Flashcards in Orthopedics 2 Deck (20)
Metatarsus adductus? Difference from clubfoot? Age of onset? Caused by? Diagnosis? Management? Prognosis?
Medial curvature of the midfoot causing a C-shaped foot that can be straightened by gentle manipulation
Unlike clubfoot, Dorsiflexion is intact
Less than one
Physical examination (no imaging needed)
1. If foot overcorrects with passive motion – observation only
2. If the foot appropriately corrects with passive motion – stretching exercises
3. If foot cannot straightened – casting
Resolution and almost all patients
Talipes equinovarus? A.k.a.? Management?
Fixed foot inversion with little ankle flexibility; clubfoot
Casting within the first week of life
Internal tibial torsion? Age of onset? Management? Prognosis?
Medial rotation of the tibia (Footpoint flexed inward when knee flexed to 90°)
Less than two years of age
Resolution by five years age
Femoral anteversion? Age? Clinical features? Management? Prognosis?
Inward angulation of the femur; less than 2 years of age
1. Feet/patella point medially
2. Hips are able to internally rotate more than normal
3. Child sits in "W" position on the floor
Observation only; excellent prognosis with resolution by 8
Out-toeing – clinical features? major cause? Due to? Management? Prognosis?
1. Flexible foot with toes pointed outward
2. restricted plantar flexion
3. Excessive dorsiflexion (dorsum of foot can be placed into contact with shin)
Calcaneovalgus foot (flexible foot held in lateral position)
Stretching the foot; excellent prognosis
Genu varum? Age? Clinical features? Diagnosis? Management? Prognosis?
Bowed legs; children younger than two (normal until two years of age)
1. Cowboys chance – when standing with together, knees laterally and the patella points forward
2. Normal gait (if not normal, consider Blount's disease)
Diagnosis from physical exam
Observation; resolution by two years of age
Blount's disease – A.k.a.? Typical patient? Theorized pathogenesis? Clinical features? Suspect in any child with? Diagnosis? Management?
Tibia vara; Obese african-American boys who are early walkers
Overload Injury to the medial tibial complete (inhibits growth to medial side)
1. Angulation below knee
2. Lateral thrust with gait
Any child with
1. progressive bowing
2. unilateral bowing
3. persistent bowing after 2 years
Metaphysical-diaphyseal angle >11°
1. Bracing if M-D angle is greater than 16° or patient is 2-3 years of age
2. Surgery if child is older than four, recurrence, or no improvement with bracing
Genu Valgrum – A.k.a.? Age? Clinical features? Most common cause? Diagnosis? Management? When to perform surgery?
Knock-knees ; 3-5; overcorrection of normal Genu varum
1. Separation of ankles when standing correct with these together
2. Swinging of legs laterally when walking
Observation; surgery if persists beyond 10 years or causes pain
Osgood-Schlatter? Age? Typical patient? Clinical features? Pain worsens with? Management?
Inflammation/microfracture of tibial tuberosity due to overuse
10-17 years; athletes
1. Swelling of tibial tuberosity and the pain quick point tenderness over to be a typical
2. Pain occurs with extension of knee against resistance
3. Worsens with running, jumping, kneeling
Patellofemoral syndrome? Typical patient? Clinical features? Radiograph may show? Management?
Slight malalignment of the patella that causes me pain
1. The pain directly under patella
2. Pain is worse with walking up and down stairs
Patellar in lateral position
Growing pains – age? occur at what time of day? Does not interfere with? Physical exam findings?
Idiopathic bilateral leg pain; 4-12 years; pain in afternoon/evening (child may awaken at night in pain)
Does not interfere with play during the day
Physical exam is normal
Analgesics and reassurance
Fractured ends are shifted
Fractured ends form an angle
Only one side of the cortex is fractured
Physeal fracture involves?
1. Same – fracture within physis
2. Above – fracture is in physis and above into metaphysis
3. Low – fracture is in physis and below into Epiphysis
4. Through and through – fracture is in physis through the metaphysis and the epiphysis
5. cRush – crushing the physis
Clavicular fracture – clinical features in infants? Older children? Diagnoses? Management?
1. Infants – asymmetric moral reflects for pseudoparalysis (refusal to move extremity because of pain). Crepitus
2. Children hold affected limb with opposite hand. Head tilted toward affected side
Sling for 4 to 6 weeks (neonates do not require treatment)
Supracondylar fracture – type of fall? Emergency if? (Because?) Clinical features? Sign on radiograph? Management?
Child falls onto outstretched arm/elbow
Emergency fracture is displaced/angulated because of risk of neurovascular injury compartment syndrome
1. Point tenderness, swelling, deformity of the elbow
2. Possible neurovascular injury – can stretch radial or median nerves/brachial artery
3. Possible compartment syndrome – pain with passive extension of the fingers
Posterior fat pad sign on x-ray
Never passively move arm (further neurovascular injury)
If displaced or angulated – requires surgery. Otherwise cast
Compartment syndrome? 5 P's of late compartment syndrome? Most sensitive indication of impending compartment syndrome?
Pressure within anterior fascial compartment is greater than 30-45 mm Hg
Pallor, pulselessness, paralysis, pain, paresthesias
Pain with passive extension fingers
1. Colles fracture – fractured distal radius
2. Monteggia – Fracture of proximal ulna with dislocation of radial head
3. Galeazzi – Fracture of radius with distal radioulnar joint dislocation
Toddlers fracture? Age? Clinical features?
Spiral fracture of the tibia
Nine months to 3 years
Child refuses to bear weight but is willing to crawl. Erythema, swelling and mild point tenderness