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Clin Med IV Exam III > Peds Ortho > Flashcards

Peds Ortho Flashcards

1
Q

What is Gowers sign

A
  • weakness of proximal hip muscles can limit child’s ability to rise from sitting position
  • to stand pt uses hands and arms to “climb up” the body
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2
Q

Normal gait

A
  • heel toe gait

- symmetric arm swing

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3
Q

Contractures–>

A

cerebral palsy

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4
Q

Decreased muscle tone–>

A

muscular dystrophy

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5
Q

Ligamentous laxity is greatest when

A

at infancy

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6
Q

What is ligamentous laxity associated with

A
  • developmental dysplasia of the hip
  • dislocating patella
  • pes planus
  • injury
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7
Q

Congential orthopedic problems in peds

A
  • malformation (spina bifida)
  • disruption
  • deformation (torticollis)
  • dysplasia (osteogenesis imperfecta)
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8
Q

Acquired orthopedic problems in peds

A
  • infection
  • inflammation
  • trauma
  • tumor
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9
Q

Where are the ossification centers in peds

A

at the ends of the long bones

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10
Q

What is responsible for longitudinal growth of long bones in peds

A

physis

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11
Q

What is responsible for circumferential growth of bones in peds

A

periosteum

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12
Q

Pediatric bones have more ___ than adults

A

cartilage

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13
Q

What does the high amount of cartilage allow for in peds

A

skeletally immature patients to withstand more force before deformation or fracture than adult bone

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14
Q

What part of the bone is thicker in kids than adults

A

periosteum

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15
Q

Acute limp in kids can be what things

A
  • transient synovitis
  • contusion
  • foot foreign body
  • fracture
  • osteomyelitis
  • arthritis (septic, reactive, lyme)
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16
Q

Chronic limp in kids can be what things

A
  • rheumatic disease
  • apophysitis
  • slipped capital femoral epiphysis
  • Legg Calve Perthes disease
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17
Q

Trendelenburg gait is what

A

normal stance phase, but excessive swaying of the trunk

*drop of the pelvis when lifting leg opposite to weak gluteus medius

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18
Q

Antaligic gait

A
  • painful limp

- stance phase and stride of affected limb shortened to decrease discomfort of weight bearing on affected limb

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19
Q

Waddling gait

A

bilateral decrease in function of gluteus muscles

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20
Q

Kids are more likely to require internal fixation with what things

A
  • displaced epiphyseal fractures
  • displaced intra articular fractures
  • fracture in child with multiple injury
  • open fracture
  • unstable fracture
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21
Q

Pedi fracture remodeling occurs through what two things

A
  • periosteal resorption

- new bone formation

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22
Q

Complications of fractures

A
  • overgrowth
  • neurovascular injury
  • compartment syndrome
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23
Q

Injuries to the physis can result in what

A

premature closure

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24
Q

Growth plate is most susceptible to what

A

torsional and angular force

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25
Q

If there is partial closure of growth plate what is the consequence? Complete closure?

A

partial–> angular deformity

complete–> limb shortening

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26
Q

Salter-Harris for what type of fracture

A

physeal fracture

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27
Q

Common sites of salter-harris fx

A
  • distal radius
  • dital tibia
  • distal fibula
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28
Q

Most common salter-harris fx

A

type II

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29
Q

Salter-Harris type I

A

fracture through growth plate

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30
Q

Salter-Harries type II

A

fracture through metaphysis and growth plate

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31
Q

Salter-Harris type III

A

fracture though epiphysis and growth plate

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32
Q

Salter-Harris type IV

A

fracture through metaphysis and epiphysis

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33
Q

Salter-Harris type V

A

crushed through growth plate

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34
Q

Greenstick fracture results from what

A

bending force applied perpendicular to shaft

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35
Q

How does a toddlers fx present

A

limping and pain with weight bearing with minimal swelling

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36
Q

What is a toddlers fracture

A

minimally or undisplaced oblique/spiral fractures of tibia without fibula fracture

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37
Q

Buckle fracture occurs after what

A

compression of the bone

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38
Q

Does the bony cortex break in a buckle fracture

A

nope

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39
Q

Bowing fracture?

