clin med IV > pedi ortho > Flashcards

pedi ortho Flashcards

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1
Q

gower’s sign

A
  • weakness of proximal hip muscles
  • limited ability to rise from sitting to standing
  • uses hand and arms to “climb” up body
  • think muscular dystrophy
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2
Q

which fractures are more likely to require internal fixation?

A
  • displaced epiphyseal fx
  • displaced intra-articular fx
  • fx in child with multiple injuries
  • open or unstable fx
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3
Q

bone remodeling

A
  • occurs through periosteal resoprtion and new bone formation
  • dont need perfect alignment
  • younger= better potential for remodeling
  • cant accept rotated fx and deformity not in plane of motion
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4
Q

fracture complications

A
  • overgrowth
  • neruovascular injury- especially distal humerus and knee
  • compartment syndrome
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5
Q

what fx are most likely to result in overgrowth

A
  • femoral fx in kids < 10 y/o
  • can have 1-3 cm of overgrowth
  • generally occur more often in long bones d/t increased BF after fx
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6
Q

salter harris fx

A
  • fx involves growth plate -> premature closure
  • partial closure= angular deformity
  • complete closure= limb shortening
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7
Q

common sites for salter harris fx

A
  • distal radius
  • distal tibia
  • distal fibula
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8
Q

salter harris type I

A
  • through growth plate
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9
Q

salter harris type II

A
  • through metaphysis and growth plate
  • most common
  • good prognosis
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10
Q

salter harris type III

A
  • through epiphysis and growth plate

- into joint- poorer prognosis

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11
Q

salter harris type IV

A
  • through metaphysis and epiphysis
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12
Q

salter harris type V

A
  • crushed through growth plate
  • doesn’t displace growth plate but damages it by compression
  • worst prognosis
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13
Q

green stick fx

A
  • bending force perpendicular to shaft
  • bone doesnt cause complete fx
  • usu in forearm of young kids
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14
Q

toddlers fx

A
  • minimally or non-displaced oblique fx of tibia
  • pts 1-3
  • limping pain with WB
  • minimal welling and pain
  • initial xray doesnt always show fx- can repeat
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15
Q

what is another name for a buckle fx

A
  • torus fx
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16
Q

buckle fx

A
  • occurs after compression of bone
  • boney cortex doesn’t truly break
  • occurs in metaphysis
  • stable fx
  • commonly d/t foosh -> buckle of distal radius
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17
Q

bowing fx

A
  • no fx line on xray
  • bone is bent, not a true fx
  • will heal with periosteal reaction
  • reductrion requires a lot of force, do under anesthesia
  • may consider comparison views on xray
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18
Q

supracondylar fx

A
  • extra-articular fx above joint line
  • fx of distal humerus at elbow
  • usu in kids 5-9
  • most often from foosh from moderate hight onto extended elbow
  • posterior displacement of distal compartment
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19
Q

conservative treatment for supracondylar fx

A
  • used if non-displaced
  • long arm cast
  • serial xrays q 1-2 weeks
  • analgesics
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20
Q

surgical tx for supracondylar fx

A
  • ORIF
  • 2 lateral pins for stable fixation, medial pin
  • be sure to correct medial pin placement to avoid ulnar n damage
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21
Q

nusemaid’s elbow

A
  • subluxation of radial head under annular l
  • common in infants/ small children
  • d/t pulling/ lifting of hand
  • present with elbow pronated and painful
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22
Q

tx of nursemaid’s elbow

A
  • pressure on radial head

- gentle supination while flexing elbow

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23
Q

galeazzi fx dislocation

A
  • fx of distal radius
  • dislocation of distal radioulnar joint
  • usu in kids 9-12
  • typically d/t foosh with flexed elbow
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24
Q

