TIM Ausink PEDS Flashcards
LCP Legg Calve Perthes
Causes avascular necrosis of the femoral head
Boys>girls ages 4-8 yr
PE: Limited Abduction
XR: AP+ Frog
Tender berg sign
Positive when patient leans out to opposite side
Appears with short leg and odd gait
Hip Dysplasia
Usually in infants 1st 4 months of life
Do Barlow ortolani and gallezati
Place in pavlick harness
May have medial knee pain
Osteogenesis imperfecta typ1
Most subtle collagen disorder in children
Triad: blue sclera, angular kelitis
Brittle bone dz
Neck tortoicollis
Mostly scm stressed
Can be rare vertebral abnml think this after pt does not work
Blount Dz
One portion of proximal Tina stops growing and other portion keeps growing
Order XR
Obese early walkers and African American children
Type infantile and adolescent
WHY ARE CHILDREN MORE PRONE TO INFECTION IN BONE
D/T high vascular ergo more room for infarction, bleeding, osteomyelitis risk increases.
Clinodactyl
Finger bend out (pinky)
Cyndactly
Club foot
Diagnostic tool for Hip dysplasia is what?
US
What other location may hip injuries present as ?
Medial knee pain
Club foot components
Pathological with rigid foot
Tendon abnmlaity
Order serial casting and bracing
Check all other joints
Three levels of Torsion include
1 femoral
2 tibial
3 metatarsal
Slipped capital femoral epiphysis - SCIFY
Typically Boys 12-15 and Gorls 10-13 Obese children Limp and Hip pain with out trauma STOP WEIGHT BEARING REFER QUICKLY XR: will show “ice cream slip off the cone” TX: Surgical pinning
Idiopathic scoliosis and characteristics
No pain
Send to spine surgeon
Cobb angle greater than 50
XR: AP and lateral view
Scheurmann Kyphosis
Thoraci kyphosis typically in teens
Refer to surgery
Valgus signs
L shaped legs like riding horse
Varus signs
Like an R out legs
Children approach to FX
If it looks broken acts broken but the XR is nml Then treat it as its broken
Recheck XR in 10-14 days
How do you care for a newborn clavicle fx?
Leave it be
Document both arms moving
Risk for brachial plexus injury
What is most common fx in children
Spiral tibia fx
Child will not weight bear and be irritable
Non accidental fx in child would be considered a red flag in what fx?
Spiral femur fx
Suspicious fractures include
Corner fractures Rib posterior Eternal Skull Scapula fx Order skeletal survey observe for multiple lesions at various healing times
Why do we worry about growth plate injuries in children ?
This can delay or stop growth
Spine spondylosis
Seperation in vertebral pars
Xr: has a Scottie dog appearance
Order XR: lumbar film
Spine spodylythithesis
Restrict physical activity
This is a spine slippage can cause foot drop
Refer to PT ortho
Shoulder growth separation
Also called little league pitcher arm, gymnastics, volleyball
This results in a seperation from growth place and shoulder
Results in salter Harris 1 rx
Acute brachial plexus injury “stinger”
Caused by 2 moa: compression, direct blow and hyper extension of neck and shoulder
SX: burning pain numbness down 1 arm resolves in minutes
Apophysis
Bony area where muscle and tendon attach. Can also looks very similar to fix but this runs parallel to the diaphysis not perpendicular like a fox
Epiphysis
End of bone involved in longitudinal growth
Knee osteochondritis
Pain felt at medial femoral condyle
Worse when climbing up stairs
What is the most common saltar Harris fx?
Type 2 A above
Type 1 saltar Harris fx
Straight across epipheseal plate
Type 2 saltar Harris fx
Above epiphiseal plate
Type 3 saltar Harris fx
Lower Than the epiphiseal plate
Saltar Harris type 4
Through the epiphiseal plate
Saltar Harris 5
Crushed epiphiseal plate
Buckle fx
D/t axial loading compression fx
Greentsick fx
Direct blow w angulation
Short term immobilization w/ viler splint 3-4 weeks
Osteomyelitis in children
Higher risk of infection due to open growth plates high vascular ivy
Kids wiht heme issues are more at risk d/t low o2 carrying capacity- like sickle cell
Room for more infarct and bleeding
MC: femur And tibia bone
Osteomyelitis presentation
Hot joint toxic patient
Elevated ESR, CRP, CBC
Order: xr, mri, bone scan
Give:v Iv abx until crp less than 50%
MC agent causing osteomyelitis in children
Staph Aures
Mc Osteomyelitis in 3–4 year olds
Kingealle kingae, salmonella
Septic arthritis
Unilateral pain in joint hot edematous joint
Fever
Source typically puncture wound, cellulitis
Aspirate: gram stain culture cell count
Iv abx Mc agents staph, strep, in teens Gonorrhea
Growing pains present as
Pain that is relieved in the AM
Most common source of joint infection
Blood
Mc bacteria causing osteomyelitis
Staph Aures
Malignant bony lesions include
Osteosarcoma
Ewing’s sarcoma
Osteosarcoma characteristics
Found in teens present with bone pain femur and tibia metaphysis
Ewing’s sarcoma
10- 20 years age range indicative of leukemia pathological fx of long bone
To: chemo and radiation
Pathological suspicious
Bone pain wakes child at night
Child limits activity
Younger child
Reactive arthritis
Often follows after a URI With nml labs Afebrile Order viral panel, viral culture Send patient home rest pain management
SLE SYSTEMIC lupus errythematous
Malar butterfly rash
Plus renal dz
Order UA to see for protein spill
Juvenile idiopathic arthritis
Joint paint in 1 joint for more than 6 wks
Autoimmune inflammation
Non toxic appearing patient
Will have uveitis and a rash
Labs: Ana, anemia
Send to: rheumatoid specialist, NSAIDs, steroids 85% goes away
