Test 2 Ortho Review Flashcards
What are 90% of osteogenesis imperfecta caused by?
defect in gene producing type I collagen
what are the physical findings of osteogenesis imperfecta
1) fragility of the entire skeleton
2) ligamentous laxity
3) changes in dentin and sclerae
Are there varying degrees of OI
yes
- bowing, fracture, scoliosis, pes panus, laxity of joints, deafness
What’s the treatment for osteogenesis imperfecta?
1) bracing to support joints
2) growth hormones
3) calcitonin
4) biphosphates
What are the nursing implications for OI?
- need to promote parent/baby bonding b/ they’re scared to hold the baby
- safety concerns with fragile musculoskeletal
What is the medical term for clubfoot
talipes equinovarus
when should treatment begin for talipes equinovarus?
- within the first week or two after birth
What can most infants with talipes equinovarus be treated with?
younger than 9 months then with serial casting
How often do you change plaster casts?
every 5-7 days
How many cast changes does clubfoot usually require?
5-8
what do 90% of patients experiencing talipes equinovarus require? what does this cause?
percutaneous tenotomy of the Achilles tendon? extra 3 weeks in cast
What is DDH?
developmental dysplasia of the hip: abnormal relationship between the acetabulum and femoral head #1 cause of pediatric lawsuits
What can DDH lead to?
poorly formed hips, abnormal gait pain, hip damage, and osteoarthritis
What are the S/S of DDH?
- uneven gluteal folds
- asymmetric hip abduction
- uneven knee heights
- waddling gait
How many bones are in the body?
206
What is bone matrix made out of?
calcium phosphate and collagen
What’s the difference between cortical and cancellous bone?
cortical: outside of bone, most of the mass, haversian systems connected by Volkman’s Canal
cancellous: spongy bone, highly vascularized, long bones, near joints, lots of bone marrows
What happens in the embryo musculoskeletal-wise on weeks... 3 4-5 6-7 8 9-12 13-20 20-40?
3rd: organogenesis, neural tubes form
4-5: limb buds develop
6-7: digits
8: digits separate, basic organ systems
9-12: first bone (clavicle) the skull ossify, upper limbs become proportionate but lower limbs remain short
13-20: rapid growth, lower limbs become proportionate, most bones ossify
20-40: growth continues, fetus looks more infant-like
What’s the first bone to ossify?
clavicle
are xrays useful in seeing cartilage at birth? what are ultrasounds indicated for?
- no
- hips
What is metatarsus adductus?
foot curved inwards in middle of the foot
What percent of metatarsus adductus cases occur bilaterally?
50%
Is metatarsus adductus equal incidence in m/f?
yes
Most cases of metatarsus adductus resolve by what age?
90% by 4 years of age
how do they treat metatarsus adductus?
- passive stretching
- casting
What should you check for in an infant with metatarsus adductus?
DDH and torticollis
is metatarsus adductus associated with long-term pain/debilitation?
no
What is calcaneovalgus foot?
- another packaging disorder where the foot is excessively flexed back and up (dorsiflexed hindfoot)
Can calcaneovalgus foot be passively corrected?
yes, improves by 2 months
Why would you perform an xray on a calcaneovalgus foot?
to rule out vertical talus
What else do you need to rule out with calcaneovalgus foot?
DDH, torticollis
What is VT?
vertical talus, dislocation of navicular on talus
- fixed hindfoot equinus
- midfoot dorsiflexion
- forefoot dorsiflexed and abducted
- very rigid
What are 50% of vertical talus cases associated with
- NM or genetic disorders like a) spina bifida b) arthrogryposis
does vertical talus correct itself?
no, poor prognosis if not surgically treated
What is tibial torsion?
inward twisting of the shin bones
What ages is tibial torsion common?
1-3 years old
What is the normal foot thigh angle?
0 to -15 degrees
Does tibial torsion resolv spontaneously?
yes, usually by age 6 so don’t need shoes/orthotic/PT
when do you need to perform surgery for tibial torsion?
if > -15 degrees after 6 yo
what is femoral anteversion?
twisting of proximal femur so soles of feet point out b/c of internal rotation
- greater than 70 degrees of internal rotation
- less than 20 degrees external rotation
- can typically W sit
Do you need surgery for femoral anteversion?
rarely, usually improves up until 10 yo
What is genu varum?
bowlegged (think you see curve out of legs and ovular space)
When is genu varum greatest and when does it resolve?
greatest at age 2 but resolves by age 3
In what types of children is genu varum more common?
- earlier walkers
What is Blount’s disease?
- a progressive pathologic illness of medial proximal tibial growth plate, different than just bowlegged
What is genu valgum?
- knock knees
When is genu valgum the greatest and by what age should i resolve?
greatest by age 3 (typically up to 20 degrees), should resolve by age 6 (normal is 12 degrees)
what is indicated if the genu valgum is severe, painful, or pathologic?
- hemiepiphysiodesis: clamps or staples are put into bone around growth plate
or - realignment osteotomy: bone cut or shaved for straightening