Pedi: MS probs Flashcards
(159 cards)
1
Q
Elements of a MS hx
A
- Birth and Developmental History
- Onset of symptoms: acute vs. chronic – acute note mechanism of injury
- Pain: location, character, alleviating vs aggravating factors, with movement or rest
- Alteration in function: ROM, weakness, instability, movement sense, gait/limp
- Deformity: structural, swelling discoloraton
- Precipitating Factors
- Family’s Perception of the problem – v. imp
- Family medical history
- Previous Treatment
- ROS
2
Q
Important elements of orthopedic exam
A
Observation
palpation
comparison of limbs
3
Q
MS PE: what are you observing for?
A
General Appearance
Gait, movement, positioning, size, color, shape
4
Q
MS PE: what are you palpating for?
A
- Firm vs. boggy
- Pain on palpation, with weight bearing, movement
- Temperature
- Sound - crepitus
- Vascular status
5
Q
MS PE: what are you comparing in 2 limbs?
A
Mobility, stability, strength, size
6
Q
Dx testing for MS complaint
A
- X-ray: bone integrity, joint spacing, bone growth-consider comparative films
- Serology: infection, inflammation, Lyme titre, synovial fluid, lactic acid, endocrine studies etc.
- Bone Scan: stress fractures
- MRI: bone and soft tissue, joint structure, blood and nerve supply
- CT Scan
- Ultrasound: infant for DDH
- EMG: nerve and muscle function
7
Q
Developmental and Categorical Approach to Musculo-skeletal System: what may be at root of complaint?
A
- Disorders
- Rotational / Angular Deformities
- Infections
- Neoplasms
- Trauma
- Prevention
8
Q
Common MS d/os in the newborn
A
- Positional Plagiocephaly – differentiate from craniosynostosis
- Birth trauma
- Fx of clavicle
- Brachial Palsy- Erb’s Palsy
- Hip dislocation: DDH
- Foot and Leg Abnormalities
9
Q
Evidence for fractured clavicle in newborn
A
area of crepitus over distal third and decreased motion of upper extremities
10
Q
Evidence for brachial palsy in newborn
A
paralysis of arm Erb’s palsy due to birth trauma
11
Q
Evidence for hip dislocation in newborn
A
Ortolani’s test, inspect for asymetrical skin folds both prone and supine, knee heights
12
Q
What is Metatarsus adductus and how does it happen?
A
- due to intrauterine packing
- resolves spontaneously within first few years
- to assess draw imaginary line from center of heel through center of foot – should bisect second toe or between 2nd and 3rd toe.
- Not to be confused with clubfoot adducted forefoot but normal hindfoot, ankle easily dorsiflexes past neutral
13
Q
How is positional plagiocephaly different from craniosynostosis?
A
Plates not fused but molded
14
Q
Why is positional plagiocephaly more common now?
A
- More common since “Back to Sleep” Campaign
- Incidence: 1:300 to 50% of infants <1 yr
15
Q
Causes of plagiocephaly
A
- Position in the womb
- Torticollis
- Prematurity
- Back Sleeping
- Car seats, bouncy seats and swings
16
Q
Management of Deformational Plagiocephaly
A
- Preventive counseling
- Mechanical adjustments and exercises
- Referral to craniofacial specialist
- Skull molding helmet - tummy time may be as good
- Rarely surgery
referral around 6mo, not before.
17
Q
Newborn: Developmental Dysplasia of Hip (DDH): what is it?
A
Spectrum of abnormalities – range from shallowness of acetabulum to capsular laxity to frank dislocation
18
Q
Risk factors for Developmental Dysplasia of Hip (DDH)
A
female, first born, breech, FMH
19
Q
Complications of DDH
A
Duck-like walk, different leg lengths, osteoarthritis of early adulthood
20
Q
Screening for DDH
A
Observation: Allis sign
Provocative tests: Otolani and Barlow
21
Q
Barlow and Ortolani - how are they done?
A
barlow dislocates hip (if DDH) - knees together, down and in
Ortolani puts back in place - abduct legs and clunks back in place
22
Q
DDH: clics vs clunks
A
- Clicks: present 15% of infants – iliotibial band passes over greater trochanter- resolve with growth
- Clunks: dislocation of femoral head on provocative test – useful to age 3-4 mos. but performed until age 1
23
Q
Dx of DDH
A
ultrasound – useful 4-6 wks to 4-6 mos
5% missed even by experienced clinicians
24
Q
Result of missed dx of DDH
A
may ambulate without difficulty but may lead to degenerative hip arthritis
25
Rx for DDH
* until 6 mos. – Bracing – Pavlik harness
* age 6-12 mos. – body casting,
* \>1year require surgical intervention
26
Erb's palsy / brachial palsy - what is the cause?
