Peds Ortho Problems Flashcards
what is responsible for longitudinal growth of long bones?
physis (growth plates)
where are ossification centers of child bones?
at ends of the long bone
when is ligamentous laxity greatest in children?
at infancy
what is trendelenburg gait?
excessive swaying of trunk with normal stance
what muscle stabilizes pelvis during stance phase and prevents the pelvis from dropping toward leg in swing phase?
gluteus medius
what is antalgic gait?
painful limp
what is bilaterally decreased in function with waddling gait? what disease is it seen in?
bilateral decrease in fxn of gluteus muscles
seen in muscular dystrophy
cause of acute limping in children?
transient synovitis
what is the MCC of hip pain in kids?
transient synovitis
what is characteristic of transient synovitis?
resolution of sx’s and return of ROM
what is transient synovitis? is there an infection?
self-limiting inflammatory condition of hip
THERE IS NO INFECTION
what are sx’s of transient synovitis? ROM of hip?
rapid onset limping and refusal to walk/bear weight
ROM of hip limited by pain and spasm
how is hip held in transient synovitis?
hip held in flexion
dx of transient synovitis?
dx of exclusion
tx of transient synovitis?
bed rest until s/s improve
gradually increase activity (NWB lasts 1-2 days)
NSAIDs
***NO ABX b/c NO INFECTION!!!
what MUST you exclude on your ddx of transient synovitis?
septic arthritis -> more severe pain
what are 3 causes of chronic limping in children?
Apophysitis (Osgood Schlater, Sever’s disease)
Slipped capital femoral epiphysis
Legg Calve Perthes Disease
what is apophysitis?
painful inflammation of a bony outgrowth and especially the area of active growth at the end of bone
what are the 2 types of apophysitis?
Osgood Schalter and Sever’s disease
what is Osgood Schlater disease?
traction of apophysitis in adolescent girls and boys
presentation of Osgood Schlater?
pain over tibial tuberosity relieved with rest
prominent tibial tubercles, redness
tx of Osgood Schlater?
rest, ice, NSAIDs, reassurance
what is Sever’s disease?
apophysitis at insertion of achilles tendon into calcaneus
what is a common cause of Sever’s disease?
repetitive stress from running/jumping on growth plate as foot strikes ground and results in inflammation/pain
Sever’s disease occurs during what?
growth spurts
s/s of Sever’s disease?
child/adolescent with heel pain bad enough to cause limp
when is Sever’s disease usually first noticed?
after sport then during and after and w/new cleats
tx of Sever’s disease?
RICE and NSAIDs
D/C sport if severe enough
Symmetric gel heel pads if moderate
Achilles stretch
what is slipped capital femoral epiphysis?
d/o of proximal femoral physis that leads to slippage of epiphysis relative to femoral neck
what is the most common d/o affecting adolescent hips?
slipped capital femoral epiphysis
what is the greatest RF of slipped capital femoral epiphysis?
obesity
what are the MC sx’s of slipped capital femoral epiphysis?
groin and thigh pain
what’s the gait like for slipped capital femoral epiphysis? hip motion is what?
external rotation or trendelenburg
decreased hip motion
imaging for slipped capital femoral epiphysis?
AP Hip and Frog Lateral
what is the treatment of choice for slipped capital femoral epiphysis?
percutaneous in situ fixation
why should you not mixx the dx of slipped capital femoral epiphysis?
b/c abnormal gait and external rotation of leg are permanent
what can you have and can you NOT have when fixing peds fx?
you can have angulation BUT NOT rotation
complications of peds fx’s?
overgrowth, neuromuscular injury, compartment syndrome
<10 y/o with femoral fx can overgrow how much?
1-3cm
what can result in premature closure of the physis (growth plates)?
growth plate fx’s
complete closure of physis before it should be closed can result in what? most common in what bones?
limb shortening
MC in distal femur and distal/proximal tibia
how are growth plate fx’s classified?
Salter-Harris
what are common sites for physis fx’s?
distal radius, tibia, fibula
what is Salter-Harris Type 1?
transverse fx through physis
S for straight through
what is Salter-Harris Type 2?
fx through part of physis and metaphysis
A for above
what is the MC type of Salter-Harris fx?
Type 2 - fx through part of physis and metaphysis
what is Salter-Harris Type 3?
fx through physis and epiphysis into joint (intra-articular)
L for lower
what is Salter-Harris Type 4?
fx through metaphysis, physis, epiphysis
T for through
what is Salter-Harris Type 5?
crush injury of physis - not displaced, but damaged by direct compression
ER for ERasure of growth plate or cRush
what confirms dx of Salter-Harris Type 5?
growth arrest, complete obliteration or diminished physical distance confirms dx
what is Toddlers Fx?
minimally/displaced oblique spiral fx of tibia w/out fibula fx
supracondylar elbow fx due to?
FOOSH from moderate height into fully extended elbow -> falling from monkey bars
posterior displacement of the distal component
tx of supracondylar elbow fx?
long-arm cast
ORIF
tx for nursemaids elbow?
pressure on radial head and gentle supination while flexing the elbow
what happens in nursemaids elbow?
radial head is subluxed
what is Monteggia Fx dislocation? MOA? Tx?
fx of ulna shaft with anterior dislocation of radial head
MOA is secondary to FOOSH
Tx is ORIF
what is Galeazzi Fx dislocation? MOA?
fx of distal radius with dislocation of the distal radioulnar joint
MOA is FOOSH
what is intact in Galeazzi Fx?
ulna proximally
wha are the anatomic abnormalities of developmental dysplasia of the hip?
hip that is dislocated and irreducible
unstable (dislocatable and reducible)
dysplastic, but within acetabulum (Femoral head isn’t rounded)
