peds ortho surg Flashcards
def. hip dysplasia
abnormal dev. of the femoral head and acetabulum
spectum of instability (5)
- subluxatable
- dislocatable
- subluxated (Reducible)
- dislocated (reducible)
- irreducible
5 risk factors for DDH
- breech
- fam hx
- female
- 1st born - less room
- swaddled babes
nat Hx of DDH
- leg length discrepancy
- scoliosis
- ipsilateral knee pain and deformity
- gait abnormal
- low back pain
- degen arth
4 clinical tests for DDH
- assymetric abduction (should be >45)
- barlow’s (clunk when hips adducted)
- ortolani (clunk when hip abducted and upward)
- galeazzi - shorter thigh segment
5 DDH findings in children >3months
- instability rare
- limited ROM
- leg lenght disc
- painless limp
- imaging studies
2 imaging studies and indications
- US
- coronal and trans planes
- high risk bbs - x-rays
- when ossific nucleaus begun
what are AAP guidelines for DDH
- screen all before discharge
- 2-week exam
- well baby exams until walking
- barlow or ortolani - refer
- imaging at 3-4 weeks for risk factors
- refer if imaging prostive
DDH mgmt
- pavlik harness up to 6 months
- full time for 6 weeks
- U/s to confrim reduction
- abandon if not better in 3 weeks
- night time for 6 weeks
- effective in majority
- not extra diapers
2ry mgmt of DDH
- closed reuction with spica cast
- for failure of harness
- older than 6 mo
- adductor tenotomy
DDH surgical mgmt
- open reduction and casuloraphy
- pevic osteotomy after 18 months
- femoral shrotening in older child
- risk of avasc. necrosis
def. clubfoot
talipes equines varus
- male>female
- diagnoses prenatally
- fam hx
4 idiopathic clubfoot etiologies
- mechanical
- neuromucular
- arrested fetal dev.
- inherited
4 syndromic causes of clubfoot
- spina bifida
- arthrogryposis
- cerebral palsy
- polio
5 findings in club foot
- hindfoot equinus
- deep posterior crease
- empty soft heel
- hinffoot varus
- midfoot cavus
what is calcaneovalgus foot
not clubfoot
- will fix spontaneously
6 treatment goals for clubfoot
- plantigrade
- flexible
- painless
- normal shoe wear
- funcitonal
- close to normal appearance
what is ponsetti treatment
- manipulation prior to each casting
- weekly changes of cast
- CAVE sequential correction
- tenotomy of achilles
- cast for 3 more weeks
- foot orthosis to maintain
effects of ponsetti
95% eliminated surgery
- recurrence in up to 20%
- poor compliance
- need to repeat serial casting
what is surg for clubfoot
rare nowadays
- failed non-operative
- posteriomedial release of joint capsule and tendons
- pin to maintain position
- brace for 1-2 years
consequence of bow legges
- constmetic
- growth dist
- joint laxity
- joint instability
- abnormal gait
- osteoarthritis
- pain
- funct. probs
DDx for bow legs (6)
- physiologic
- blounts
- metabolic - ricket and renal
- skeletal dysplasias
- trauma
- infection
7 tumor
how does alignment change with age
swtich from varus to valgus around 2 years
6 parts to Phx
- body habitus
- general dysmorphia
- static assessment of alignment
- dyanmic assess of walking
- supine - ROM and joint stability
- prone - torsion profile
features of physiologic genu varus
- early walker
- Fam Hx
- bilateral
- femur and tibia bowed
- no joint laxity
- normal physes
features of infantile blount’s
- onset as toddler
- decreased medial physial plate
- increasing varus
- in toe-ing
- varus thrust
- commonly bliat
- F>M
- obesity and blacks
mgmt of blounts
- early osteotomy (before 4)
- over correct
- role for guided growth
- litte evidence for braces
features of late onset blounts
- 5-10yo
- obesity common
- unilateral tibia vara common
- knee pain
- assess femoral alignement
mgmt of late onset blounts
- restore mech axis
- acute correction
- gradual with external fixator
- surg - minimize risk of recurrence
- earlyintervention
- over correct - consider limb length
features of ricketts
- imparied mineralization of bone
- failure of osteoid to calcify properly
- growth reatardation
- skeletal deformity
- osteopenia
- irreg. widened physes
risk for rickets
- nutrition
- prolonged breast feeding
- ## limited sun
