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Peds 1 > Peds Ortho > Flashcards

Peds Ortho Flashcards

1
Q 
Club foot 
-aka 
-what anatomical changes take place? 
-tx 
-
A

aka: talipes equinovarus

Anatomical changes:

  • talus plantar flexed
  • heel cord tight
  • fore foot adducted/supinated

Tx: ponseti method = serial casting + percutaneous heel cord lengthening

Dennis browne bar = less commonly used.

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2
Q

Developmental Dysplasia of the Hip (DDH)

  • what is this?
  • cause
  • presentation
  • how do you test for this?
A

What: loss of normal femoral head-acetabular relationship/stability

Cause: physiological and mechanical factors:

  • ligamentous laxity, hormonal and familial factors
  • breech position and congenital deformities

Presentation:

  • hip that is reduced but is unstable and can be dislocated
  • dislocation that can be reduced
  • fixed dislocation that cannot be reduced
  • bony deformities that require surgery

Test:

  • barlow test: hip reduced but can be dislocated
  • ortolani test: hip dislocated but can be reduced.
  • lack of full abduction = hip is out and cant be reduced.
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3
Q

Developmental Dysplasia of the Hip

  • tx
  • prognosis
A

-depends on extent of deformity and if hip can be reduced.

*if hip can be reduced:
-harness or pillow for first 6mo of age.
Harnesses= pavlik (MC), Boch
Pillow = Frejka

  • if hip will not stay in:
  • reduce under anesthesia and hold with spica cast
  • still wont stay in:
  • requires surgery; femoral and/or acetabular osteotomy

Prognosis: if femoral head can be held in normal relationship with socket pt will develop normal hip.

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4
Q

Legg-Calve Perthes Dz

  • MC in which gender?
  • what is this?
  • sx
  • tx
A

MC in males 3-11yrs

What:

  • loss of blood supply to femoral head
  • -head can collapse and subluxation of femoral head
  • -eventually revascularizes, but may not occur until fixed deformity present

Sx: variable hip/knee sx, limited internal rotation and abduction of the hip.

Tx:

  • reduce pressure on femoral head:
  • -braces, crutches
  • -traction
  • -adduction muslce release
  • correct resulting deformity:
  • -femoral and/or acetabular osteotomy
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5
Q

Scoliosis

  • definition
  • types
  • at what angle are we concerned?
A

def: lateral curvature of the spine greater than 10degrees

Types: idiopathic(MC), congenital, secondary, neuromuscular

Be concerned when the Cobb angle is greater than 25 degrees.

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6
Q

Idiopathic scoliosis:

  • MC age range?
  • forms?
  • MC type of curvature?
  • dx
A

MC in adolescents (10 yrs +)

Forms: lumbar, thoracic, thoracolumbar, DOES NOT extend into the cervical spine!

Typically right thoracic curvature

Dx:

  • Adams Forward Bend test
  • Radiographic examination (AP & Lat full length of spine)
  • MRI (neuro deficits, neck stiffness, or HA)
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7
Q

Kyphosis

  • what is this?
  • Tx
  • Scheuermanns dz & Tx
A

What: increased thoracic curvature in the saggital plane.

Tx: corrects with time and bracing

Scheuermanns dz:

  • osteochondrosis of spine, wedges vertebra
  • sharper more rigid curve
  • may need surgical correction
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8
Q

Muscular Dystrophy

  • what is this?
  • MC sign
  • onset
  • MC in which gender?
  • prognosis
  • Key presentation of this disorder?
A

What: progressive weakness and wasting of muscles

MC sign: Gowers Sign: indicates weakness of the proximal muscles namely those of the lower limb. when transitioning from sitting to standing pose they have to walk themselves up.

Most common in boys, genetic.

Prognosis: death by ages 15-18yrs.

Key: difficulty walking up stairs.

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9
Q

Muscular Dystrophy:

  • dx
  • tx
A

Dx: Bx, EMG

Tx:

  • PT/OT
  • Bracing
  • Surgery (scoliosis)
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10
Q

What is polydactyly? Syndactyly?

