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Semester 3 > orthopedic pathology (pediatric pathologies) > Flashcards

orthopedic pathology (pediatric pathologies) Flashcards

1
Q

Valgus/Varus Deformity

A

Describes distal bone relative to proximal joint

Valgus
Deviation away from midline of distal bone

Varus
Deviation towards the midline of distal bone

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2
Q

Coxa Vara

A

Aka coxa adducta, coxa flexa

Angle between NECK of femur and SHAFT is less than 120 degrees

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3
Q

Coxa Vara etiology

A

Etiology
Congenital/developmental or acquired

Developmental usually appears b/w ages 2 and 6.

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4
Q

acquired Coxa Vara associated with

A

SCFE, OI, infection (TB), trauma (rare)

SCFE = slipped capital femoral epiphysis

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5
Q

Coxa Vara female vs male

A

Female=male

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6
Q

diagnosis

A

Xray

Relative elongation of greater trochanter

Appears enlarged and “beaked”

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7
Q

Coxa Vara symptoms

A

Can be asymptomatic

Mild shortening of limb
Limited abduction

Delay and difficulty in walking

Painless Trendelenburg (lurching) limp
—> I.e. gait problems

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8
Q

Coxa Vara treatment

A

Treatment – none or surgery

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9
Q

Coxa Valga

A

Femoral neck-shaft angle is greater than 135 degrees

Less common than Coxa Vara

Most commonly associated with neuromuscular disease such as Cerebral Palsy
—> Causes a lack of mechanical stimulation to growth plate and muscular imbalances.

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10
Q

WHAT IS COXA VALGA COMMONLY ASSOCIATED WITH

A

commonly associated with neuromuscular disease such as Cerebral Palsy

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11
Q

Genu Valgum

A

Aka knock knees

Knees touching, but ankles are apart (more than 3 inches apart)

Normal in children 2-3 years, should straighten out 5-6 years

Due to hypermobility of knee joint

—> Valgus deformity can result

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12
Q

which age is genu valgum common/normal

A

Normal in children 2-3 years, should straighten out 5-6 years

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13
Q

how much farther apart are ankles when knees touching?

A

ankles are apart (more than 3 inches apart)

MORE THAN THREE INCHES

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14
Q

Genu Varum

A

Aka bow legs

Ankles are touching, but knees are not when standing

Normal in infants – grow out of it in childhood

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15
Q

when is genu varum normal?

A

normal in infants

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16
Q

varus deformity and skeletal dysplasias / metabolic bone diseases

A

Varus deformity can be caused by skeletal dysplasias and metabolic bone diseases

E.g. osteogenesis imperfecta

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17
Q

what disease is related to varus deformity

A

Osteogenesis imperfecta

“Symptoms of more severe forms of OI may include: Bowed legs and arms.”

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18
Q

Torsion:

Femoral anteversion (internal torsion)

A

inward twisting of the femur causing the knee and foot to turn inward (pigeon toed).

Most obvious at age 5-6.

The condition usually normalizes by age 8-9

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19
Q

when is femoral anteversion most obvious?

When does it generally resolve on its own?

A

Most obvious at age 5-6.

The condition usually normalizes by age 8-9

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20
Q

what is treatment if femoral anteversion does not resolve on its own?

A

Treatment is surgery if it doesn’t self-correct

Typically only needed in cases of neuromuscular disease.

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21
Q

note about femoral torsion (E.g. anteversion)

A

this is rotation of the bone itself, not at the joint

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22
Q

Femoral Retroversion (External torsion)

A

external twisting of the femur causing the knee and foot to turn outward (flared feet).

Much less common than femoral anteversion.

Usually due to abnormal positioning in utero and will spontaneously correct by age 8

Treatment is surgery.

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23
Q

which is most common

A

femoral anteversion (leading to pigeon toes)

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24
Q

what is common cause of femoral retroversion?

A

abnormal positioning in utero and will spontaneously correct by age 8

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25
Q

Tibial torsion (internal)

A

Torsion is usually internal/medial

Internal tibial torsion will cause a toeing-in, which becomes more obvious as child begins to walk.

Internal tibial torsion will typically correct itself as they continue to grow and walk.

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26
Q

tibial torsion (external)

A

External tibial torsion has a poorer prognosis, because the tibia continues to externally rotate with growth.

This leads to deformity that worsens through late childhood and adolescents

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27
Q

which tibial torsion is usually worse

A

external tibial torsion

poorer prognosis, because the tibia continues to externally rotate with growth.

deformity that worsens through late childhood and adolescence

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28
Q

treatment for external torsion of tibia?

A

surgery (?)

