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Ortho > Peds Ortho > Flashcards

Peds Ortho Flashcards

1
Q

What is Legg-Calve-Perthes Disease? Age range?

A
  • idiopathic osteonecrosis of the femoral head in kids
  • sequence of femoral head fragmentation and repair
  • age range: 4-8 commonly (2-12)
  • 2-5x more common in boys than girls
  • 10% cases are bilateral
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2
Q

Clinical presentation of Legg-Calve-Perthes disease?

A
  • prolonged limping or waddling gait w/ pain in thigh, groin or knee
  • 90% have delay in bone age and short stature
  • bilateral LCPD both hips usually don’t become sx at same time
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3
Q

Dx LCPD?

A
  • AP and lateral view of hip
  • wrist and hand films for bone age
  • AP pelvis w/ hips abducted to determine containment
  • bone scan w/ pinhole collimation
  • MRI
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4
Q

Etiology of LCPD?

A
  • anterolateral portion of head is commonly involved
  • the ascending lateral cervical vessels from medial femoral circumflex artery
  • circulation is less developed in 3-10 yo boys
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5
Q

Prognosis of LCPD?

A
  • if disease begins b/f 6 and tx begins b/f 8yo then you have favorable prognosis
  • adolescents fxn well in spite of poor radiographs
  • 70-80% develop arthritis in long term studies
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6
Q

Tx of LCPD?

A
  • goals: reduce pain, impove fxn, and minimize femoral head deformity
  • revascularization of femoral head
  • traction, bed rest
  • bracing: not proven to alter natural hx
  • surgery
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7
Q

What is a SCFE?

A
  • disorder in which epiphysis becomes posterior displaced on the femoral neck
  • this may lead to OA in adults or result in chondrolysis or avascular necrosis in the adolescent
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8
Q

Epidemiology of SCFE?

A
  • prevalence of 0.2/100,000 in Japan, 10/100,000 in connecticut
  • tends to occur in boys 10-17, girls 8-15, males to females 2:1
  • obesity 50% weigh more than 90% of the kids in their age group
  • bilaterally 37% for the sx slips
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9
Q

Clinical findings of SCFE?

A
  • abrupt onset of groin pain
  • longer duration of sxs, medial thigh and knee pain
  • acute: sxs less than 3 wks
  • chronic: sxs for longer than 3 wks
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10
Q

Clinical findings in SCFE?

A
  • stable: no independent movement on fluoroscopy
  • unstable: independent movement on fluoroscopy
  • pain is ocalized to anterior hip, groin or medial thigh and knee
  • child walks w/ antalgic gait w/ leg in external rotation. Passive hip flexion results in obligatory external rotation
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11
Q

Imaging studies for SCFE?

A
  • AP and lateral radiographs are most impt imaging studies
  • AP on pre-slip will show slight widening and fuzzy irregularity of the physis
  • lateral views gives the most info the percent epiphyseal displacement and the lateral head/shaft angle
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12
Q

Etiologies of SCFE?

A
  • hypothyroidism (may also be cause of obesity)
  • hypogonadism
  • parathryorid adenoma w/ growth hormone abnormality
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13
Q

Tx of SCFE?

A
  • stabilize slipping process and achieve premature closure of physis
  • single screw fixation under fluoroscopic conrol. Screw generally needs to be placed anteriorly on the femoral neck
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14
Q

What is club foot?

A 
- congenital foot deformity characterized by 4 components:
plantar flexion of ankle
inversion of heel
high arch at midfoot
adduction of forefoot 
- idiopathic 
- males 2x that of females
- familial
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15
Q

Clinical presentation of club foot?

A
  • look like they could walk on top of foot
  • plantar flexion is most severe, drawn up position of heel and inability to pull calcaneus down
  • high arch difficult to see
  • forefoot adduction
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16
Q

Tests for club foot?

A
  • R/O neuromuscular disorders

- xrays not needed unless dx unclear

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17
Q

Tx of club foot?

A
  • manipulation and casting should be started immediately
  • 2-4 months of manipulation and casting are reqd to correct club foot
  • surgery if conservative fails
  • surgery lengthens tendons and ligaments so that bones can be positioned in normal alignment
  • child can run and play after
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18
Q

What is metatarsus adductus?

A
  • common congenital deformity characterized by medial deviation of forefoot
  • 25% preterm infants
  • 13% term infants
  • often resolves spontaneously
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19
Q

Exam findings of metatarsus adductus?

A
  • convex lateral border of foot w/ palpable prominence at base of 5th metatarsal
  • hindfoot is in neutral or increased valgus
  • normal ankle dorsiflexion
  • pigeon toe
20
Q

Dx of metatarsus adductus?

A
  • serial photocopies

- heel bisector line

21
Q

Tx of metatarsus adductus?

A
  • supine sleeping position
  • delay tx until 6 mo old
  • serial casting
22
Q

Genu Varum presentation?

A
  • tibia adducted in relation to femur
  • 10-15 degrees is normal
  • straighten by 12-18 mo of age
  • after 30-36 months, bracing or surgery
23
Q

Genu Valgus presentation?

A
  • alignment of knee w/ tibia abducted in relation to femur
  • knock knees
  • observation is TOC
24
Q

Variants of Developmental dysplasia of the hip?

