Peds: Ortho Flashcards
What is developmental dysplasia of the hip?
generalized hip laxity
complete hip dislocation
acetabular abnormality
What are some risk factors for developmental dysplasia of the hip?
first child
girls > boys
breech presentation
family hx
What are some S/S of developmental dysplasia of the hip?
first noticed w/ walking, limp
decreased leg length
assymety of skin folds
loss of motion
What are the two tests used to diagnose developmental dysplasia of the hip?
Barlow’s test (dislocation test)
Ortolani test (relocation test)
When is a ultrasound performed for possible developmental dysplasia of the hip?
at 6 weeks if female & breech
What are some treatments for developmental dysplasia of the hip?
braces/harness (Pavlik) -best used < 6 months old
casting for > 6 months
spica cast for 8-12 weeks
surgical reduction if > 2 yrs
Wahat is the goal of treatment for developmental dysplasia of the hip?
to keep the hip located!
What is Legg-Calve-Perthes disease?
idiopathic osteonecrosis of the femoral head
What can the progression of Legg-Calve-Perthes disease lead to?
loss of blood supply
bone dies (osteonecrosis)
loss of structural rigidity
femoral head collapses
What is the typical child like who has Legg-Calve-Perthes disease?
age 2-12
small stature
thing
physically active
rare in blacks
What are some S/S Legg-Calve-Perthes disease?
pain & limping (worse w/ activity)
pain radiates to groin/proximal thigh
decreased AROM & ROM
How is Legg-Calve-Perthes disease diagnosed?
x ray
initial increased density at femoral head, crescent sign
What is the treatment for Legg-Calve-Perthes disease?
observation
femoral head re-vascularizes, usually regenerates in 12-18 months
restrict vigorous activity, NSAIDs, crutches
What is slipped capital femoral epiphysis (SCFE)?
slippage of the femoral epiphysis
(usually posteriorly)
What is the most common adolescent hip disorder?
SCFE
2-3x more common in boys
What are some S/S of SCFE?
onset may be sudden or progressive
pain w/ activity, pain in hip, groin, thigh, knee
limp
decreased hip motion (internal rotation)
possible limb shortening
What are some red flags for SCFE?
older child
male
obesity
limp
pain in hip/groin/thigh/knee
How is SCFE diagnosed?
What will be seen?
X-ray
‘fuzzy’ irregularities on physis, appears that the epiphysis has slipped/rotated
What is the treatment for SCFE?
surgical fixation
NEED to fix this
single cannulated screw into epiphysis
non-weight bearing
slippage WILL progress if left untreated
What is transient synovitis of the hip?
sterile effusion of the hip
(inflammation of the hip for no apparent cause)
What are some S/S of transient synovitis of the hip?
usually acute onset
worse in AM
limp is initial presentation
pain in groin/thigh
decreased abduction
AFEBRILE
How is transient synovitis of the hip diagnosed?
diagnosis of exclusion
joint aspiration if suspecting sepsis
What is the treatment for transient synovitis of the hip?
rest
monitor temp
reassurance
full resolution in 3-14 days
What is the most common cause for lower extremity rotational disorders?
intrauterine constraint of the fetus
(small uterus, twins, uterine fibroids)
What are some symptoms of lower extremity rotational disorders?
usually present by age 2 (walking)
noticed by parents first
rarely pain, limp, or instability
may stumble if severe rotation
What is the most common cause of ‘toeing in’?
internal tibial torsion
Is internal tibial torsion exaggerated with weight bearing?
yes
What is the treatment for internal tibial torsion?
no treatment necessary
spontaneous resolution
What is the most common cause of ‘toeing in’ after 3 years old?
femoral anteversion
What might pes planus be evident in?
external tibial torsion
What is the treatment for external tibial torsion?
no treatment necessary
surgery for extreme cases
What are some of the diagnostics used to assess lower extremity rotational disorders?
rotational profile
foot progression angle
measurement of thigh-foot angle
measurement of femoral ante/retroversion
assessment of foot adductus
What is the treatment (in general) for lower extremity rotational disorders?
careful monitoring of rotational measure
reassurances
referral if no change/improvement
What is Osgood-Schlatter disease?
What causes it?
inflammation at the tibial tubercle apophysis
caused from reptitive trauma/overuse, jumping, repetitive quadriceps contraction pulling on the tibial tubercle
What kids does Osgood-Schlatter disease affect?
early adolescence
5x more common in athletic children
2-3x more common in males
What are the S/S of Osgood-Schlatter disease?
usually a gradual onset
pain worsens w/ jumping, running, kneeling
point tender at tibial tubercles, most often bilaterally
What is the treatment for Osgood-Schlatter disease?
treat symptoms
ice, heat, NSAIDs, active rest, knee pads
may take several months for results
What is metatarsus adductus?
medially rotated forefoot
What is the etiology of metatarsus adductus?
most likely due to position of fetus in utero
What are some S/S of metatarsus adductus?
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)
How is metatarsus adductus diagnosed?
serial weight-bearing photocopies
(measures amount of deviation)
What is the treatment or metatarsus adductus?
treatment usually not necessary
will spontaneously resolve by age 6 months
if not, serial casting
What is Talipes equinovarus?
club foot
congenital deformity of foot
What are some S/S of Talipes equinovarus?
noticeable deformity at birth
plantarflexion is usually most severe (inability to dorsiflex heel)
How is Talipes equinovarus diagnosed?
physical exam (you can see the deformity)
must also assess muscle & nerve function
What is the treatment for Talipes equinovarus?
immediate casting (before leaving hospital)
surgery indicated if no results after 4 months
What is scoliosis?
lateral curvature of the spine greater than 10 degrees
Which parts of the spine does scoliosis usually affect?
thoracic or lumbar
What are some S/S of scoliosis?
usually asymptomatic
may notice postural changes/asymmetry
How is scoliosis diagnosed?
physical exam- Adam’s forward bend test
X rays if greater than 5-7 degrees
What is the treatment for scoliosis?
must monitor progression while growing
20-40 degrees = brace
> 50 degrees = surgical intervention (fusion or rodding)
What is torticolis?
unilateral contraction of the sternocleidomastoid muscle
What are some S/S of torticolis?
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
What is the treatment for torticolis?
passive stretching exercises (usually performed by parents)
usually resolves within a year
surgical intervention- longer than 18 months, release of SC
What is a Type I salter harris fracture?
transverse through the physis
What is a Type II salter-harris fracture?
transverse through the physics into the metaphysis
What is a Type II salter-harris fracture?
transverse through the physis into the epiphysis
What is a Type IV salter-harris fracture?
fracture through the metaphysis, physis, & epiphysis
What is a Type V salter-harris fracture?
compression/crush injury to the physis
What is something important to remember about X rays?
always get at least 2 views
What is the treatment for salter-harris fractures?
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
What is the most common injury in children, caused by increased joint laxity?
nursemaid’s elbow
What is a nursemaid’s elbow?
radial head is wedged in annular ligament
What is osteogenesis imperfect?
genetically transmitted disease
defect in Type I collagen
What are some S/S of osteogenesis imperfect?
short stature
lax ligaments
several bony deformities
blue sclera
decreased hearing
poor dentition
What is the treatment for osteogenesis imperfect?
symptomatic, treat fractures routinely
modify activity to lessen risk