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29
Q

tibial torsion

A

“Tibial torsion is the twisting of a child’s shinbone, also known as the tibia. In most cases, tibial torsion causes a toddler’s legs and feet to turn inward (internal tibial torsion), giving them a pigeon-toed appearance. Less often, the legs turn outward (external tibial torsion).”

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30
Q

Spina Bifida

A

Is a developmental congenital disorder caused by the incomplete closing of the embryonic neural tube

Some of the vertebrae overlying the spinal cord are not fully formed and remain unfused and open (neural tube defect)

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31
Q

Spina Bifida linked with…

A

Neural Tube Defects

Folate (B9) deficiency during pregnancy

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32
Q

what is the MOST COMMON congenital abnormality of the SPINE

A

Spina Bifida

2/1000

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33
Q

“bifida”

A

“bifid”

bifida = split

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34
Q

where does Spina Bifida most commonly affect?

A

m/c @ lumbosacral region

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35
Q

Spina Bifida etiology

A

Multifactorial

Genetic

Deficient maternal folic acid intake

Maternal diabetes or drug use

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36
Q

how is spina bifida detected?

A

Prenatal screening:

—> Alpha-fetoprotein (?)
—> Ultrasound (95%)

(??)

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37
Q

Spina Bifida, severity –> mild to severe

A

mild can have few/no symptoms

severe can lead to paraplegia

(Spina Bifida Occulta vs Spina Bifida Manifesta)

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38
Q

paraplegia etymology

A

“paralysis of the legs and lower body, typically caused by spinal injury or disease.”

para = beside
plegia = to strike

“to strike at side”

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39
Q

Spina Bifida Occulta vs Spina Bifida Manifesta

A

..

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40
Q

Spina Bifida Occulta

A

Results in only a bony defect

the spinal cord, meninges and spinal fluid remain intact

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41
Q

Spina Bifida Manifesta

A

Bony defects are found

also involves nervous tissue damage/displacement

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42
Q

meningocele (manifesta)

A

meningocele etymology

meninges
cele = Suffix meaning swelling, hernia, or tumor

Meningocele = meninges protrude from bifid end of vertebra (where SP is missing) (?)

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43
Q

myelomeningocele

A

not just meninges protrude, but also spinal cord

Myelo- = “Myelo- is a combining form used like a prefix meaning “marrow” or “of the spinal cord.””

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44
Q

medical management of spina bifida (Dx)

A

Diagnosis
Ultrasound
Blood test
Amniocentesis

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45
Q

amniocentesis define

A

“the sampling of amniotic fluid using a hollow needle inserted into the uterus, to screen for developmental abnormalities in a fetus.”

miscarriage risk of about 0.25 - 0.5 % (some studies say 1%)

amnio- = amnion
centesis- = pricking

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46
Q

spina bifida treatment

A

Pre or post-natal surgery, C-section (often breech birth)

47
Q

fetal surgery

A

“Your surgeon first makes an incision in your abdomen to reach your uterus. Then, they make an incision in your uterus to reach the fetus. They keep the fetus inside your uterus while they operate. Then they close up your uterus and abdomen and let the pregnancy proceed to as close to term as possible.”

48
Q

Klippel-Feil Syndrome

A

Failure of vertebral segmentation of C-spine

Congenital fusion (synostosis) between varying number of vertebrae

Can be any two or more of the 7 cervical segments

Etiology unknown possibly genetic

Very rare (less than 1%)

49
Q

Klippel-Feil Syndrome features

A

Neck is short, stiff, webbed

Posterior hairline is low and transverse

Head tilted/high scapula

May be associated with a variety of other conditions including scoliosis, heart defects, spina bifida, etc.

Treatment – cosmetic surgery

50
Q

what are some conditions associated with Klippel-Feil Syndrome

A

scoliosis,
heart defects,
spina bifida,
etc.

51
Q

Hemivertebrae

A

Congenital triangular deformity of the body of the vertebrae

Usually co-exists with other vertebral anomalies

Usually occurs in upper lumbar and lower thoracic

Can lead to structural scoliosis

Can lead to neurological problems

52
Q

where do hemivertebrae usually occur

A

lower thoracic and upper lumbar region

53
Q

what are some complications of hemivertebrae

A

Can lead to structural scoliosis

Can lead to neurological problems

(Usually co-exists with other vertebral anomalies)

54
Q

cause / risk factor for hemivertebrae formation

A

Lack of blood supply causing part of the vertebrae to not form

55
Q

Clubfoot

A

Aka congenital talipes equinovarus (CETV)

Common congenital condition in which the foot is malformed in a specific position

56
Q

congenital talipes equinovarus

A

talipes comes from TALUS and PES

ankle-foot

equinovarus:
equino comes from equine

“congenital ankle-foot horse varus”

57
Q

why equino (?)

