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Flashcards in pedi ortho Deck (84)
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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
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
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
4
Q

fracture complications

A
  • overgrowth
  • neruovascular injury- especially distal humerus and knee
  • compartment syndrome
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
6
Q

salter harris fx

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

common sites for salter harris fx

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

salter harris type I

A
  • through growth plate
9
Q

salter harris type II

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

salter harris type III

A
  • through epiphysis and growth plate

- into joint- poorer prognosis

11
Q

salter harris type IV

A
  • through metaphysis and epiphysis
12
Q

salter harris type V

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

green stick fx

A
  • bending force perpendicular to shaft
  • bone doesnt cause complete fx
  • usu in forearm of young kids
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
15
Q

what is another name for a buckle fx

A
  • torus fx
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
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
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
19
Q

conservative treatment for supracondylar fx

A
  • used if non-displaced
  • long arm cast
  • serial xrays q 1-2 weeks
  • analgesics
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
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
22
Q

tx of nursemaid’s elbow

A
  • pressure on radial head

- gentle supination while flexing elbow

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
24
Q

monteggia fx dislocation

A
  • fx of ulnar shaft
  • dislocation of radial head anteriorly
  • usu secondary to foosh
25
Q

tx for galeazzi and monteggia fx

A
  • ORIF
26
Q

developmental dysplasia of the hip (DDH)

A
  • hip that is dislocated and irreversible
  • hip that us dislocated and reducible
  • dysplastic but within acetabulum (most common)
27
Q

risk factors for DDH

A
  • first born- smaller uterus
  • females > males
  • breech position in utero
    • family hx of DDH or early hip replacement
28
Q

possibly signs of DH

A
  • toe walking, may be unilat
  • limb length inequality
  • waddling gait
  • hyperlordosis (sway back)
  • usually assess for DDH at newborn visits
29
Q

barlow test

A
  • used for DDH

- adduct hip with thumb and dislocate it

30
Q

ortolani test

A
  • used for DDH

- abduct hip to reduce it

31
Q

galeazzi test

A
  • used for DDH

- difference in knee height when knees are bent and feet are in the same position

32
Q

tx of DDH

A
  • 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
Q

legg calve perthes (LCP)

A
  • idiopathic osteonecrosis of capital femoral epiphysis

- vascular interruption into subchondral bone

34
Q

who gets LCP

A
  • ages 5-8
  • more commonly boys
  • usu the hyperactive boy who plays several sports, complains of vague hip pain
35
Q

clinical presentation of LCP

A
  • 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
Q

stages of LCP

A
  • necrosis
  • fragmentation
  • re-ossification
  • remodeling
37
Q

necrosis stage in LCP

A
  • initial ischemia to femoral head
38
Q

fragmentation stage of LCP

A
  • re-absorption of bone with femoral head collapse
39
Q

re-ossification stage of LCP

A
  • new bone re-grows to reshape the femoral head
40
Q

remodeling stage of LCP

A
  • femoral head reshapes itself into spherical shape
41
Q

PE findings for LCP

A
  • limp
  • limited ROM: abduction and internal rotation
  • quad atrophy
  • leg length inequality
42
Q

dx of LCP

A
  • AP pelvis and frog lateral
  • early changes: smaller epiphysis, radiodense, crescent sign, mild flattening
  • metaphyseal radiolucency
43
Q

prognosis of LCP

A
  • 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
Q

tx of LCP

A
  • reduced activities, NWB
  • NSAIDs
  • refer to pedi ortho for surgery within 2-3 weeks
  • surgery= osteotomy
45
Q

slipped capital femoral epiphysis (SCFE)

A
  • 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
Q

when do SCFEs occur

A
  • during periods of rapid growth
  • 13 in males
  • 12 in females
47
Q

clinical presentation of SCFE

A
  • 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
Q

dx of SCFE

A
  • AP hip and frog leg lateral
49
Q

tx of SCFE

A
  • 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
Q

prognosis of SCFE

A
  • abnormal gait and ext rotated leg position are permanent

- outcome depends on severity of slippage and if stable/ unstable

51
Q

transient synovitis of the hip

A
  • most common cause of hip pain in kids
  • self limited
  • usu undetermined etiology
  • occasionally follows URI
52
Q

clinical features of transient hip synovitis

A
  • rapid onset limping
  • refusal to walk/ weight bear
  • ROM limited by pain and spasms
  • hip held in flexion
53
Q

dx of transient hip synovitis

A
  • 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
Q

when do you aspirate the hip to dx transient hip synovitis

A
  • ESR > 20

- temp > 37.5 (99.5)

