Week 3 Pediatric orthopedics

Question 1

What is the natural history of knee alignment from birth to age 7 years?

Answer 1

First varus then valgus then to normal alignment

Question 2

What are the causes of in toeing?

Answer 2

1. Metatarsus adductus
2. internal tibial torsion
3. femoral anteversion
   these typically resolve on their own, only 0.1% need surgery

Question 3

What is SCFE? What causes it? Who gets it? How is it treated?

Answer 3

• slipped capital femoral epiphysis
• etiology is unknown
• obesity is risk factor
• 10-16 yo boys, african americans, most common hip problem in adolescents
• usually presents as delayed diagnosis, hip thigh or knee pain, acute or chronic, bilateral up to 50%
• PE: has increased external rotation on hip flexion
• Tx: surgery aimed at preventing further slippage with pin in situ

Question 4

What is DDH? What are risk factors? How diagnosed? Treatment?

Answer 4

• developmental dysplasia of the hip: subluxation, dislocation
• common in eastern europeans
• risk factors: breech position, female, first child, family hx
• associated anomalies: packaging problems, oligohydranios, tight uterus
• diagnosis: limited hip abduction, Galeazzi sign (flex infant’s at hip, check if knees are level)
• treatment: harness, closed reduction and casting, osteotomies, open reduction

Question 5

Describe Perthes disease.

Answer 5

• idiopathic avascular necrosis of the femoral head in children
• 4-8 yo, boys, 10% bilateral
• present with limp, groin, hip, thigh, or knee pain
• delayed diagnosis common
• natural hx: 50% will need hip replacements by age 50
• controversial treatment: supportive treatment or surgery
• age of onset-younger the better prognosis

Question 6

Describe scoliosis.

Answer 6

• abnormal lateral curvature of the spine >10 degrees
• common: adolescent idiopathic scoliosis
• congenital: failure of spine to completely form or separate properly
• early signs: uneven shoulders, prominent shoulder blades, uneven waistline, lumbar prominence, leaning to one side
• adam’s forward bending test
• natural hx: pulmonary compromise for thoracic curve, measure difference at 20 degrees,
• treatment: bracing for 24-45 degrees, observation for less, surgery for large curves >45/50 degrees

Question 7

How are fractures of the growth plate classified?

Answer 7

Salter Harris classification
I: same level. fracture of cartilage of the physics
II: fracture above growth plate
II: lower
IV: through metaphysics, physics, and epiphysis
V: erase, crushed

Question 8

What is the most common operative fracture in kids?

Answer 8

Supracondylar humerus fracture
-can have neuro injury: most common is anterior interosseous, also can damage medial nerve, radial nerve, ulnar nerve depending on displacement of bone

Question 9

How do you differentiate between septic arthritis and transient synovitis?

Answer 9

4 predictors: fever, NWB (non weight bearing), WBC>12, ESR>40

• probably of septic arthritis increases with more of the clinical predictors
• most recent addition is CRP