Tx?

A

Polydactyly = extra digits

Syndactyly = webbed hands/feet

Tx: live with deformity
Referral to orthopedic specialist for reconstruction surgery

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11
Q

Metatarsus Adductus:

  • what is this?
  • tx
  • Most likely cause
A

What: excessive amount of adduction of the metatarsals

Tx: 85-90% resolve spontaneously by 1yo

  • stretching 5x at each diaper change
  • when greater than 8 mo: biweekly casting
  • extreme adduction of great toe: surgical release of abductor hallucis 6-18mo of age

Most likely cause: intrauterine restriction

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12
Q

Axial Rotation:

  • Toe in
  • -results from what?
  • Toe out
  • -results from what?

Tx

A

Toe In:

  • internal femoral torsion (too much hip anteversion; from W sitting)
  • internal tibial torsion (MC)
  • metatarsus adductus

Toe Out:

  • external femoral torsion (too much hip retroversion)
  • external rotation contracture
  • external tibial torsion
  • flat foot

Tx:

  • infant: good sleeping positions
  • Toddler: good sitting habits, nocturnal bar (Dennis Browne Bar), weekly corrective cast for 4-5wks if no better by age 4.

Surgery:

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13
Q

Idiopathic Toe Walking

  • what?
  • seen in children of what age?
  • tx
A

what: walk with toe - toe gait pattern in absence of any known cause

Seen in children less than 4yrs

Tx:

  • heel-cord lengthening if does not subside after 4yrs
  • PT/OT
  • orthotics
  • serial casting
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14
Q

Flat Foot

  • what is this?
  • when do arches form?
  • tx
A

What: immature foot - normal variant
-low arch heel valgus

Arches start to form around age 4

tx: no need, can try wedge

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15
Q

Genu Varum

  • what is this?
  • causes
  • tx

Genu Valgum

  • what is this?
  • tx
A

Varum: bow legs
Causes: vit D deficiency (Rickets), blounts dz
Tx: usually corrects by age 2.

Valgum: knock knees
Tx: most correct spontaneously, after age 11-13 may need surgery for marked deformity

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16
Q

Slipped capital femoral Epiphysis

  • what is this?
  • MC at what ages?
  • increased frequency with what associated disorders?
  • sx
A

what; that ball at the upper end of the femur slips off in a backward direction d/t weakness in growth plate. (grow faster than what your growth plates are ready for)

MC from 9yrs - end of growth

Increased frequency w/

  • endocrine disorders
  • hypothyroid
  • renal dz
  • growth and sex hormone imbalance
  • obesity

Sx;

  • unstable: sudden severe pain with limp
  • stable: limp w/ groin pain, variable knee and anterior thigh pain
17
Q

Slipped Capital Femoral epiphysis

  • dx
  • complications
  • tx
A

dx: XRAY: AP & frog leg lateral
complications: avascular necrosis, chondrolysis, osteoarthritis

Tx: immediate referral; surgical pin or screw placement.

18
Q

Radial head Dislocation

  • aka
  • what is this?
  • sx
  • dx
  • tx
A

aka: nurse maids elbow
what: subluxation or dislocation injury from sudden pull of childs arm

Sx: elbow locked in sligh flexion w/ forearm pronation, swollen, tender to palpation of radial head

Dx:
Xray often normal

Tx: gentle supination of hand while flexing elbow with thumb placing gentle pressure over radial head.

19
Q

What are the 5 types of Growth Plate Fractures?

A 
Salter Harris Classifications: 
Slipped 
Above 
Lower 
Through 
Rammed
20
Q

Suprecondylar Humerus Fracture

  • occurs from what type of injury
  • MC nerve injured?
  • What other things need to be considered with this fx?
  • Tx
A

Occurs from fall on an outstretched hand; ligamentous laxity and hyperextension of the elbow are important mechanical factors.

MC injured nerve is the anterior interosseous nerve.

Need to make sure vasculature, nerves, and musculature are all still intact.