monteggia fx dislocation

A
  • fx of ulnar shaft
  • dislocation of radial head anteriorly
  • usu secondary to foosh
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25
tx for galeazzi and monteggia fx
- ORIF
26
developmental dysplasia of the hip (DDH)
- hip that is dislocated and irreversible - hip that us dislocated and reducible - dysplastic but within acetabulum (most common)
27
risk factors for DDH
- first born- smaller uterus - females > males - breech position in utero - + family hx of DDH or early hip replacement
28
possibly signs of DH
- toe walking, may be unilat - limb length inequality - waddling gait - hyperlordosis (sway back) - usually assess for DDH at newborn visits
29
barlow test
- used for DDH | - adduct hip with thumb and dislocate it
30
ortolani test
- used for DDH | - abduct hip to reduce it
31
galeazzi test
- used for DDH | - difference in knee height when knees are bent and feet are in the same position
32
tx of DDH
- pavlik harness - abduction orthosis if pavlik harness fails - closed reduction first surgical option - open reduction if closed fails - spica cast to hold hips after reduction
33
legg calve perthes (LCP)
- idiopathic osteonecrosis of capital femoral epiphysis | - vascular interruption into subchondral bone
34
who gets LCP
- ages 5-8 - more commonly boys - usu the hyperactive boy who plays several sports, complains of vague hip pain
35
clinical presentation of LCP
- small for age - delayed bone age - very active or hyperactive, usu male - nonspecific pain in ant hip, thigh, knee - mild limp - insidious onset, no trauma
36
stages of LCP
- necrosis - fragmentation - re-ossification - remodeling
37
necrosis stage in LCP
- initial ischemia to femoral head
38
fragmentation stage of LCP
- re-absorption of bone with femoral head collapse
39
re-ossification stage of LCP
- new bone re-grows to reshape the femoral head
40
remodeling stage of LCP
- femoral head reshapes itself into spherical shape
41
PE findings for LCP
- limp - limited ROM: abduction and internal rotation - quad atrophy - leg length inequality
42
dx of LCP
- AP pelvis and frog lateral - early changes: smaller epiphysis, radiodense, crescent sign, mild flattening - metaphyseal radiolucency
43
prognosis of LCP
- self healing 2-4 weeks - not all pts end up with spherical head - permanent femoral head deformity -> early OA - poorer outcomes in pts > 8 y/o
44
tx of LCP
- reduced activities, NWB - NSAIDs - refer to pedi ortho for surgery within 2-3 weeks - surgery= osteotomy
45
slipped capital femoral epiphysis (SCFE)
- slippage of epiphysis relative to femoral neck - neck and shaft displace anteriorly, rotate externally - head slips posteriorly - most common disorder affecting adolescent hips - males > females - obesity major risk factors
46
when do SCFEs occur
- during periods of rapid growth - 13 in males - 12 in females
47
clinical presentation of SCFE
- may be bilat - groin/ thigh pain most common - can have knee pain in up to 25% of cases - ext rotated gait or trandelenburg gait - decreased hip motion
48
dx of SCFE
- AP hip and frog leg lateral
49
tx of SCFE
- immed referral to pedi ortho - nonweight bearing - percutaneous in situ fixation tx of choice - stabilize epiphysis from further slippage - promote closure of proximal femoral physis
50
prognosis of SCFE
- abnormal gait and ext rotated leg position are permanent | - outcome depends on severity of slippage and if stable/ unstable
51
transient synovitis of the hip
- most common cause of hip pain in kids - self limited - usu undetermined etiology - occasionally follows URI
52
clinical features of transient hip synovitis
- rapid onset limping - refusal to walk/ weight bear - ROM limited by pain and spasms - hip held in flexion
53
dx of transient hip synovitis
- dx of exclusion* - +/- mild elevation of WBC, ESR, CRP - AP pelvis and frog leg lateral usu normal - may see joint space widening - US to eval for effusion - MUST exclude septic arthritis
54
when do you aspirate the hip to dx transient hip synovitis
- ESR > 20 | - temp > 37.5 (99.5)
55
treatment of transient hip synovitis
- bed rest until sx improve - gradual increase to activity - NSAIDs - resolution of sx and return to ROM are characteristic
56
what disorders are included in apophysitis
- osgood- schlatter's - severe's disease - occurs during periods of rapid grwoth
57
osgood- schlatter's
- traction at insertion of patella tendon into tibial tubercle - pain usu relieved by rest - prominent tibial tubercle - +/- swelling or redness
58
tx of osgood- schlatter's
- rest - ice - NSAIDs
59
severe's disease
- aka calcanea aphophysitis - common cause of heel pain in kids - repetitive stress on growth plate -> inflammation and pain
60
when does severe's disease occur
- beginning of new sports season | - usu new cleats or footwear
61
clinical presentation of severe's disease
- child with heel pain -> limp - usu first noticed after sports - then pain during and after sports - then pain before sports
62
tx of severe's disease
- RICE - gel heel pads for mild - d/c sports if mod- severe - achilles stretches - modify activity - good prognosis if compliant, may require casting if not
63
genu varum
- aka bow legged - normal in ages 0-2 - usu benign and resolves without intervention - normal growth plate on xray
64
when is genu varum worrisome
- lateral thrust during gait - short stature - ligament laxity - abnormal location of deformity - apparent enlargement of elbow, wrist, knees, ankles
65
when are xrays indicated for genu varum
- asymmetric - atypical age - worsening deformity
66
blount's disease
- pathologic genu varum deformity - progressive - unilat - early walking, obesity, family hx - lateral thrust during gait - refer if genu varum > 2 y/o
67
ricketts
- can cause pathologic genu varum - short stature - enlargement of elbows, wrists, knees,hands
68
genu valgus
- aka knock knees - symmetric valgus normal at age 3-5 - improves with growth - normal growth plate on xrays
69
toe walking
- common in early walkers - eval any child > 3 who still toe walks - most likely habit/ idiopathic - consider neuromusc disorder, achilles contracture, leg length discrepancies
70
tx for idiopathic toe walking
- improves spont with maturity and weight - heel cord stretching - serial casting - surgical heel cord lengthening (rarely needed)
71
club foot
- congenital abnormality - equinus, adductus, varus, medial rotation - dx should prompt search for other musculoskel problems
72
tx of club foot
- surgery- heel cord lengthening - and/or serial casting - PT guided stretching daily
73
scoliosis
- lateral spinal curvature with cobb angle > 10 degrees - most common peds back deformity - not painful
74
causes of scoliosis
- idiopathic: most common, usu females, adolescent growth spurt - congenital vertebral abnormalities - neuromuscular disorders
75
PE findings for scoliosis
- one shoulder higher than the other - larger space from arm to side of body - uneven waist creases - uneven hip levels - look at pts back while standing erect and bending forward
76
dx of scoliosis
- full length scoli series - asses pelvic obliquity and limb length discrepancy - measure cobb angle
77
what is the risser classification
- used to grade skel abnormalities based on level of ossification of iliac crest apophysis
78
risser 0
- no ossification at center of iliac crest apophysis
79
risser 1
- apophysis < 25% of iliac crest
80
risser 2
- apophysis 25-50% of iliac crest
81
risser 3
- apophysis 50-75% of iliac crest
82
risser 4
- apophysis > 75% of iliac crest
83
risser 5
- complete ossification and fusion of iliac crest apophysis
84
treatment of scoliosis
- observe if curve < 25 degrees - orthosis/ brace if curve 25-40 degrees - operate if curve > 40 degrees or rapidly progressive curve
clin med IV
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