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Topics in Peds > Exam and Treatment of Orthopedic Conditions > Flashcards

Exam and Treatment of Orthopedic Conditions Flashcards

1
Q

3 types of foot deformities

A
  • metatarsus adductus
  • calcaneovalgus
  • club foot
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2
Q

Metatarsus Adductus

A
  • Forefoot is curved medially;
  • hindfoot is in a normal
    amount of slight valgus,
  • full dorsiflexion range of
    motion is present
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3
Q

3 grades of metatarsus adductus

A
  • Grade I = flexible with ability to correct beyond midline
  • Grade II= moderately correctable with ability to correct to midline
  • Grade III=severe with inability to achieve midline
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4
Q

metatarsus adductus exam

A
  • Tracing or photo of foot
  • Stroke/tickle lateral border of
    foot, watch for spontaneous correction
  • Evaluate PROM
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5
Q

Metatarsus Adductus Treatment

A
  • Grade I: Monitor – Usually
    resolves on its own
  • Grade II: Corrective shoes
    (Straight-last or Reversed-last)
  • Grade III: Manipulation,
    casting/splinting, and corrective shoes
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6
Q

When is orthopedic surgery considered for grade III metatarsus adductus

A
  • when conservative treatment is ineffective
  • older than 4 yo
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7
Q

positional calcaneovalgus

A
  • Excessive dorsiflexion, hindfoot valgus,
    and forefoot abduction
  • no treatment needed
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8
Q

congenital calcaneovalgus caused by vertical talus

A
  • Talus is vertically oriented, navicular is displaced onto the dorsal surface of the talus – “rocker bottom foot”
  • Requires surgical correction
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9
Q

clubfoot

A
  • Midfoot/forefoot CAVUS
  • Midfoot ADDUCTUS
  • Subtalar VARUS
  • Ankle EQUINUS
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10
Q

clubfoot treatment

A
  • Ponseti serial casting
  • comprehensive release
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11
Q

femoral antetorsion causes

A

Structural, muscle imbalance, abnormal muscle tone

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12
Q

femoral antetorsion exam

A

Ryders/Craig’s test, Trochanteric Prominence test

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13
Q

Femoral antetorsion treatment

A
  • May resolve naturally
  • Discourage W-sitting
  • Braces, twister cables, shoes (not typically effective if structural)
  • Surgery after 10-14 y/o
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14
Q

tibial torsion cause

A

Uterine positioning, muscle imbalance,
abnormal muscle tone

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15
Q

tibial torsion exam

A

Thigh-foot angle, transmalleolar angle

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16
Q

tibial torsion treatment

A
  • Watch until after 18 m/o
  • Denis-browne shoes and bar, Friedman counter splint
  • Surgery after 8 y/o
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17
Q

in-toeing/ out-toeing causes

A
  • Femoral torsion
  • Tibial torsion
  • Metatarsus adductus/abductus
18
Q

developmental dysplasia of the hip - condition

A
  • Seen at birth due to poor development
    of the joint capsule, ligamentous laxity, intrauterine positioning
  • Generally posterior and superior
  • Can lead to avascular necrosis
19
Q

developmental dysplasia of the hip screening

A
  • asymmetric skin folds
  • limited hip abduction (should be 75-80)
  • Galeazzi test (greater than 1 yo)
  • Ortolani test ( <2-3 mo)
  • Barlow test (<2-3 mo)
20
Q

Ortolani Test

A
  • Detects hip dislocation
  • Distract and abduct leg with hip flexed to 90 degrees – feel “clunk as head of femur goes back into place
21
Q

Barlow Test

A
  • Detects hip instability
  • Apply downward pressure to a flexed
22
Q

conservative treatment of developmental dysplasia of the hip

A

pavlik harness
- abducted, ER, flexed

23
Q

acquired hip dislocation caused by

A
  • Muscle imbalance * Spasticity * Positioning * Trauma
24
Q

screening for acquired hip dislocation

A
  • Pain
  • Galeazzi
  • Skin fold asymmetry
  • Gait
  • Unilateral: Trendelenburg on involved side
  • Bilateral: Waddling gait
25
Q

Treatment for Aquired hip dislocation

A
  • Pavlik Harness
  • Abduction orthosis
  • Orthopaedic surgery after 2 y/o
26
Q

limp due to trendelenburg gait

A
  • Lean toward involved side
  • Usually related to hip problem
27
Q

limp due to antalgic gait

A
  • Decreased stance time on involved side
  • Usually related to foot, ankle, or lower leg problem
28
Q

Under 4 y/o with a limp

A
  • Rule out trauma
  • Most likely related to infection (osteomyelitis, septic arthritis)
29
Q

Legg Calve Perthes Disease

A
  • Typically 4-10 y/o but can occur up to 12 y/o
  • Males: Females – 4:1
  • Cause unknown but may be related to exposure to 2nd
    hand smoke and poor nutrition
  • Positively correlated with learning disabilities and ADD
  • Positive Trendelenburg – hip pain or abductor weakness
  • Limited abduction and IR ROM
  • Pain in groin, hip or knee
30
Q

4 stages of LCP

A
  1. initial stage
  2. feagmentation
  3. re-ossification
  4. healed
31
Q

LCP Acute treatment

A

abduction brace,
decrease weight bearing

32
Q

LCP gait training

A

after surgery or in residual stage

33
Q

Sever’s Disease was in sports injury lecture

A

not doing that again

34
Q

slipped capital femoral epiphysis

A
  • Posterior-inferior displacement of femoral head on femoral neck due to growth plate failure
  • 60% bilateral
  • Males > females
35
Q

slipped capital femoral epiphysis symptoms

A
  • Decreased hip ROM in flexion, abduction, IR – If hip is flexed, see increased ER
  • Pain at groin, anteriomedial thigh and knee
  • antalgic gait
  • gonna need surgery
36
Q

osgood schatter was also in sports injury

A
37
Q

growing pains

A
  • kids 3-12
  • nonarticular, pain occurs late in the day or at night, lasts
    minutes to hours, episodic
38
Q

Physical therapy for mild curves

A
  • the schroth method
  • visual feedback, breathing, postural ed to re-establish where midline is
39
Q

Spondylolisthesis

A
  • seen in kids who participate in sports w/ repetitive lumbar hyperext (gymnastics)
40
Q

spondylolisthesis symptoms

A
  • Back pain
  • L5 radiculitis
  • Shortened trunk
  • Palpable lumbosacral stepoff of a spinous
  • Anterior pelvic tilt with increased lumbar lordosis
  • Heart-shaped buttock appearance
  • Hamstring tightness
41
Q

spondylolisthesis treatment

A
  • Activity modification
  • Strengthening/Stretching
  • Bracing
  • Surgical stabilization/fusion if Grade 3
    and above or if progressive
  • Decompression if L5 radiculopathy is
    persistent
  • Surgical repair of pars interarticularis
42
Q
A

Topics in Peds (15 decks)

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