Peds ortho Flashcards
Legg-Calve Perthes Dz:
- What is this?
- MC in which ages?
- MC in boys or girls?
- cause
- presentation
- dx
- tx
What: osteonecrosis of the femoral head in children
MC in 4-8YO
MC in boys
Cause: idiopathic; lack of blood flow (AVN)
Presentation:
- prolonged limp or waddling gait with pain in the thigh groin or knee.
- delay in bone age/short stature
Dx:
- AP and lateral view of the hip
- wrist and hand films for bone age
- AP pelvis with hips abducted to determine containment
- Technetium-99m BONE SCAN
- MRI
Tx:
- reduce pain, improve function, minimize femoral head deformity
- revascularization of femoral head
- traction, bed rest
- surgery
Slipped Capital Femoral Epiphysis -what is this? -consequences? -MC in which gender/age? -clinical presentation -
What: epiphysis becomes posterior displaced on the femoral neck.
Consequences:
-leads to osteoarthritis in adults or avascular necrosis in adolescents.
MC in obese males ages 10-17YO
Clinical presentation:
- abrupt onset of groin pain w/o trauma
- anterior hip, groin, medial thigh and knee pain
- may be acute (less than 3wks) or chronic (more than 3wks)
- stable or unstable
- obligatory external rotation***
Slipped Capital Femoral Epiphysis:
- dx
- associated disorders
- tx
Dx:
- AP and lat XRAY***
- lateral gives most info on % displacement
Associated disorders:
- hypothyroidism
- hypogonadism
- parathyroid adenoma w/ growth hormone abnormality
Tx:
- stabilize slipping process
- single screw fixation (Surgery!)
Club Foot:
- what is this?
- deformity characteristics
- cause
- MC in which gender?
- Clinical presentation
WHat: congenital foot deformity.
Deformity characteristics: (KNOW THIS)
- plantar flexion of ankle
- inversion of heel
- high arch
- adduction of forefoot
Cause: idiopathic, familial
MC in males
Clinical presentation:
- look like they could walk on top of foot.
- refer to characteristics of deformity.
Club foot:
- dx
- tx
Dx:
- xray not needed.
- clinical
- *though, XRAY is used for all the surgical planning.
Tx:
- manipulation and casting immediately (2-4mo)
- surgery if conservative fails (lengthens tendons and ligaments so the bones can be positioned in normal alignment
Metatarsus Adductus:
- congenital deformity?
- PE exam findings
- Dx
- tx
Congential deformity: medial deviation of the forefoot (pigeon toed)
PE findings:
- convex lateral border of foot w/ palpable prominence at base of 5th metatarsal
- hindfoot is neutral or increased valgus
- normal ankle dorsiflexion
**Middle heal should go through the second and 3rd toe in normal individual.
Dx:
- serial photocopies of the footprints
- heel bisector line
Tx:
- supine sleeping
- delay tx until 6mo old
- serial casting
Genu Varum :
- what is this?
- tx
Genu Valgus:
- what is this?
- tx
Varum:
What: tibia adducted in relation to the femur
Tx: straightens by 12-18mo of age, if not corrected by 30-36mo bracing or surgery.
Valgus:
WHat:
-alignment of knee with the tibia abducted in relation to femur
-Knock knees
Tx: observation is the tx of choice.
Developmental Dysplasia of the HIp:
-what are the variants?
Variants:
-Teratologic: fixed dislocation
- unstable hip: femoral head is reduced, can be fully dislocated or partially subluxated.
- dislocated: femoral head does not articulate and may not be reducible.
- subluxated hip: femoral head contacts a portion of the true acetabulum.
- acetabular dysplasia: acetabulum is shallow, femoral head is subluxated or normal
Developmental Hip Dysplasia:
- what is this?
- cause
- MC in which gender?
- MC in which hip?
What: congential dislocation of the hip resulting in hip dysplasia (abnormal growth of the hip)
Cause:
- ligamentous laxity, hormonal, and familial
- -Mechanical factors:
- prenatal
- breech
- oligohydramnios
- primigravida
- congenital muscular torticollis
- metatarsus adductus
- -Post-natal factors:
- swaddling
- strapping
MC in female
MC in left hip
Developmental Hip Dysplasia:
- PE findings
- imaging
- tx
- complications
PE:
-Barlow + (hip is reduced but is dislocatable)
-Ortolanis + (hip that is dislocated but reduceable.)
Imaging:
- US
- arthrogram
Tx:
- closed reduction (preferred tx up to 24mo YO)
- pavlik harness up to 6mo age
- open reduction (generally for older children)
Complications:
- osteonecrosis
- broadening of the femoral neck
- deformity of the femoral head and neck
- failed reduction
Osgood-Schlatter Dz:
- what is this?
- MC cause
- MC gender
- clinical sx
- dx
- tx
What: small avulsion injuries at the bone-tendon junction where the patellar tendon inserts into the tibial tuberosity.
MC cause: sports
MC gender: males
Sx:
-pain exacerbated by running, jumping, and kneeling
Dx:
- tenderness and swelling at the tibial tubercle
- often bilateral
- stable joint
- XRAY: soft tissue swelling
Tx:
- Ice, NSAIDS, protective knee pad
- decreased activity 2-3mo
Septic Arthritis:
- MC locations
- spread?
- sx
- dx
MC infection in the hip*, knee, ankle
Spread:
-hematogenous, contiguous, direct inoculation
Sx:
- pain, malaise, loss of appetite, failure to use affected joint.
- toddler refused to walk
- Temp above 102, neonates may not have a fever.
Dx: ABRUPT ONSET -swelling, tender, warmth -hip held in flexion, abduction, and external rotation -knee and elbow flexion -pseudodparalysis -AP/LAT xrays (8-14d to show up) Labs: CBC w/ diff, sed rate, CRP, blood cultures -Joint aspiration
Septic Arthritis: Joint aspirate:
- what types of cells are found?
- sugar?
- protein?
Cells: WBC greater than 50,000, PMN 90% (leukocytes)
Sugar: low
Protein: increased (leaking)
**Lower WBC with N. Gonorrhoeae
Septic Arthritis:
- tx
- complications
- MC Cause in infants/adults
Tx:
- surgical drainage
- abx within 4day of sx
Complications:
- destruction of joint surface
- secondary arthritis
- scarring of capsule
- osteonecrosis of femoral head
MC cause in infants younger than 1 = Group B strep
MC cause in population is staph aureus
