Flashcards in ortho Deck (99):
this is the most common cause of a painful limp in TODDLERS
this is idiopathic avascular necrosis of the femoral head
Legg-Calve- Perthes disease
Legg - Calve - Perthes disease pain occurs on internal or external rotation?
what is the hallmark sign on radiograph of legg calve perches disease?
" AP and frog leg lateral radiograph show an increased density int he affected femoral head or a crescentic subchondral fracture int he femoral head"
what is the management for legg calve parties disease?
physical therapy and restriction of excursive
the typical patient for this is an OBESE ADOLESCENT BOY
slipped capital femoral epiphysis
endocrine disorder related to SCFE
obese adolescent boy
true or false a klein line crosses the epiphysis in a SCFE?
false, it does NOT cross the epiphysis at all
name 4 complications of SCFE
1. avascular necrosis of the femoral head
3. Limb length discrepancy
this is an infection of the bone
pathogen for osteomyelitis w/ sickle cell?
what are the lab studies for osteomyelitis?
MRI/BONE SCAN/ PLAIN RADIOGRAPH to diagnose osteomyelitis?
- not plain radiograph because it is not a good initial study
what 2 things may cause chronic osteomyelitis
sequestrum and involucrum
metatarsus adductes causes ?
intoning of the foot
how can you distinguish clubfoot w/ intoe?
clubfoot cannot dorsiflex
what is the management of a intoefoot that can overcorrect?
what is the management of intoe foot that cannot over correct but is flexible?
what is the management of stiff foot that cannot be straightened?
refer to pediatric orthopedic specialist
talipes equinovarus AKA?
management of club foot?
casting and then surgical correction
this form of intoe is caused by utero position?
internal tibial torsion
what is the management for internal tibial torsion?
what is the difference in incidence age of internal tibial torsion and femoral ante version?
femoral anteversion >2 years
internal tibial torsion
if a child prefers to sit in a W position vs. a cross legged position what may he have?
clinical presentation of calcaneovalgus foot
foot is excessively dorsiflexed
ghetto walk of african american boys? Lateral thrust with gait?
etiology of blunts disease?
overload injury to the medial tibial growth plate causing inhibited growth only on the medial side
when should blounts disease be considered in a child ?
anyone with leg bowing after 2 years old
this is inflammation or micro fracture of the tibial tuberosity caused by overuse injury?
osgood shatter disease
true or false, radiographs diagnose osgood shatter disease?
FALSE - too small to be seen
lateral position of the patella causing knee pain in girls
patellofemoral syndrome ( patellar chondromalacia)
what is the timing of growing pains?
bilateral leg pain occurring in LATE AFTERNOON OR EVENING ( DONT INTERFERE W/ PLAY )
open vs closed fracture?
closed- skin intact
open - skin broken (need antibiotics)
fracture ends that are shifted
Fracture ends that are well approximated
A. Non displaced
fracture ends that override w/out cortical contact
Occur w/ twisting injuries common in child abuse
buckle fracture occurring under a compressive force in the metaphysis?
incomplete fracture where one side side of cortex is fractured and the other side is intact causing angulation. may require fracturing the other side to minimize angulation
type of fracture w/ many pieces?
diagonal fracture across a bone
the salter harris classification system describes what?
fractures involving the growth plate
bone growth is affected in all grade ____ -_____ fractures?
grade IV (through and through)
grade V ( Crush )
SALTR stands for?
SAME, ABOVE, LOW, THROUGH, cRUSH
why is supracondylar fracture an orthopedic emergency?
when it is DISPLACED or ANGULATED because risk of neuromuscular injury and compartment syndrome
how can you detect neuromuscular injury and compartment syndrome in Supracondylar fracture?
assess pulse, sensation and movement of fingers + passive extension
posterior fat gap sign shows what?
what do you never do in a supracondylar fracture?
never passively move the arm
this is a fracture to the distal radius
fracture to the proximal ulna w/ dislocation of the radial head
fracture of the radius w/ distal radioulnar joint dislocation
this is a ' tollders fracture' which occurs after a very mild or no identified trauma
spiral fracture of the tibia
upper brachial plexus injury involving c5 and c6 roots
erbs palsy position?
extended pronated and flexed fingers
involves c7 and c6 nerve roots?
klumpke palsy position?
claw hand, decreased ability to extend elbow and flex wrist
what may be present in klumpke's palsy?
horners syndrome (ptosis, miosis and anhydrosis)
this is a subluxation of the radial head that occurs when pulling the toddler upward?
what is the most common shoulder dislocation?
true or false, recurrence is common with anterior shoulder dislocation?
defined as tilting of the head to one side?
management of cervical torticollis?
stretching excersizes, if not helmet therapy by 4-6 months of age
what are complications of torticollis?
skull deformity and facial asymmtery (plagiocephaly)
altantoaxial instability is seen most w/ what anomaly?
if there is severe instability in the AA joint what is management?
c1 and c2 fusion
this is a failure of normal vertebral segmentation that results in relative fusion of the involved vertebrae?
klippel feil syndrome
klippel fiel syndrome is also related to what?
torticollis, genitourinary, hearing loss and sprengels deformity ?
what is sprengels deformity?
abnormality of the scapula where scapula is rotated laterally leading to shoulder asymmetry and diminished shoulder motion
how is the cobb angle measured?
line along the most angulated vertebra on either end of the curve
when does progression of scoliosis occur?
only during growth or if spinal curvature is greater than 50 %
so if a woman has had her period for 6 months and has scoliosis does it need to be managed?
no because all growth in females ceases between 6 months of menarche
this degree of scoliosis only requires observation
this degree of scoliosis requires bracing?
this degree of scoliosis requires surgery if still growing?
what degree of scoliosis causes respiratory and CV compromise?
backpain, urinary incontinence, and palpable step off in the limbo sacral area are a result of?
how can you distinguish between ankylosing spondylitis and spondylolithesis?
spondylolithesis will have a neurologic component
this is a infection caused by staph aureus of the intervertebral disk?
what is treatment of a herniated disk in an adolescent?
bed rest unless abnormal neurologic examination
flat acetabulum and breech position cause?
developmental dysplasia of the hip
this maneuver attempts to dislocate a hip by pushing posterior and laterally?
this maneuver attempts to reduce a hip by pushing upward and medial
how can you diagnose DDH in older infants?
assymmetric buttock folds
what is used to diagnose DDH in infants 4-6 months of age?
if someone greater than 6 months is suspected of DDH, what do you order?
this holds the head of the femur against the acetabulum to stimulation formation of the normal cup shape of the acetabulum used in ages 2-3 months if dx by 6 months?
if diagnosis is made beyond 6 weeks of age what is indicated in DDH?
what is most commonly affected in younger children w/ septic arthritis?
what is most commonly affected in older children w/ septic arthritis?
how is the hip held in septic arthritis?
flexion/abduction and external rotation
how are lab studies in septic arthritis?
elevated white blood cell count, elevated ESR and elevated CRP
what is the best imaging used for septic arthritis?
what should you do before ultrasound for septic arthritis?
synovial fluid aspiration
what is the management for septic arthritis?
1. surgical decompression
2. empiric antibiotics covering gram positive organisms
what usually processed transient synovitis?
URI and Diarrhea