Injury to brachial plexus during difficult delivery with shoulder dystocia
27
Erb's palsy: effect and Tx
* Effects moving upper arm and rotating lower arm
* RX: PT only to surgery
28
Common MS complaints in children and ados
* Legg Calve Perthes Disease
* Slipped Capital Femoral Epiphysis
* Scoliosis
* CRPS
29
Legg Calve Perthes Disease: what is it and what causes it?
* Definition: idiopathic avascular necrosis of femoral head
* Cause: multifactorial – genetic component, traumatic catalytic event
30
Legg Calve Perthes Disease: incidence - gender, age, location
* Male, age 4-8, sudden onset of limp with pain localized to knee or thigh rather then hip
* 10% bilateral
31
Clinical manifestations of LCP
Limp
Sudden groin or knee pain worse in AM and after activity
32
Four stages of LCP
Incipient (few weeks)
Necrotic (several months to one year)
Regenerative (2-4years)
Residual
33
Dx LCP
* AP and frog lateral pelvic x-ray
* Ultrasound may show joint effusion
34
Course and Rx of LCP
* Course: approx. 2 years for disease to run course, 2 yrs. regenerative phase
* Rx: Maintenance of ROM
35
Slipped Capital Femoral Epiphysis (SCFE): definition
displacement of femoral head through the growth plate usually during period of rapid growth
36
Slipped Capital Femoral Epiphysis (SCFE): onset, age, gender, at risk
* Onset: Insidious pain or limp or acute pain often in knee or thigh \<50% c/o groin pain
* Age: 11-13 girls, 13-15 boys
* Male to Female ratio 2:1
* Incidence: increased in AA, 2/3 obese
37
SCFE: physical findings
imp, external rotation of foot on affected side, painful, limited internal rotation of hip, unable to walk
38
SCFE: dx
Bilateral AP and frog lateral x-ray of pelvis (20% cases bilateral), 30% slip other side within a year
39
SCFE Rx
Surgery – metal screws across growth plate to stabilize
40
Scoliosis: definition and incidence
* Lateral curve of spine with rotation of lumbar, thoracic or rarely cervical vertebrae
* Incidence: 2-3% adolescents age 10-16
41
Scoliosis: cause
* 65% idiopathic
* Non-structural (functional): due to secondary condition e.g. leg length discrepancy, spasm
* Structural Scoliosis
* genetic, hormonal and environmental factors being considered
42
Three types of scoliosis
* Infantile (0-3 yrs) spontaneous resolution in 90% of cases
* Juvenile (3-10 yrs) 12-16% of cases, difficult to manage
* Adolescent Idiopathic (AIS): (\>10 yrs) female to male 5.7:1
Significant progression occurs during the adolescent growth spurt
43
Scoliosis: risk factors for curve progression
* Female: 10:1 – curves \>30 degrees
* Thoracic or double major curves
* Curves \> 20 degrees
* Skeletal immaturity/ pre-menarchal
44
Detection of scoliosis
Screening examination
* Unequal shoulder heights
* Uneven scapula
* Asymmetry of waist/hip
* Head not centered
* On forward bend-thoracic or lumbar asymmetric prominence
45
Dx of scoliosis
Spine films - curve\>10 degrees
Scoliometer
46
What is a ScoliScore and who is it used for?
Used mainly with AIS
In skeletally immature. Patients: 9-13+
* Molecular test used to predict risk of spinal curve progression
* DNA sample from patient’s saliva
* Indicates likelihood of curve progression
* Low
* Moderate
* Severe
47
What is the Risser scale and how is it used?
The lower the Risser scale at the time of detection the greater the risk of progression.