A

not a true fracture, bone appears to be bent on x-ray

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40
Q

Treatment of bowing fracture

A

reduction requires a lot of force, do under general anesthesia

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41
Q

What is helpful in identifying a bowing fracture

A

comparison view of the other extremity

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42
Q

Supracondylar elbow fracture

A

extra articular fracture of distal humerus at elbow

caused by fall on extension

43
Q

Displacement with a supracondylar elbow fracture?

A

posterior displacement of the distal component

44
Q

Treatment for supracondylar elbow fracture

A

Conservative

  • long arm cast
  • analgesics
  • serial radiographs q2wks

ORIF- two lateral pin technique with medial pin

45
Q

Presentation of nursemaids elbow

A

pronated and painful elbow

46
Q

Treatment for nursemaids

A

pressure on radial head and gentle supination while flexing the elbow

47
Q

Galeazzi fracture dislocation

A
  • fracture of distal radius

- dislocation of distal radioulnar joint

48
Q

What causes a galeazzi fracture

A

FOOSH w/ flexed elbow

49
Q

Monteggia fracture dislocation

A
  • fracture of ulna shaft (displaced and overlapped)

- dislocation of radial head (anteriorly)

50
Q

Standard of care for Monteggia fracture dislocation

A

ORIF

51
Q

Mnemonics for Galeazzi/Monteggia

A 
Grimus
G: Galeazzi
     R: radius
     I: inferior
M:Monteggia
    U:ulna
     S:superior
52
Q

Why is the blood supply to the hip unique in peds

A

blood vessels are extraosseous and lie on the surface of the femoral neck, entering epiphysis peripherally

53
Q

What three things are under the category of developmental dysplasia of the hip

A
  • hip that is dislocated and irreducible
  • unstable (dislocatable and reducible)
  • dysplactic, but withing the acetabulum
54
Q

Risk factors for DDH

A
  • first born
  • female
  • breech birth
  • positive family history of hip dysplasia or early total hip replacement
55
Q

Associated diagnoses with DDH

A
  • congential knee dislocations
  • congenital muscular totricollis
  • metartarsus adductus and/or clubfoot
56
Q

Presentation of DDH

A
  • toe walking, can be unilateral
  • limb length inequality
  • waddling gait
  • hyperlordosis
57
Q

Tests for DDH

A
  • galeazzi test
  • barlow test
  • ortolani test
58
Q

Treatment of DDH

A

-pavlik harness
-abduction orthosis
-if all conservative measures fail of >6mnth at diagnosis:
closed reduction
open reduction if above failed
spica cast to hold hips in place

59
Q

Legg-Calve Perthes

A

idiopathic osteonecrosis of capital femoral epiphysis

60
Q

Presentation of LCP

A
  • boy
  • small for age
  • delayed bone age
  • very active or hyperactive
  • pain may be non specific
  • mild limp
  • usu no hx of trauma
61
Q

What are the four stages of LCP

A

Necrosis: initial period of ischemia/loss of blood supply to femoral head

Fragmentation: re-absorption of bone w/ femoral head collapse

Re-ossification: new bone re-growth to reshape the femoral head

Remodeling: femoral head reshapes itself into spherical shape

62
Q

PE for LCP

A
  • limp
  • limited motion–> abduction and internal rotation
  • atrophy of quad
  • leg length inequality due to collapse of femoral head
63
Q

Imaging for LCP

A

AP pelvis and frog lateral

64
Q

Treatment of LCP

A
  • reduce activities
  • crutches, walker, wheelchair
  • NSAIDs
  • referral to peds ortho for surgical intervention
65
Q

Slipped capital femoral epiphysis

A

disorder of proximal femoral physis that leads to slippage of epiphysis relative to femoral neck

66
Q

Risk factors for SCFE

A
  • obesity
  • males more than females
  • occurs during period of rapid growth
67
Q

Clinical presentation of SCFE

A
  • can be bilateral
  • groin/thigh pain most common
  • knee pain
  • gait: external rotation or trendelenburg
  • decreased hip motion
68
Q

