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Ortho - The Pediatric Leg and Knee (Turek's Orthopedics) > The Pediatric Leg and Knee > Flashcards

The Pediatric Leg and Knee Flashcards

1
Q
  • Presents as recurvatum of the knees at birth
  • Evident at birth
  • Incidence: 1%
  • May be an isolated entity or may occur with associated problems (dislocated hip, clubfoot, myelodysplasia, Larsen’s syndrome, arthrogryposis)
  • Special attention must be paid to the hip joint
  • Due to hyperextension of the knee in newborn infants
  • Fibrosis of the quadriceps mechanism is secondary to the dislocation
  • Present with passive knee flexion at birth
A

Congenital sublaxation and dislocation of the knee

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2
Q

Used to identify the femoral-tibial relationship of congenital sublaxation and dislocation of the knee

A

Routine lateral radiographs

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3
Q

Type of congenital sublaxation and dislocation of the knee wherein hyperextension is minimal, and the knee can passively be flexed to 90 degrees

A

Type I

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4
Q

Type of congenital sublaxation and dislocation of the knee wherein there is sublaxaton of the tibia anteriorly on the femoral condyles, the knee can be flexed up to 45 degrees

A

Type II/ Moderate type

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5
Q

Type of congenital sublaxation and dislocation of the knee wherein there is complete anterior dislocation of the proximal tibia on the femoral condyles with no contact between the tibia and the femur

A

Type III/ Severe type

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6
Q

Treatment of Type I and II cases

A

Gentle manipulation and serial casting program or Pavlik harness (maintain knee flexion for a few works

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7
Q

T or F. Treatment of congenital dislocation of the knee or hip associated with Larsen’s syndrome or myelodysplasia is difficult

A

T

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8
Q

Differentiates Type I and II from Type III

A

Fibrosis of the quadriceps

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9
Q

Treatment of unresponsive to nonoperative treatment and Type III

A

Early open reduction and quadricepsplasty

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10
Q

First step before flexing and reducing the knees

A

Surgical lengthening of the quadriceps-patellar tendon complex

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11
Q

T or F. Knee dislocation must be resolved prior to treatment of congenital hip instability

A

T

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12
Q

Postoperative management of congenital sublaxation and dislocation of the knee

A
  • Initial positioning of the knee in slight flexion to remove tension on skin incision
  • Progressive flexion to obtain at least 90 degrees of knee flexion
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13
Q
  • Unusual condition
  • Hypoplasia of the patella, lateral femoral condyle, trochlea groove, and quadriceps mechanism are seen along with lateral displacement and fixation of the patella
  • There is fixed flexion contracture of the knee, and the patella is laterally displaced with genu valgum and the tibia is externally rotated
A

Congenital dislocation of the patella

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14
Q

T or F. Nonoperative treatment is futile in congenital dislocation of the patella

A

T

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15
Q

Surgical correction of congenital dislocation of the patella

A
  • Extensive lateral release
  • Advancement of the vastus medialis obliquus
  • Semitendinosus tenodesis to the patella
  • Centralization of the patella tendon insertion
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16
Q
  • Frequent causes of anxiety in parents

- Common cause of referral to the orthopedic surgeons

A

Bowleg (genu varum) and knock nee (genu valgum)

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17
Q

T or F. Genu varum most of the time corrects by itself with growth

A

T

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18
Q

Normal knee of varus at birth

A

10 - 15 degrees

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19
Q

When does neutral alignment progress?

A

18 months

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20
Q

What exacerbates or accentuates the appearance of genus varum?

A

Concurrent internal tibia torsion

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21
Q

When is persistence of genus varum considered abnormal?