48
Mgmt of scoliosis based on degree of curve
* Curves: 10-25 degrees – Observation with follow – up every 6 months
* \>25 degrees – Bracing if growth remaining
* Surgery: \> 40-45 degrees – Anterior or posterior spinal fusion with instrumentation
49
options for innovative tx of juvenile scoliosis
* **Casting** for Infantile and Juvenile Scoliosis: utilizes growth as a corrective force
* **VEPTR:** Vertical Expanding Prosthetic titanium ribs: enhances pulmonary function, most advanced treatment for children with TIS: thoracic insufficiency syndrome
* Allows for rib cage and lung growth as the patient grows
* Expansions done in out- patient every 4-6 months
50
Torticollis: what is it and how does it happen?
* Congenital muscular: 1% incidence associated with difficult delivery, noted at 2-8 wks. – resolves spontaneously
* Congenital positional: present at birth, resolves spontaneously
* Trauma: painful, LOM, muscle injury or fx.
51
Torticollis: Rx
positioning/exercise in infants, analgesia, heat, rest – Refer prn
52
Pectus excavatum: what is it and who has it?
* Chest deformity - concavity
* Occurrence: 1:300, 5:1 male to female
* Seen in: Marfan’s, Hurlers syndromes (metabolic disease w dwarfism, MR)
53
Pectus excavatum: concern
cosmetic/psychologic, cardiac and pulmonary compromise in severe cases
54
Pectus excavatum: Rx
Surgery
55
Back pain: Ddx for pre-pubertal
infection (diskitis, osteomyelitis), tumor
56
Back pain: Ddx for pubertal
* spasm due to exercise, lumbar strain from overuse,
* tumor, spondylolysis or spondylolisthesis: herniated disk, Scheuermann disease (kyphosis)
57
Back pain red flags
* Child
* Causes functional disability
* Duration \> four weeks
* Fever
* Postural changes in trunk from splinting to decrease pain
* LOM
* Neurologic abnormality
58
Back pain and backpacks - what the problem?
* Incidence: 2013 - Overloaded backpacks caused 14,000 injuries treated in ED
* Can lead to herniated disc and osteoarthritis in later life
* Weight and amount of time carried influences cervical and shoulder posture
causing headache, spasm, back pain and aggravation of pre-existing scoliosis
59
Recommendations for Safe Back Pack Use – NASN
* Size of backpack matched to size of student
* Lightweight with padded shoulders, waist strap and padded back
* Position to rest evenly in middle of back
* Weight not \> 15% of body weight
* Lighten load whenever possible
60
Ehlers Danlos Syndrome: what is it?
* Group of inherited disorders that affects connective tissue, skin, bones, blood vessels and other organs
* Soft velvety skin, highly elastic, **bruise easily**, skin may split and bleed
* Skin sags and wrinkles, loose joints, B/l CHD
* Incidence: 1:5000 worldwide – all types
## Footnote
*Can miss the mark and think child abuse*
61
Rotational and Angular Deformities of Foot and Legs
* Congenital Talipes Equinovarus
* Metatarsus Adductus
* Internal Tibial Torsion
* Femoral Anteversion
* Genu Varum
* Genu Valgum
62
Congenital Talipes Equinovarus (CTEV)- “Clubfoot” - definitions
* equinus – plantar flexed
* Varus – inverted
* Cavus – abnormally high arch
63
CTEV (clubfoot) incidence
* Caucasians 1.2/1000
* South Pacific natives 7/1000
* 2:1 male predominance
* 50% have bilateral disease
* 20-30 X increase if affected primary relative
64
CTEV (Clubfoot): cause
Genetic 1:4 have positive family history
65
CTEV (Clubfoot): Dx & Signs
* **Dx:** clinical signs, antenatal dx on ultrasound
* **Signs**: deformity often rigid but may be supple enough to bring to normal position, Calf smaller on affected side
66
CTEV (Clubfoot): Types
Idiopathic and Neurogenic
* Neurogenic/Teratologic– associated with spina bifida and other paralytic states: FAS, CP
* Positional
67
CTEV (Clubfoot): comorbid conditions
hip dysplasia, and tortocollis
68
Management of CTEV: nonoperative
* Bracing without casting
* Physical therapy and continuous passive motion
* Serial casting beginning at 2 weeks – change every 2 weeks-long leg cast
* \>90% success for manipulation and casting
69
Management of CTEV: operative
First year of life
Often includes achilles tenotomy
70
Genu Varum: definition and causes
Bowlegged – common variant birth-18 months
* Physiologic due to intrauterine positioning- improves after several months of walking
* Other Causes
