Flashcards in Orthopedics Deck (30):
By what point should infants triple their birth weight?
Treatment of developmental dysplasia of the hip
<6 months Pavlik harness (holds hips flexed)
Noted ages 4-8yo; limited internal rotation, avascular necrosis of femoral head.
Dehiscence of capital femoral growth plate, proximal femoral neck migrates anteriorly and laterally. Internal rotation limited and child limps. Management is surgical!
Treatment of clubfoot
What are the Ottawa ankle rules?
An Ankle x ray is required only if: Any pain in the malleolar zone AND 1.) bony tenderness along distal 6cm of posterior edge of tibia or tip of medial malleolus OR 2.) Bony tenderness along the distal 6cm of posterioir edge of fibula or top of lateral malleolus OR 3.) Inability to bear weight in the ED for 4 steps.
What is the most likely cause of death for patient with achondroplasia?
Cervicomedullary junction compression.
An infant with head tilited to one side, a mass in the sternocleidomastoid muscle and or facial asymmetry. Treated with daily stretching and physical therapy - if no improvement in one year - needs surgery
Migrain variant seen in infants - repeated attacks of head tilting, last for only a few minutes at a time. No intervention necessary
Which side is developmental dysplasia of the hip more common?
How do you diagnose DDH?
ultrasound - after 4 months can see on x ray
What is the Barlow exam?
Adduction with downward pressure
What is the Ortolani exam?
attempt to relocated a dislocated femoral head
Other physical findings of DDH
May have asymm gluteal folds, later on waddling gait or leg length deformity
Risk factors for DDH?
first born, female, breech delivery, family history
What degree of scoliosis needs treatment?
> 25 degrees and still more growth to be had - should brace. If > 40 should have surgery
What is the normal degree of kyphosis in the spine?
Infantile cortical hyperostosis. Occurs during first 6 months of life, swelling of bone shafts, only involves cortical bone, not periosteum.
The patient falls back on a posteriorly rotated abducted arm
Anterior humeral dislocation
Pain over distal clavicle with a prominence over area of point tenderness
Bowlegged fancy name
Knock-kneed fancy name
When does genu varus need intervention
When persists past 2, or unilateral
Salter harris type 1
Separation of epiphysis and metaphysis. Fracture right through physis. X rays may be negative - diagnose clinically. needs casting for 2-3 weeks
Salter Harris type 2
physis and metaphysis, closed reduction 3-6 weeks
Salter Harris type 3
through growth plate and epiphysis (worse than type 2 bc goes through growth plate.
Salter Harris type 4
crack through metaphysis, physis, growth plate, epiphysis - needs OR reduction
Salter Harris type 5
compression fracture causing microvascular compromise - may have poor growth later
pain in snuffbox - often x ray is normal