A

> 2 years of age

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22
Q

Spontaneous correction of the physiologic genu varum will be occasionally be delayed until _____ months of age

A

30 months

23
Q

Even pronounced physiologic genu varum ______ degrees can correct with continuing growth

A

> 30 degrees

24
Q

Overcorrection to excessive genu valgum is maximal at ____ years of age

A

4 years

25
Q

Valgus angulation averages ____ degrees

A

8 degrees

26
Q

Correction to physiologic valgus is usually by _______ years of age

A

5-6 years of age

27
Q

T or F. Genu varum is not routinely evaluated radiographically.

A

T

28
Q

If genu varum falls outside the normal range in a child 18-36 months old, or is associated with short stature or asymmetry, what radiograph should be taken?

A

Standing anteroposterior radiographs

29
Q

Treatment of physiologic genu varum and valgum

A

Periodic observation and exam + Education and reassurance of the parents that the deformity is a variant of normal and not a disease

30
Q

What factors make the genu valgum appear more severe?

A
  • Fat thighs
  • Ligamentous laxity
  • Flat foot
31
Q

Treatment for uncorrected physiologic genu valgum > 20 degrees

A

Hemipiphysiodesis or osteotomy

32
Q

Other name for Tibia vara

A

Blount’s disease

33
Q
  • Most frequent nonphysiologic cause of genu varum in children and adolescents
  • Developmental condition
  • Affects posteriomedial aspect of the proximal tibial physis resulting in a progressive varus deformity
A

Tibia vara

34
Q

Biopsy of tibia vara

A
  • Disorganized physeal cartilage with abnormally large groups of capillaries, densely packed hypertrophic chondrocytes
  • Islands of almost acellular fibrous tissue
35
Q

Examination of a child with tibia vara

A
  • Angular deformity just below the knee

- Lateral thrust (indicating laxity of the lateral ligamentous complex)

36
Q

Difference of physiologic genu varum from tibia vara

A

More gentle curvature of the entire extremity

37
Q

Subdivisions of tibia vara

A
  • Infantile

- Late onset

38
Q

Subdivision of tibia vara which is difficult to diagnose in its early form until 2 years of age

A

Infantile tibia vara

39
Q

Staging classification of the progression of tibia vara in untreated patients

A

Langenskiold radiographic staging classification

40
Q

The natural history of untreated cases is to progress to complete medial physeal arrest, which can occur by the age of ____

A

6

41
Q

T or F. Subsequent treatment is difficult, because both angular deformity and tibial shortening must be addressed.

A

T

42
Q

T or F. Some children with metaphyseal-diaphyseal angles described as compatible with infantile tibia vara (an angle of 16 degrees is currently accepted) spontaneously improve without treatment

A

T

43
Q

T or F. Brace management in patients < 3 years old may be successful in correcting the mild deformity

A

T

44
Q

Risk factors for failure:

A
  • Obesity
  • Instability
  • Delayed bracing
45
Q

T or F. Early valgus osteotomy > 4 years of age is strongly recommended to minimize deformity of the proximal medial physis

A

T

46
Q

T or F. Overcorrection into 5 to 10 degrees valgus angulation beyond normal should be the goal.

A

T

47
Q

T or F. In late onset tibial vara, bracing is not effective

A

T

48
Q

T or F.

A

For those adolescent patients with significant growth remaining, consider selective lateral epiphysiodesis

(rate of correction following is procedure is 4 degrees per year)

49
Q

Posture of the newborn with posteromedial bowing of the leg

A

Marked calcaneovalgus and dorsiflexion of the foot

50
Q

Natural history of congenital posteromedial bowing of the tibia

A

Gradual resolution of the foot deformity and the tibial bowing with growth

51
Q

T or F. No treatment for bowing is necessary or indicated.

A

T

52
Q

T or F. Serial documentation of discrepancy throughout childhood is advisable, and physeal arrest of the contralateral leg or lengthening of affected tibia should be performed, if the discrepancy is projected to exceed 2.5 cm at maturity

A

T

53
Q
  • Not a
A

Congenital pseudoarthrosis of the tibia

Ortho - The Pediatric Leg and Knee (Turek's Orthopedics) (1 decks)

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