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Flashcards in Pediatric MSK disorders Deck (32):
1

________= apex of angulation away from midline

varus

2

________ = apex of angulation towards midline

valgus

3

What are three causes of in-toeing in children

1. from the foot: metatarsus adductus
2. from the tibia: internal tibial torsion
3. from the femur: femoral anteversion

4

What is metatarsus adductus?

medial angulation of the forefoot present at birth, can usually be corrected with manipulation on exam

5

When is surgery indicated for metatarsus adductus?

feet have enough deformity to cause problems wearing shoes

6

Though internal tibial torsion is very common at birth, it is usually not detected until ________

children begin walking

7

Internal tibial torsion and femoral anteversion are both likely due to ________ positioning

in utero

8

What is treatment for internal tibial torsion?

None, usually deteriorates by about age 5. Braces or bar and shoe devices to not speed up resolution

9

Children with femoral anteversion have significantly increased ______ rotation of the hip

internal

10

Femoral anteversion usually resolves by about age ____

10

11

When is surgery indicated for internal tibial torsion?

continuing to cause tripping after 8 yrs old

12

When is surgery indicated for femoral anteversion?

causes "miserable malalignment syndrome" with anterior knee pain

13

Describe the normal progression of sagittal plan development of the lower extremities

- varus/ bowlegged at birth
- valgus/ knock kneed by about 3 years
- relatively straight adult alignment by about 6 years

14

Guided growth therapy requires detection of abnormalities before puberty and an open ______

physis

15

Describe guided growth surgery

the growth plate is tethered on the convex side, allowing the concave side to continue to grow until the leg is straight

16

_______ is a pathologic bowing of the lower extremity resulting from varus of the tibia

Blount disease

17

What causes Blount disease?

compressive forces on the medial portion of the proximal tibia causing inhibition of physeal growth in an asymmetric fashion

18

What children are at risk for Blount disease?

heavy toddlers
early walkers
additional internal tibial torsion

19

What is the treatment for Blount disease?

- bracing to attempt to decrease medial tibial forces and promote normal growth
- may require surgery to re-align tibial and rebalance forces across the growth plate

20

What is the treatment for Blount disease?

- bracing to attempt to decrease medial tibial forces and promote normal growth
- may require surgery to re-align tibial and rebalance forces across the growth plate

21

How is "adolescent" Blount disease different from the infantile form?

- presents later
- treated with guided growth, bracing is not effective
- due to obesity

22

What are two pathologic processes that should be considered in a child with leg bowing?

rickets, bone dysplasia

23

Scoliosis is due to asymmetric growth of the ____ spine relative to the _____ spine

anterior vs posterior

24

Scoliosis is due to asymmetric growth of the ____ spine relative to the _____ spine

anterior vs posterior

25

What are the proposed etiologies of scoliosis?

genetics
hormonal influences including melatonin
structural deficiencies- fibrillin, elastin, collagen

26

Left untreated, spinal curves in scoliosis progress at what rate?

about 1 degree per month
only the most severe curves continue after skeletal maturity

27

Severe curves in scoliosis can cause _________ compromise

cardiorespiratory

28

What is the treatment for scoliosis?

bracing
surgical straightening and spinal fusion

29

The risk of _______ of scoliosis is highest in children who develop scoliosis before age 10.

progression

30

A foot arch develops in most children by about ____ years old

8

31

Are orthotics helpful in development of foot arch in children?

NO
actually barefoot is best

32

Clubfoot includes four deformities:

metatarsus adductus, cavus (high arch), hindfoot varus and equinus