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