55
Q

treatment of transient hip synovitis

A
  • bed rest until sx improve
  • gradual increase to activity
  • NSAIDs
  • resolution of sx and return to ROM are characteristic
56
Q

what disorders are included in apophysitis

A
  • osgood- schlatter’s
  • severe’s disease
  • occurs during periods of rapid grwoth
57
Q

osgood- schlatter’s

A
  • traction at insertion of patella tendon into tibial tubercle
  • pain usu relieved by rest
  • prominent tibial tubercle
  • +/- swelling or redness
58
Q

tx of osgood- schlatter’s

A
  • rest
  • ice
  • NSAIDs
59
Q

severe’s disease

A
  • aka calcanea aphophysitis
  • common cause of heel pain in kids
  • repetitive stress on growth plate -> inflammation and pain
60
Q

when does severe’s disease occur

A
  • beginning of new sports season

- usu new cleats or footwear

61
Q

clinical presentation of severe’s disease

A
  • child with heel pain -> limp
  • usu first noticed after sports
  • then pain during and after sports
  • then pain before sports
62
Q

tx of severe’s disease

A
  • 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
Q

genu varum

A
  • aka bow legged
  • normal in ages 0-2
  • usu benign and resolves without intervention
  • normal growth plate on xray
64
Q

when is genu varum worrisome

A
  • lateral thrust during gait
  • short stature
  • ligament laxity
  • abnormal location of deformity
  • apparent enlargement of elbow, wrist, knees, ankles
65
Q

when are xrays indicated for genu varum

A
  • asymmetric
  • atypical age
  • worsening deformity
66
Q

blount’s disease

A
  • pathologic genu varum deformity
  • progressive
  • unilat
  • early walking, obesity, family hx
  • lateral thrust during gait
  • refer if genu varum > 2 y/o
67
Q

ricketts

A
  • can cause pathologic genu varum
  • short stature
  • enlargement of elbows, wrists, knees,hands
68
Q

genu valgus

A
  • aka knock knees
  • symmetric valgus normal at age 3-5
  • improves with growth
  • normal growth plate on xrays
69
Q

toe walking

A
  • 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
Q

tx for idiopathic toe walking

A
  • improves spont with maturity and weight
  • heel cord stretching
  • serial casting
  • surgical heel cord lengthening (rarely needed)
71
Q

club foot

A
  • congenital abnormality
  • equinus, adductus, varus, medial rotation
  • dx should prompt search for other musculoskel problems
72
Q

tx of club foot

A
  • surgery- heel cord lengthening
  • and/or serial casting
  • PT guided stretching daily
73
Q

scoliosis

A
  • lateral spinal curvature with cobb angle > 10 degrees
  • most common peds back deformity
  • not painful
74
Q

causes of scoliosis

A
  • idiopathic: most common, usu females, adolescent growth spurt
  • congenital vertebral abnormalities
  • neuromuscular disorders
75
Q

PE findings for scoliosis

A
  • 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
Q

dx of scoliosis

A
  • full length scoli series
  • asses pelvic obliquity and limb length discrepancy
  • measure cobb angle
77
Q

what is the risser classification

A
  • used to grade skel abnormalities based on level of ossification of iliac crest apophysis
78
Q

risser 0

A
  • no ossification at center of iliac crest apophysis
79
Q

risser 1

A
  • apophysis < 25% of iliac crest
80
Q

risser 2

A
  • apophysis 25-50% of iliac crest
81
Q

risser 3

A
  • apophysis 50-75% of iliac crest
82
Q

risser 4

A
  • apophysis > 75% of iliac crest
83
Q

risser 5

A
  • complete ossification and fusion of iliac crest apophysis
84
Q

treatment of scoliosis

A
  • observe if curve < 25 degrees
  • orthosis/ brace if curve 25-40 degrees
  • operate if curve > 40 degrees or rapidly progressive curve