A

comes from limited dorsiflexion of foot

58
Q

clubfoot severity, rate, gender ratio

A

Mild, moderate, severe

1/1000 live births

50% bilateral

Boys>girls (2:1)

59
Q

can clubfoot (CTEV) be unilateral?

A

Yes

50% bilateral

60
Q

clubfoot most common for boys or girls

A

boys (2:1)

61
Q

ctev etiology

A

Idiopathic

Possibly genetic

Deformity develops early in embryo

Muscles of posterior and medial leg are unduly short

Fibrous capsules
thick and contracted

62
Q

which muscles shortened (contractures)

A

posterior/medial leg

(Note contractures of calcaneal tendon)

(also contracture of Posterior talofibular lig)

63
Q

fibrous capsules?

A

Thick and contracted (contractures)

(fibrous capsules of joints, including tibiotalar capsule (of talocrural), and talocalcaneal capsule)

64
Q

appearance of clubfoot (CTEV)

A

Forefoot adduction and supination through the midtarsal joint

Heel varus through the subtalar joint

Equinus through the ankle joint (TIGHT CALCNEAL TENDON – contractures) –> limited dorsiflexion

Medial deviation of the foot relative to the knee

65
Q

Equinus

A

When the ankle joint lacks flexibility and upward, toes-to-shin movement of the foot (dorsiflexion) is limited

congenital or acquired

66
Q

clubfoot (CTEV) treatment

A

Performed early

Plaster casts
Splints
Orthotics
Surgery

Can take years to correct

67
Q

Osgood-Schlatter’s disease

A

Common cause of knee pain in children and young adults usually between the ages of 10 and 15years

Occurs during a period of rapid growth combined with a high level of sporting activity

This results in pulling by the patella tendon on the tibial tuberosity resulting in the area becoming inflamed, painful and swollen

68
Q

OS Sx

A

Pain at tibial tuberosity

Inflammation, tenderness

Pain with quadricep activity

Bony lump

69
Q

OS Tx

A

Rest

Stretching of quadriceps

Knee support

massage

70
Q

Sever’s Disease

(Aka calcaneal apophysitis)

A

Common heel injury

Common heel injury

Occurs is children who are physcially active, during a growth spurt

71
Q

Sever’s disease (calcaneal apophysitis)

Sx

A

Pain and tenderness in one or both heels

Difficulty walking

Discomfort or stiffness in the feet upon awaking

72
Q

Sever’s (calcaneal apophysitis)

Dx, Tx

A

Dx
physical exam, xray, MRI, bone scan

Tx
Rest
PT
NSAIDS

73
Q

Legg–Calve Perthes disease

A

Associated with inadequate blood supply to part of the hip joint

Typically affects one hip
(UNILATERAL)

m/c among boys ages 4 to 10 years

Younger the diagnosis, better the prognosis

74
Q

most common gender/age for Legg-Calve Perthes

A

m/c among boys ages 4 to 10 years

75
Q

etiology

A

Inadequate blood flow to the femoral head

Causes deterioration, unstable joint

76
Q

risk factors (Legg-Calve Perthes disease)

A

Risk Factors:

Caucasian

Boys>girls

Physically active children

77
Q

Legg-Calve Perthes Symptoms

A

Limping

Pain and stiffness in the hip or knee

Limited ROM

Shortened leg on the affected side

78
Q

complications

A

Complications:

Permanent hip deformity

Increased chance of OA

79
Q

Dx, Tx

A

Physical exam, x-ray, MRI, bone scan

TX
Protect the hip from further stress and injury

Anti-inflammatories

PT

Crutches
Braces
Surgery

80
Q

Chandler’s disease

A

Avascular necrosis of femoral head in adults

Associated with micro-emboli in the femoral head or trauma to the hip

embolus:
An embolus is anything that moves through the blood vessels until it reaches a vessel that is too small to let it pass. When this happens, the blood flow is stopped by the embolus

81
Q

CHandler’s disease … characteristics

A

Severe pain and progressive stiffening of hip

Collapse of femoral head

82
Q

CHandler’s disease treatment

A

Treatment – hip replacement

83
Q

SCFE

A

Slipped capital femoral epiphysis

Idiopathic

Occurs in adolescents (boys>girls)

Epiphysis slips off femur
Bilateral (30%)

84
Q

SCFE unilateral or bilateral

A

Bilateral (30%)

Most commonly unilateral

85
Q

SCFE, characeristics/manifestations

A

Discomfort in hip

Slight limp

Lurching or waddling gait

Externally rotated limb

Short leg

Unable to bear weight on the affected side

Often associated with obesity

86
Q

Achondroplasia

A

Characterized by limbs proportionately shorter than trunk, larger than average head and characteristic facial features

