DDH - pediatric Flashcards Preview

Peds Orthopaedics > DDH - pediatric > Flashcards

Flashcards in DDH - pediatric Deck (23):
1

Incidence of dysplasia:

1:100

2

Incidence of dislocation

1:1000

3

When does femoral head begin to ossify

4-6 months

- thefeore, get xrays beginning in this age group

4

When should ultrasound be done?

typically no earlier than 4-6 weeks of age

5

When should you abandon Pavlik harness?

if no reduction in 3-4 weeks

think similarly for abduction bracing

6

Age for closed reuction and spica casting?

6-18 months

7

When should you definitely consider osteotomy of femur/tab?

>2 years with residual deformity do the femur

>4 with acetabular deformity do the pelvis too

8

Possible blocks to closed reduction?

- iliopsoas contracture
- capsular constriction
- inverted labrum
- pulvinar
- hypertrophied ligamentum teres

9

Who gets a Dega?

neuromuscular hip patients with posterior acetabular deficiency
- needs open triradiate cartilage
- reduced acetabular volume

10

What is the radiographic acetabular teardrop?

- quadrilateral surface + cotyloid fossa
- should be present in normal hips by 18 mo

11

When are barlow/ortolani unreliable?

after 6 mo of age

12

Which acetabular osteotomy does not require a concentrically reduced hip?

Shelf procedure_ salvage procedure that covers a portion of the femoral head with capsule, hoping for capsular metaplasia. the hip may be subluxated.

13

Congenital muscular torticollis - associated conditions:

- DDH in 5-20%
- metatarsus adductus

14

DDx of congenital muscular torticollis

- congenital atlantoaxial rotatory instability
- klippel-feil syndrome

15

Grisel's Disease

atlantoaxial rotatory subluxation following a URI

16

Differentiating congenital torticollis from congenital atalantoaxial rotatory subluxation?

subluxation is painful
there will not be a nodular SCM
get a CT of the C1-2 junction with the child looking max left, then max right

17

Indications for surgical correction of torticollis?

failure of 1 year of stretching or rotational limitation is <30 degrees
- do Z-plasty or distal bipolar release of the SCM

18

when does the basilar synchondrosis fuse?

age 6

19

when does the dense secondary osification center appear?

age 3 it appears
fuses to dense at age 12

20

treatment of atlantoaxial rotatory subluxation

- <1week, treat with soft collar and NSAIDs for spontaneous recovery
- >1 week, head halter traction, benzos, NSAIDs, hard collar
- >1 month - halo vest x3 months

21

indication for C1-2 fusion in pediatric atlantoaxial rotatory subluxation?

subluxation present >3 months, neuro deficits present, or failed halo vest

22

most common location for pseudosubluxation of the c spine

C2-3

23

Swischuk's Line

spinolaminar line from C1-3
C2 should fall within 1.5mm of the line in pseudosubluxation
- if greater than 1.5mm, then consider true injury