstable fracture

62
Q

What is the most common injury in children, caused by increased joint laxity?

A

nursemaid’s elbow

63
Q

What is a nursemaid’s elbow?

A

radial head is wedged in annular ligament

64
Q

What is osteogenesis imperfect?

A

genetically transmitted disease

defect in Type I collagen

65
Q

What are some S/S of osteogenesis imperfect?

A

short stature

lax ligaments

several bony deformities

blue sclera

decreased hearing

poor dentition

66
Q

What is the treatment for osteogenesis imperfect?

A

symptomatic, treat fractures routinely

modify activity to lessen risk

67
Q
A

SD: Peds (11 decks)

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