8) Pediatric Orthopedics

Question 1

Why does age matter?

Answer 1

Bc if a child is hit by a car, it will hit a different body part depending on their height

Question 2

Priorities of pediatric trauma

Answer 2

• ABC’s
• Limb Ischemia
• Open Fx

Question 3

Finish the phrase: Children are not _______.

Answer 3

Small adults

Question 4

What does the fact that a kid’s head is larger than their trunk incr the tendency for?

Answer 4

Trunk flexion

Question 5

What does post-fx bone remodeling potential depend on?

Answer 5

• Age
• Which growth plates are involved
• Proximity of injury to growth plate
• Plane of jt motion

Question 6

What is a sleeve fx?

Answer 6

Periosteum gets ripped off the bone & then the bone fx’s in a certain location depending on the area

Question 7

What causes compartment syndrome?

Answer 7

Build-up of pressure in a closed space in the body

Question 8

What can compartment syndrome cause?

Answer 8

Compromised circulation, necrosis, or nerve damage

Question 9

What are the 5 P’s of compartment syndrome?

Answer 9

Pulse, Pain, Parasthesia, Paresis, & Pressure

Question 10

Describe the pain of compartment syndrome

Answer 10

Pain will be out of proportion to the injury

Question 11

What can a fx at femoral growth plates cause?

Answer 11

Leg length discrepancy

Question 12

What are the causes of leg length discrepancy?

Answer 12

• Fx at femoral growth plates
• Devo disorder
• Congenital disorder
• Infection
• Dysplasia
• Metabolic disorder

Question 13

Pathological fx’s are the result of what?

Answer 13

Tumors

Question 14

What do you need to know about in-toeing/out-toeing?

Answer 14

If its local & where the twist is coming from

Question 15

Tx for club foot

Answer 15

Ponsetti stretching & percutaneous heel cord tendinotomy

Question 16

What is miserable malalignment

Answer 16

Femur gets turned in, tibia turns out, & the patella tracks laterally causing patellar instability or dislocation

Question 17

When are flat feet not a problem?

Answer 17

If they’re flexible but not painful

Question 18

What can cause flat feet?

Answer 18

Pathological from tight achilles, tarsal coalition, neuromuscular, etc

Question 19

By what age should a child have straight legs?

Answer 19

18 months

Question 20

By what age should a kiddo have max valgus/varus?

Answer 20

Age 3 or 4

Question 21

Ricketts

Answer 21

Whitening & cupping of growth plates

Question 22

Is ricketts a systemic problem?

Answer 22

Yes

Question 23

What are the pathological causes of malalignment?

Answer 23

• Trauma
• Metabolic
• Infection
• Tumor
• Developmental
• Bone Dysplasia

Question 24

When is imaging needed?

Answer 24

For kiddies w/severe deformity, asymmetries, short stature, & dysmorphic features

Question 25

Risk factors for hip dysplasia

Answer 25

* 1st born * Female * FHx * Intrauterine crowding * Breech delivery * Torticollis * Post-natal positioning * Ethnicity

Question 26

What happens if hip dysplasia is dx'ed after the child is 18mo?

Answer 26

Tx becomes more invasive

Question 27

How is hip dysplasia dx'ed?

Answer 27

* Barlow Test * Ortolani Test * Asymmetric thigh creases * Abduction deficits

Question 28

Tx for hip dysplasia

Answer 28

* Closed reduction * Anterior open reduction if CR fails * Pelvic Osteotomy * Femoral Shortening * Capsulorraphy * Adductor tendonotmy * Arthrogram * FU CT * Pavlik harness/Abduction brace * Positioning in 100° of flexion & 50° abduction

Question 29

How many wks of tx for hip dysplasia does it take to achieve clinical stability?

Answer 29

6-12wks

Question 30

Perthe's Disease

Answer 30

Idiopathic necrosis of the femoral head

Question 31

Tx for perthe's disease

Answer 31

Containment & mobility

Question 32

Who does perthe's disease most commonly effect?

Answer 32

Males ages 4-10

Question 33

For a pt w/perthe's disease, what is prognosis based on?

Answer 33

Amount of femoral head involvement & age of onset

Question 34

Cerebral Palsy

Answer 34

Group of permanent developmental & postural disorders as the result of non-progressive insult to UMN's

Question 35

What can CP effect?

Answer 35

Cognition, Behavior, & MSK system

Question 36

Diplegia

Answer 36

LE's are more involved than UE's

Question 37

What is the role of PT for CP?

Answer 37

Stretching, strengthening, gait training, positioning, pt ed, & emotional support

Question 38

Types of Orthotics

Answer 38

* Standing Frame * RGO * HKAFO * KAFO * AFO * SMO * Inserts

Question 39

Other modalities that can be good for CP

Answer 39

* Water therapy * Hippotherapy * Botox for spasticity * Baclofen pumps * Selective dorsal root rhizotomy

Question 40

What is the management of leg length discrepancy based on?

Answer 40

* Predicted LLD * Predicted height * Jt Instability * Foot/Ankle Form & Fxn * Psychosocial * Surgeon bias

Question 41

Tx for LLD

Answer 41

Shoe lift & prosthetics

Question 42

Describe the surgery done for LLD

Answer 42

Cut the bone, put in a fixation, distract, & then new bone will grow in the gap

Question 43

What are the stages of LLD surgery?

Answer 43

1) Latency 2) Distraction 3) Consolidation

Question 44

What will be the WB status of a pt who just had LLD surgery w/internal lengthening nails?

Answer 44

TTWB

Question 45

What can LLD surgery cause?

Answer 45

Contractures

Question 46

What are the disadvantages of LLD surgery?

Answer 46

* Compromises fxn for length * Jt instability * Psychological stress * Misleading info * Unrealistic goals * Lack of planning

Question 47

Blount's Disease

Answer 47

Growth disorder of the tibia that causes pt to be bowleg

Question 48

What is the tx for blount's disease?

Answer 48

Tibial osteotomy

Question 49

Congenital Radial Club Hand

Answer 49

Radius is missing

Question 50

Chondrolysis

Answer 50

Degeneration of the acetabuluar labrum

Question 51

Scoliosis

Answer 51

7° lateral curvature of the spine

Question 52

What are the indications for an MRI for scoliosis?

Answer 52

* Atypical Sx's * Neurological findings * Atypical curve pattern * Rigid curve * Rapid progression

Question 53

Management of Scoliosis

Answer 53

* Observation * Bracing * Surgery

Question 54

True or False: Stim, exercises, & manips have no substantial effect to pt's w/scoliosis

Answer 54

True

Question 55

When will they do bracing for pt's w/scoliosis?

Answer 55

If the pt has a curve between 25°-40° & they still have growing to do

Question 56

When will they do surgery on a pt w/scoliosis?

Answer 56

If the pt has a curve >45° or curve gets worse even w/bracing

Question 57

Who is at risk for compartment syndrome?

Answer 57

Kids w/tibial or forearm fx