peds67 Flashcards
management of osteomyelitis
antibiotics for 6 weeks; when ESR goes down, can start oral abx; surgery to drain abscess if fever and swelling for >48 hours
complications of osteomyelitis
spread of infection; chronic osteomyelitis; pathologic fracture; angular deformity or limb length discrepancy
in-toeing
most is normal and corrects with growth
causes of in-toeing
metatarus adductus (medial curvature of the midfoot); talipes equinovarus (clubfoot); internal tibial torsion; femoral anteversion
metatarsus adductus
medial curvature of the mid-foot
metatarsus adductus- what age and cause?
kids less than 1; caused by intrauterine constraint
clinical features of metatarsus adductus
C-shaped foot that can be straightened by manipulation; ankle can’t dorsiflex
management of metatarsus adductus
observation, exercises, if foot is stiff and cannot be straightned, refer to ortho for possible cast
talipes equinovarus
clubfoot; fixed foot in inversion with no flexibility; bilateral in 50% of cases
etiology of clubfoot
fam hx; associated with DDH, myelomeningocele, myotonic dystrophy, and some skeletal dysplasias;
treatment of clubfoot
casting within the first week of life; surgical correction may be necessary if does not improve
internal tibial torsion
medial rotation of the tibia, causing the foot to point inward
most common cause of intoeing in kids less than 2
internal tibial torsion
cause of internal tibial torsion
uterine positioning
clinical features of internal tibial torsion
foot points medially; bilateral most commonly; present at birth but noticed when kid starts to stand
management of internal tibial torsion
observation only; usually improves by 3 yo and resolution by 5 yo
femoral anteversion
inward angulation of the femur
most common cause of in-toeing in kids over 2 years
femoral anteversion
clinical features of femoral anteversion
feet and patella point medially; hips are able to internally rotate more than normal; kid prefers to sit in W position
management of internal tibial torsion
observation only; usually resolves by 8 yo
out-toeing major cause
calcaneovalgus foot (flexible foot held in lateral position)
out-toeing cause
uterine constraint
clnical features of out-toeing
flexible foot with toes pointed outward; plantar flexion is restricted and foot is excessively dorsiflexed
management of out-toeing
stretching the foot; rarely, casting may be needed
bowed legs
aka genu varum; symm bowing of the legs in kids less than 2
clinical featuers of bowed legs
“cowboy stance”; normal gait;
when to order a radiograph for bowlegged
only if bowing is unilateral, is severe, or perists after 2 years of age to assess for pathologic bowing (rickets, growth plate injury)
management of bowing
observation; bracing not necessary; resolved by 2 yo
blount’s disease
aka tibia vara; progressive angulation a the proximal tibia
classic kid for blount’s disease
obese african american boys who are early walkers; thought to be result of overload injury to the medial tibial growth plate
clinical features of blount’s disease
angulation just below the knee; lateral thrust with gait (shifting weight away from midline when walking)
when should blount’s disease be suspected?
any kid with progressive bowing, unilateral bowing, or persistent bowing after 2 yo; dx with AP radiograph
metaphyseal-diaphyseal angle of greater than 11 deg in lower extremity
Blount’s disease
management of blount’s disease
bracing for 1 year; surgical osteotomy of no improvement w bracing
prognosis for blount’s disease
osteoarthritis common if angulation not corrected; recurrance of angulation common in obese kids or if treatment started after 4 yo
knock-knees
aka genu valgum; idiopathic angulation of the knees toward the midline
cause of knock-knees
usually overcorrection of normal genu varum
clinical features of knock knees
separation of ankles when standing erect; lateral swinging of legs when walking
management of knock knees
observation; surgery only if it persists after 10 yo or causes knee pain
prognosis for knock knes
spontaneously resolves in majority of patients; osteoarthritis may occur if persists beyond adolescence
osgood-schlatter disease
inflamm or microfracture of tibial tuberosity caused by overuse injury
age of onset for osgood-schlatter
10-17 yo; happens in kids who play sports like basketball or soccer w repetitive jumping
clinical features of osgood shlatter
swelling of tibial tuberosity and knee pain with point tenderness over the tibial tubercle; pain worsens with running/jumping
management of osgood-shlatter
rest, stretchign of quads and hamstrings, and analgesics
patellofemoral syndrome
slight malalignment of the patella that causes knee pain; common in adolescent girls
clinical features of patellofemoral syndrome
knee pain directly under or around the patella; pain worse with activity and relieved w rest; phys exam shows patella in lateral position
diagnosis of patellar femoral sydnrom
hx and pe; a “sunrise view” radiograph of the knee may show he patella in a lateral position
management of patellofemoral syndrome
rest, stretching and strengthening of the medial quadriceps
growing pains
idiopathic bilateral leg pains that occur in the late afternoon or evening but do not interfere w play during the day
growing pains in what age group
very common; occur in 4-12 year olds