* Skeletal Dysplasias: achondroplastic dwarfism
* Pathologic: Rickets, Blount’s Disease, Old FXs
* Dx Tests: X-ray, bone scan, metabolic screening
* Due to Rickets
* Provide Vitamin D supplementation esp. breast fed infants \> 2 months
71
Genu Valgum: definition and causes
* Definition: \> 10 cm distance b/w ankles with knees together
* Associated with general ligamentous laxity
* Physiologic developmental finding
* X-ray if valgus \> 15-20 degree, short stature or asymmetry
72
Genu varum / genu valgum Tx
both genuverum and genu valgum will resolve on own. If older, may refer
73
Common Normal Variations in gait: Toddler
* Wide based gait with lumbar lordosis
* Out toeing
* In toeing,
* Toe walking
74
Causes of Limping in Childhood
* Pain
* Weakness
* Structural or Mechanical abnormalities of spine, pelvis and lower extremities
* Trauma
* LCP disease
* Toxic Synovitis
* Diskitis
75
Types of Gaits
* **Normal Gait**: Stance phase (60%) and swing phase
* **Antalgic gait** : shortened stance phase due to trauma or infection
* **Vaulting gait:** leg length discrepancy or abnormal knee mobility
* **Trendelenburg gait**: downward pelvic tilt seen in SCFE
* **Stooped gait:** common in pelvic or lower abdominal pain
76
What should you do if you notice intoeing gait in a child?
Check location of origin – foot, b/w hip and knee,b/w ankle and knee
77
What is the liekly cause of intoeing that originates in the foot?
And what to do about it
* MTA metatarsus adductus (packing defect)
* Actively correctible – straightens on tickling lateral aspect of foot – no rx
* Passively correctible – straightens with gentle pressure - exercises
* Rigid – does not correct – stretch casting/bracing
78
What is the liekly cause of intoeing that originates btwn the knee and ankle?
And what to do about it
_Tibial torsion_
* Cause: packing defect – twist in tibia
* Most common cause of intoeing in children
* Recognized when child begins to walk
* Improves after walking one year
* Treatment rarely necessary
79
What is the liekly cause of intoeing that originates btwn the hip and knee?
And what to do about it
_Medial Femoral Torsion (MFT) Femoral Anteversion_
* Cause: twist in femur b/w hip and knee
* Most common cause of intoeing in children \> age 3
* Sit in “W” position – may be acquired rotational deformity *avoid!*
* Deformity self corrects slowly by about age 8-10 years
80
Pes Planus – Flat Feet: mgmt if flexible
* Flexible – patient reform arch when standing on toes – Rx: Reassurance
81
Pes Planus - Flat feet
mgmt if rigid
* Rigid – less common, symptomatic in adolescence –
* fused tarsal bone
* Dx: CT scan
* Rx : Surgical – removal of bony blockage and restoration of motion
82
Toe walking: when is it normal / abnormal?
* Heel – toe gait developed by age 3
* Toe walking abnormal \> age 3
83
Toe walking: causes
* Idiopathic
* Tight heel cords
* Neurologic disorder e.g. CP, tethered spinal cord, muscular dystrophy, intraspinal lesion or tumor, CRPS – Complex Regional Pain Syndrome
84
Toe walking: Tx
* PT – stretch Achilles tendon
* Ankle –foot orthoses to maintain tendon length
* Serial stretch casting
* Botulinum toxin injections – decrease muscle tone as adjunct to stretching
* Surgical lengthening and bracing
85
What are growing pains? Who tends to get them and when?
* Idiopathic, intermittent, deep leg pain
* Cause: ? Overuse, rapid growth, psychological stress
* 15-30 % of children, female\>male
* Especially 3-5 years and 8-10 years
86
Growing pains: H & P
History: awakens from sleep, recurrent, short duration, b/l, nl activity
Normal exam
87
Growing pains: mgmt
Parental education, Reassurance
88
Common MS infections
* Toxic Synovitis
* Osteomyelitis
* Rheumatic Fever
* Diskitis
* Septic Arthritis
* Costochrondritis
89
Toxic/Transient Synovitis: what is it? Who gets it?
* Transient unilateral inflammation of hip joint
* Age: 2-12 yrs esp. boys
90
Toxic/Transient Synovitis: presentation
* Most common cause of limp with hip pain, may refuse to walk, may awaken at night
* Vague leg or knee pain, no systemic symptoms, associated with viral illness
91
Toxic/Transient Synovitis: Rx and prognosis
* Rx: NSAIDS, improvement 24-48 hours, if not refer
* 6-15% develop LCP disease and/or osteo-arthritic changes
92
Osteomyelitis: what is it and who gets it?