Autosomal dominant disease

Failure of longitudinal growth in the cartilage of the epiphyseal plate

Total height averages just over 4 feet

Radiographically bones are thick

87
Q

average height achondroplasia

A

Total height averages just over 4 feet

88
Q

etiology, achondroplasia

A

Genetic is 85% of cases

Often hypermobile/double jointed

89
Q

complications of achondroplasia

A

frequent dislocations

Joint malalignment

90
Q

achondroplasia life expectancy

A

Normal mental/intellectual capability and life expectancy

Diagnosis through examination at birth

—> Ultrasound for femur length

91
Q

osteogenesis imperfecta

A

Aka “brittle bone disease”

A congenital genetic disease
Autosomal dominant inheritance

Gene mutation leads to errors in collagen production

8 different classifications
—> Each presenting slightly differently

92
Q

OI symptoms/signs

A

Weak bones – susceptible to fractures

Below average height

characteristic signs:
—> Blue sclera
—> Multiple bone fractures
—> Early hearing loss (bones of inner ear)

93
Q

characteristic sign of OI

A

blue sclera

94
Q

other signs/symptoms

A

Hypermobility

Bowed legs and arms

Scoliosis/kyphosis

95
Q

OI, Dx, Tx

A

Dx
Physical exam
Skin punch biopsy
DNA test

Tx
No cure

Focused on reducing pain and complications

Medications

Low impact exercises

Surgery

96
Q

what is a test type used to diagnose OI

A

SKIN PUNCH BIOPSY test

Why?
since OI has to do with collagen production, same type of collagen can be evaluated in the skin to detect OI

97
Q

what is mechanism of OI

A

Gene mutation leads to errors in collagen production

“They either don’t have enough collagen in their bones or the collagen doesn’t work as it should.”

“This makes their bones weaker and more brittle than normal bones. It also can lead to abnormally shaped bones.”

98
Q

Radial head subluxation (Nursemaid’s elbow)

A

Aka pulled elbow, slipped elbow, toddler elbow

Common in children under 4 years old

Most common dislocation in kids

Radius slips out from under the annular ligament

Occurs when there is a sudden pulling or traction on the hand or forearm

99
Q

what ages is radial head subluxation common?

A

children under 4 years old

100
Q

what is a structural change that occurs in head of radius that reduces likelihood of radial head subluxation

A

end of head of radius flare out more, cause the annular ligament to have a tighter hold of head of radius

101
Q

radial head subluxation signs/Sx

A

Immediate pain in the injured arm

Refusal or inability to move the injured arm

Instability upon inspection

102
Q

Still’s disease (Systemic Juvenile Arthritis)

A

Form of juvenile idiopathic arthritis (JIA)

Characterized by high spiking fevers and transient rashes

Autoimmune

103
Q

characteristic features

A

Characterized by high spiking fevers and transient rashes

104
Q

Still’s (JIA) disease

SSx

A

Arthritis, often in more than one joint

Severe joint pain and joint damage

Intermittent fever

Rash – pale pink, blanching, lasting minutes to hours

Muscle pain

Anemia

Enlarged liver and/or spleen (immune activity)

Inflammation of the heart and/or lungs

All symptoms tend to wax and wane for periods of 2-6 weeks

105
Q

which other organs are affected by Still’s disease (JIA)

A

heart

lungs

spleen

liver

106
Q

what about blood related symptoms

A

anemia

107
Q

what is the characteristic symptom of Still’s disease (JIA)

A

RASH

Severe joint pain and joint damage

Intermittent fever

Rash – pale pink, blanching, lasting minutes to hours

108
Q

Still’s disease (JIA) Diagnosis

A

-onset at less than 16 years of age

-arthritis in one or more joints

-persistent for at least 6 weeks

-exclusion of other types of childhood arthritis

109
Q

Still’s disease treatment

A

Medications – anti-inflammatory, corticosteroids

Physical therapy

Massage therapy

Chiro
-Focused on ROM, limit contractures, increase blood flow (not during acute flareups)

Surgery

110
Q

Still’s disease prognosis

A

The fever and most of the other symptoms tend to run their course within several months.

Complete remission occurs in about 50% of cases.

However, the arthritis can become a long-term problem if joint damage occurs (OA)

111
Q

what is the rate of remission for Still’s disease (JIA)

A

Complete remission occurs in about 50% of cases

112
Q

how long does it take for intermittent fevers/rash to run their course?

A

The fever and most of the other symptoms tend to run their course within several months.

113
Q
A

Semester 3 (32 decks)

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