A
  • teratologic: fixed dislocation, occurs prenatally, usually assoc w/ NM disorder
  • unstable hip: femoral head reduced, can be fully dislocated or partially subluxated
  • dislocated hip: femoral head doesn’t articulate and may not be reducible
  • subluxated hip: femoral head contacts portion of true acetabulum
  • acetabular dysplasia: acetabulum is shallow, femoral head is subluxated or normal
25
Q

How common is DDH?

A
  • 2.7-17/1000 live births
  • 1/1000 est dislocation
  • 0.4-.0.6/1000 late dislocation
26
Q

Etiology of DDH?

A
  • physiology: ligamentous laxity (CT disorder), hormonal and familial
  • mechanical:
    prenatal, breech, oligohydramnios, primigravida, congenital knee recurvatum w/ dislocation, congenital muscular torticollis, metatarsus adductus
  • Post-natal factors:
    swaddling, strapping
  • genetic: fender is femal, left hip 3:1
27
Q

Dx of DDH?

A
  • all cases may not be detectable at birth
  • late cases aren’t always misdx cases
  • screening programs must be dynamic
  • sonography for routine screening isn’t cost effective or practical
28
Q

PE findings of DDH?

A
  • neonate
  • barlow test: hip that is reduced but is dislocateable
  • ortolani’s test: hip that is dislocated but reducable
29
Q

Imaging for DDH?

A
  • xray is diff to interpret in the very young child
  • US is useful in kids under 6 mo of age and can be effective up to 1 yo
  • arthrogram demonstrates soft tissue impediments to reduction and concentricity and stability of reduction
  • CT isn’t for routine screening but can be useful in reconstruction
30
Q

Tx of DDH?

A
  • closed reduction
  • pavlik harness can be used for up to 6 mo:
  • hip is dislocateable or dislocated and capable of being reduced
  • reduction of hip should be confirmed by 3 wks
  • this is effective 90% of time
  • AVN rate is low, less than 5%
31
Q

When is closed reduction TOC for DDH?

A
  • for pts up to 24 months of age
  • this needs general anesthesia and arthrogram guidance
  • spica cast is worn 3 months
32
Q

When is open reduction TOC for DDH?

A
  • for older kids
  • anterior and medial approach is MC
  • anterior approach is most versatile and commonly used
33
Q

Complications of DDH?

A

osteonecrosis MC complication:

  • there is a failure of appearance of ossific nucleus for period of over 1 yr following reduction
  • broadening of femoral neck over similar period
  • residual deformity of femoral head and neck
  • there is increased radiographic density followed by fragmentation

failed reduction
one needs to repeat reduction

34
Q

What is Osgood-Schlatter disease?

A
  • condition results from repetitive injury and small avulsion injuries at bone-tendon junction where patellar tendon inserts into secondary ossification center of tibial tuberosity
  • sports
  • males
35
Q

Clinical sxs of Osgood-schlatter?

A
  • pain exacerbated by running, jumping, and kneeling

- most continue all activities

36
Q

Exam and dx of Osgood schlatter?

A
  • exam reveals tenderness and swelling at insertion of patellar tendon into tibial tubercle
  • often bilateral
  • jt stable
  • xrays show soft tissue swelling, maybe small spicules of heterotopic ossification anterior to the tibial tuberosity
37
Q

Tx of osgood schlatter?

A
  • Ice, NSAIDs, protective knee pad

- decreased activity for around 2-3 months

38
Q

Diff spreads of septic arthritis?

A
  • jt infections most commonly affect kids at hip, knee, and ankle
  • hematogenous spread (staph)
  • contiguous spread (from jt)
  • direct inoculation (puncture wound)
39
Q

Sxs of septic arthritis?

A
  • pain, malaise, loss of appetite, failure to use affected jt
  • toddler refuses to walk
  • temp above 102, but neonates may not have fever
  • hip MC in kids younger than 2
40
Q

Exam and dx of septic arthritis?

A
  • swelling, tender, warmth
  • hip held in flexion, abduction, and external rotation
  • knee and elbow in flexion
  • pseudoparalysis (flacid limb) shoulder
  • AP/lateral X-rays: takes 8-14 days to show up
  • labs: CBC w/ diff, sed rate, CRP, and blood cultures
  • jt aspiration
41
Q

+ jt aspiration results in septic arthritis?

A
  • WBC greater than 50,000 mm^3
  • PMNs 90%
  • they eat sugar and protein would be increased
  • lower WBCs w/ N gonorrhoeae
42
Q

Bad outcomes of septic arthritis?

A
  • can lead to destruction of jt surface, secondary arthritis, scarring of capsule
  • osteonecrosis of femoral head
  • prognosis is good if surgical drainage and abx w/in 4 days of sxs
43
Q

Common bugs of septic arthritis?

A
  • staph aureus MC
  • GBS infants younger than 1
  • H flu 6 months-4 yrs
  • N. gonorrhoeae 12-18 yrs
  • refer early: ID and ortho needs to be involved
44
Q

Pearls of ortho?

A
  • examine jts above and below
  • xray jts above and below
  • xray opp side if unsure esp in kids/open growth plates
  • everything in ortho takes 6 wks to heal
45
Q

Osteosarcoma presentation?

A
  • 2nd most common primary bone tumor after myeloma. High risk of mets, 20% of all bone sarcomas, 2nd decade male = females, appendicular (50% knee), metaphyseal, xrays missed lytic/sclerotic w/ cortical destruction (codman’s triangle, star burst, periosteal rxn), MRI
  • then worry about other cancers as well that may met to bone: breast, prostate

Ortho (24 decks)

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