Xrays for SCFE

A

ap hip and frog lateral

69
Q

Treatment for SCFE

A
  • percutaneous in situ fixation
  • stabilize epiphysis from further slippage
  • promote closure of the proximal femoral physis
70
Q

Most common cause of hip point in children

A

transient synovitis

71
Q

What does transient synovitis of the hip typically follow

A

an URI =/- fever

72
Q

Clinical presentation of transient synovitis of the hip

A
  • rapid onset of limping and subsequent refusal to walk/bear weight
  • limited ROM d/t pain and spasm, hip held in flexion
73
Q

What must you exclude for a diagnosis of transient synovitis of the hip

A

septic arthritis

74
Q

Hip aspiration for transient synovitis?

A

only when the ESR is >20mm/hr

75
Q

Treatment of transient synovitis of the hip

A
  • bed rest
  • gradual increase of activity
  • NSAIDs
76
Q

Prognosis of transient synovitis of the hip

A

symptoms resolve and range of motion returns to normal

77
Q

Osgood-Schlatter?

A

transient apophysitis in adolescents

78
Q

Characteristic pain of Osgood-Schlatter

A

pain over the tibial tuberosity relieved with rest

can be bilaterally

79
Q

PE for Osgood-Schlatter

A

-prominent tibial tubercle

+/- swelling, redness

80
Q

Treatment of Osgood-Schlatter

A
  • rest
  • ice
  • NSAIDs
  • reassurance
81
Q

Sever’s disease aka

A

calcaneal apophysitis

82
Q

When does Sever’s disease occur

A

during adolescence particularly during a growth spurt

83
Q

What causes pain in Sever’s disease

A

repetitive stress on the groth plate as foot strikes the ground

84
Q

Clinical presentation of Sever’s

A
  • heel pain bad enough to cause a limp
  • usu first noticed after sports
  • pt will often report new cleats or foot wear
85
Q

Treatment of Sever’s

A
  • RICE
  • DC sports if sx severe
  • gel heel pads or heel inserts
  • NSAIDs
  • stretching of Achilles’
86
Q

Growth plate with physiologic genu varum?

A

normal

87
Q

Worrisome clinical features of genu varum

A
  • lateral thrust during gait
  • short stature
  • ligament laxity
  • abnormal location of the deformity
  • apparent enlargement of the elbow, wrists, knees and ankles
88
Q

When do you do xrays with genu varum

A
  • asymmetry
  • atypical age
  • worsening deformity
89
Q

Pathological bow legs?

A
  • osteochondral dystrophy
  • rickets
  • tibia varum
90
Q

Risk factors for Blount’s disease

A
  • early walking
  • obesity
  • family history
91
Q

Signs of rickets

A
  • short stature

- enlargement of elbow, wrists, knee, ankles

92
Q

Genu valgus—>

A

knock knees

93
Q

What should be considered if a child is walking on their toes

A
  • cerebral palsy
  • tethered cord
  • achilles tendon contracture
  • possible leg length discrepancy
94
Q

Treatment of idiopathic toe walking

A
  • physical therapy
  • serial casting
  • surgical heel cord lengthening
95
Q

What must be ruled out before a patient can be diagnosed with idiopathic toe walking

A
  • neuromuscular disorder
  • cerebral palsy
  • autism
96
Q

Club foot is what kind of rotation

A

equinus, adductus, varus and medial rotation

97
Q

Treatment of club foot?

A

surgery or serial casting

98
Q

Diagnosis of club foot should prompt what

A

a search for other MS problems

99
Q

3 types of scoliosis

A
  • idiopathic: most common
  • congenital: vertebral abn
  • neuromuscular: underlying d/o
100
Q

Cobb angle great than what = scoliosis

A

10 degrees

101
Q

What should you observe for when doing a PE for scoliosis

A

-one shoulder being higher than the other
larger space from arm to side of body
-uneven waist crease
-uneven hip levels

102
Q

What is the Risser staging used for

A

used to grade skeletal maturity based on level of ossification and fusion of iliac crest apophyses

103
Q

Treatment for scoliosis

A

<25: observe
25-45: brace
>50: surgery

Clin Med IV Exam III (8 decks)

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