Tx: long arm cast for stable/non-displaced fx
-percutaneous fixation with K wires for unstable fxs.

21
Q

Wrist Forearm fxs:

  • Torus (buckle) Fx
  • -tx
  • Greenstick

-Complete

A

Torus Fx: no reduction needed, if greater than 48hrs old ok to cast at first visit otherwise splint and cast at 5-7days.

Greenstick: short arm cast if non-displaced. if displaced greater than 15degrees reduce and immobilize in long arm splint, 4wks cast and then 2 wk splint

Complete: nondispaced short arm cast for 3-6wks . Displaced = reduce ASAP and cast

22
Q

Distal Radius Fractures:

  • MC cause
  • examine what areas?
A

MC cause: fall on out stretched hand.

Examine elbow and wrist!!! along with median and ulnar nerves.

23
Q

What is the MC pediatric fx?

A

Clavical Fx

24
Q

Clavical Fx:

  • where is the most common place of fx?
  • tx
A

Most are fx in the middle third of the clavical

Tx: stable injuries treat with sling or figure of 8 splint

25
Q

Osteochondrosis

  • what is this?
  • causes
  • examples
  • tx
A

What: pain at tendonous insertions at secondary ossification centers

Cause:

  • increased activity level
  • increase in mass
  • puberty

Examples: Osgood Schlatter (patellar tendon-tibial tuberosity)
-Sever Dz (achilles-calcaneus)

Tx:
-conservative: Rest, NSAIDS, ice, PT, Cast/boot(Severs Dz)

-surgical: indicated for avulsion of apophysis greater than 1cm

26
Q

Osgood Schlatter:

  • what is this?
  • tx
A

What: inflammation where patellar tendon inserts on the tibia.

Prominent tender tibial tubercule

Tx:

  • majority of time pt outgrows it
  • eccentric
  • steroid
  • brace/pressure band
  • excision of detached/fragmented bone
27
Q

Patello-feoral arthralgia

  • aka
  • what is this?
  • sx
  • dx
  • tx
A

aka: chondromalacia Patellae

What: sore kneecap, inflammation of articular surface of patella

Sx:

  • overuse more than acute injury
  • anterior knee discomfort, pain with stairs, cant sit with bent knee
  • tight hamstrings &/or quads

Dx: clinical

Tx:

  • rest, PT, Ice, NSAIDS, patellar stabilization brace
  • surgery rarely indicated.
28
Q

SPondylolysis;

  • what is this?
  • cause
  • sx
  • dx
  • tx
A

What; stress fracture of pars

Cause: repetitive hyperextension of back (gymnastics, football, wrestling, rowing)

Sx: progressive low back pain with activity

Dx;
Xray, CT, or bone scan, MRI*

Tx: rest, brace, rare cases fusion.

29
Q

Acute Septic Arthritis:

  • cause
  • MC joint affected
  • Most common bug
  • sx in infant
  • sx in older children
A

Cause: pyogenic bacteria invade a synovial joint, peds have close association of osteomyelitis.

MC joint affected is hep and elbow

MC bug is Staph aureus

Sx: INFANT

  • few sx
  • tender
  • warmth over joint
  • pseudoparalysis
  • fever

Sx; OLDER CHILD

  • severe pain, pain with passive motion
  • protective muscle spasm
  • tenderness
  • fever
  • elevated WBC, ESR/CRP
30
Q

Acute Septic Arthritis:

  • Dx
  • tx
A

Dx: C&S blood, urine

  • xray, US
  • immediate needle aspiration
  • -culture and sensitivity
  • -gram stain
  • -crystals

Tx: immediate referral for surgical I&D
Emperic IV abx (3rd gen cephalosporin and penicillinase resistant synthetic penicillin, MRSA covered by clinda or vanco)

31
Q

Open Fx:

  • what is this?
  • tx
A

What: fracture with overlying skin compromise; this may be subtle (tenting)

Tx: immediate referral to ortho. Must be washed out within 24hrs

Peds 1 (12 decks)

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