Local bone infection, usually bacterial
50% pediatric cases
93
Osteomyelitis: areas most often affected
* Femur and tibia most often affected
94
Osteomyelitis: presentation
* Sudden onset: high fever, refusal to walk
* May mimic rheumatoid arthritis, trauma, or neoplasm
95
Causes of Osteomyelitis
* Staphylococcus aureus most common cause
* Usually secondary to trauma (75%)
* High incidence in sickle disease - seed bacterial infection
* May be extra-intestinal site in salmonella infection
96
Osteomyelitis: Dx & Rx
* Bone scan and MRI - more sensitive than x-ray
* Dx studies: CBC, ESR, C-reactive protein
* Blood Culture + \> 50% of cases
* Bone Culture + \> 60-70 % of cases
* Rx: Antibiotic therapy - IV to oral
97
Diskitis: what is it / how does it present?
* Low back pain manifested as refusal to walk in irritable toddler
* Low grade fever
98
Diskitis: Dx and Rx
* Normal x-rays initially but change to show narrowing of the joint space and irregular margins of the vertebral plates
* RX: symptomatic/bed rest, Abx if poor response to conservative rx.
99
Rheumatic fever: who gets it and why?
Not common in western countries
Occurs 14-28 days after Strept pharyngitis or Scarlet Fever
100
Signs & Symptoms Rheumatic Fever
* Fever
* Painful and tender joints esp. ankles, knees, elbows or wrists
* Pain in one joint that migrates to another
* Red hot or swollen joints
* Rash, chest pain, fatigue
* Sydenham chorea
101
Rheumatic Fever: complications
damaged heart valves, often noted later in life
Mitral Stenosis
102
Dx of Rheumatic Fever
Major and minor criteria
Diagnosis
* CBC
* EKG
* ESR
Minor Criteria for DX:
* Fever
* Elevated ESR
* Joint Pain
* Abnormal EKG
Major Criteria for DX:
* Polyarthritis
* Carditis
* Subcutaneous nodules
* Erythema marginatum
* Sydenham chorea – “St Vitus Dance” *(involuntary mvmts)*
103
Rheumatic fever: Rx
Antibiotics
104
Costochondritis: what is it, who gets it, Rx
* “Chest pain of non-organic origin”
* Common in adolescence due to preoccupation with body and awareness of own mortality
* Definition: Inflammation of chest cartilage.
* Pain reproducible by palpation of affected chest cartilage with no signs or symptoms of other abnormalities
* RX: Reassurance, NSAIDS
105
MS problems in which sed rate and temp are normal
* Transient synovitis
* Local trauma
* LCP Disease
* SCFE
* Osteoid osteoma
106
MS problems in which sed rate and temp are elevated
* Septic Hip
* Osteomyelitis
* Trauma + URI
* Neuroblastoma, Ewing’s tumor
107
Nursemaid’s Elbow: definition & cause
* Definition: interposition of annular ligament into the radial-humerus joint
* Cause: extended arm pull, swinging while being held by hands
* Occurrence: girls \> boys, age 1-3
108
Nursemaid’s Elbow: Dx and Tx
* DX: history, physical exam, refusal to move arm
* Treatment: Support radial head, supinate or pronate forearm and flex = click/reduction
* Full use within 30 minutes, may be recurrent
## Footnote
*Can reduce in office*
109
Common Neoplasms in kids
Osteosarcoma
Ewing Sarcoma
110
Osteosarcoma: what is it and who gets it, where?
* Bone tumor caused by spindle cell sarcoma
* Most common bone tumor in first three decades of life
* Peak age: 13.5 female, 14.5 Male
* 40% occur distal femur, 90% occur in metaphysis
111
Osteosarcoma: cause and clinical presentation
* Cause: unknown, possibly due to prior radiation, chromosomal abnormality
* Clinical presentation: pain over involved bone, fever, weight loss, night sweats, pallor, malaise, increased pain at night and with weight bearing
112
Osteosarcoma: Dx, Rx, Px
* Dx: plain x-ray shows characteristic sunburst pattern
* Rx: Referral to tertiary care facility
* Px: 50-60% survival rate
113
Ewing Sarcoma: what is it and who gets it?
* Bone tumor caused by small, round blue cells (onion skin pattern on x-ray)
* Second most common tumor in children and adolescents esp. Caucasian males
114
Ewing sarcoma: Clinical presentation
Clinical presentation: pain, fever, tenderness over site, palpable mass
115
Ewing sarcoma: rx & px
Rx: Refer tertiary care, surgery, chemo - one year
Px: 60-70% survival rate w/o metastasis
116
A&P of bone: periosteum
outer shell of bone, thick and strong, flexible, vascular, often intact despite fx of underlying bone
117
A&P of bone: cortex
hard lamellar shell underlying periosteum, gives shape and strength, increases in thickness with growth and becomes less flexible
118
A&P of bone: apophysis
medial growth center, accounts for growth in bone width
119
A&P of bone: diaphysis
elongated shaft of long bone
120
A & P of bone: Metaphysis
spongy area toward end of bone covered by thin laminar bone
121
A & P of bone: Epiphysis
osseus end of bone, articular portion covered with cartilage
122
A&P of bone: Physis
growth plate in long bone, separates epiphysis from metaphysis, “weak link in children’s bones”
123
Mgmt of injuries to kids' bones
Dependent on age and degree of injury
* RICE
* Soft goods: sling, immobilizer/boot
* Traction
* Casting
* External fixation
* Surgery
124
What to do if child comes in w/sprain or strain
and Rx
* Evaluate mechanism of injury-Direct relationship b/w force and severity - ? abuse
* Observe: color, deformity, ROM
* Palpate: temperature, point tenderness, passive ROM
* RX: RICE – rest, ice, compression, elevation
125
Complex Regional Pain Syndrome: former name + when and where ususally begins
* Formerly RSD – Reflex Sympathetic Dystrophy or causalgia
* Historically considered rare in pediatric patients
* Typically begins in adolescence, rare before age 6
* Female \> Male
* Especially lower extremities
* Precipitated by trauma/surgery
126
CRPS: characteristics
* Extremity pain with neuropathic features:
* Painful sensitivity to light touch (allodynia)
* Neurovascular dysregulation: warmth/coolness, mottling, cyanosis, non articular swelling
* Sudomotor dysfunction: sweating/dryness
* Trophic changes: atrophy, abnormal hair and nail growth
* Movement disturbances: tremors, spasms, dystonia
127
Treatment: CRPS
* Rehabilitative Treatment: emphasizing biopsychosocial framework
* Physical Therapy
* Occupational Therapy
* Cognitive Behavioral Therapy
* Both inpatient and outpatient programs exist
* Outpatient: more cost effective
## Footnote
*Perhaps overstimulation of neuro system? Not yet clear.*
128
Trauma: Fractures - When to Refer
* Around or involving joint surfaces
* Deformity or displacement
* Skin compromise associated with fracture
* Neurovascular concerns: swelling, severe pain distal to fx., muscle weakness
* Epiphyseal plate injuries
* Specific areas: spine, hip, femur, tibia, calcaneus, talus (ankle bone), elbow, forearm, fingertip
129
Salter-Harris Fracture Classification
* Salter Harris I: Involve only physis, may not be seen on initial x-ray
* Salter Harris II: Fx line through physis and corner of metaphysis
* Salter Harris III: involves epiphysis and physis, not metaphysis, extends to joint, ? Surgical repair
* Salter Harris IV: Fx through epiphysis, physis,and metaphysis. Requires anatomic realignment
130
Types of Fractures
* Comminuted: \> 2 fragments of bone
* Complete: fracture through width vs crack
* Complex: includes soft tissue injury
* Compound: bone fragments penetrate through skin
* Compression/Impact
* Greenstick: incomplete, stable
* Oblique: unstable, rare
* Spiral: twisting motion, unstable
131
What is the most common fracture in kids?
forearm
132
Where do kids tend to get forearm fracture and what is the SH classification?
75% in distal 1/3 of radius
SH I or II common in teens
133
Common causes of forearm fractures?
Fall onto outstretched hand from bike, skateboard, inline skates
134
Mgmt of forearm factures?
* Obtain x-ray of wrist and elbow - ? Supracondylar humeral fx in forearm injuries
* Immobilize - Refer
135
What is a Toddler’s Fracture & who gets them?
Oblique or Spiral Fx of mid or distal tibia
Usually 1-3 years but
Less than 1 year old suspect child abuse
136
Cause of Toddler’s Fracture?
Fall or jump with twisting motion foot caught in fixed position
137
Dx of Toddler’s Fracture?
Refusal to walk or bear weight, little swelling, normal ROM
Tibia x-ray normal, 45 degree oblique shows fx
138
Fractured clavicle: on exam
* Swelling around fx but skin not compromised
* Lungs clear with good air entry
* Neck FROM with no tenderness
* Nl neurovascular exam upper limb
139
Fractured clavicle: Dx & Rx
* X-ray: midshaft fx minimal or no angulation or displacement
* RX: Clavicular splint - 6 weeks
140
Fractured Phalanx: on exam
* Swelling with no deformity
* Normal neurovascular exam
141
Fractured Phalanx: Dx and Rx
* X-ray = angulation
* RX: Aluminum splint middle and distal phalanx, immobilizing joint proximal and distal to fx for approx 3 weeks
142
Toe Fracture: on exam
* Swelling around fracture but no deformity
* Normal neurovascular exam
143
Toe Fracture: Dx and Rx
X-ray RX: Buddy taping for 3 weeks
144
Orbital Fracture: types
* 45% of all facial trauma
* Type I: Pure orbital
* Type II: Craniofacial
* Type III: Common fracture - requires surgery
145
Mallet Finger / Baseball Finger
what is it and what should you do?
disruption of the terminal extensor mechanism at the distal interphalangeal (DIP) joint
Seen in athletes and non after "innocent trauma"
Often consider it minor, thus untreated - but can lead to serious probs
146
ACL tears: new ways to repair
* Use of a collagen hydrogel and platelet rich blood plasma to facilitate healing
* Surgical devices
* Help facilitate regeneration of ligamentous tissue
147
Overuse syndromes
* Osgood Schlatter Syndrome
* Sever’s Syndrome-heel pain
* Iliac Apophysitis-esp. in runners
* Shin Splints-acute pain along anterior aspect of shin
148
What is Osgood Schlatter Syndrome and what causes it?
* Def: Inflammation of patella tendon at tibial tuberosity
* Symptoms: dull ache progresses to pain on ambulation, 10% develop bone fragment in tendon (Lump on knee)
* Causes: repetitive sports activity, tightness of tendon due to growth spurts
149
Osgood Schlatter Syndrome Rx
* RX: RICE, referral if symptoms persist and are significant
* Quad strengthening exercises QID - best
150
Management of Overuse Syndromes
* Avoid activity that causes pain-usually sports until healed (often 4-6 wks)
* Ice 20 minutes after exercise
* Identify cause when possible
151
Sever’s Syndrome: def and cause
Def: Calcaneal Apophysitis – inflammation in the growth plate of young children
Cause: Repetitive stress to the heel esp. in children who are athletically active
152
Sever’s Syndrome: Dx & Px
* DX: Clinical, X-rays normal, no edema or redness
* + squeeze test-pain on medial –lateral compression of calcareous
* Resolves with rest or completion of bone growth
153
Sever's syndrome: age of onset
Age of onset: 9-11, Boys \> girls
154
Orthopedic Complications of Overweight
* Progression of degenerative osteoarthritis
* Decline in physical functioning
* Poorer outcomes after orthopedic surgery
* Knee pain
* Impairment in mobility
* Increased incidence of SCFE
* Blounts Disease: progressive bowing of legs
155
key age for bone dvpt
9-18
156
Calcium boosters for prevention of osteoporosis (foods)
milk, cheese, yogurt, ice cream, sardines, tofu, almonds, salmon, calcium fortified products
157
Foods/drinks that are calcium blockers
soda, fad diets, alcohol, vegan diets, certain medications, excess salt, protein, phosphorus
158
Risk Factors for Osteoporosis
* No Breakfast
* Lack of physical activity
* Irregular periods or absence of periods
* Poor calcium intake
* Balance issues
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Calcium supplement: how much and what kind?
* Daily Calcium requirement: 1200-1500mg (Elemental Calcium)
* Calcium carbonate: best with food, may decrease iron absorption from diet
* **Calcium citrate:** more soluble, e_nhances iron absorption_ and can be taken any time of day (May contain less elemental CA and therefore require more pills/day)
