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Clin Med II MHM - FINAL > Pediatric Ortho > Flashcards

Pediatric Ortho Flashcards

1
Q

Definition of torticollis

A
  • Unilateral contraction of neck muscles causing head to be tilted to one side
  • Chin rotates to opposite side of contraction
  • 80% are congenital (rest are trauma/disease)
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2
Q

When does congenital torticollis MC occur?

A

Following breech deliveries

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3
Q

What can congenital torticollis be associated with?

A
  • Hip dysplasia

- Clubfoot

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4
Q

What happens to the SCM in congenital torticollis?

A

Fibrosis of SCM causes a palpable “mass”

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5
Q

When does the SCM mass resolve in congenital torticollis?

A
  • A few weeks after birth

- SCM is shortened and contracted after

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6
Q

What happens if congenital torticollis is left untreated?

A
  • Plagiocephaly (facial asymmetry/skull deformity)

- Changes in cervical vertebrae

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7
Q

How is congenital torticollis diagnosed?

A
  • Clinically (based on PE and palpable mass of SCM)

- Xray of cervical spine is recommended

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8
Q

Conservative treatment of congenital torticollis

A
  • Stretching exercises

- Doc band to help improve secondary plagiocephaly

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9
Q

Surgical treatment of congenital torticollis

A
  • For pts who fail conservative tx or are diagnosed late

- Release of SCM (traction/casting and exercises)

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10
Q

Define plagiocephaly

A

Skull deformity from external forces (either in utero or infancy)

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11
Q

Risk factors for plagiocephaly

A
  • Position in womb
  • Multiple births
  • Premature
  • Torticollis
  • Sleeping on the back
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12
Q

Treatment of plagiocephaly

A
  • Encourage belly time
  • Reposition often
  • Stretching for torticollis
  • Doc Band (4-6 months)
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13
Q

Define scoliosis

A

Lateral curvature with rotation of the spine in upright position

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14
Q

MC cause of scoliosis?

A

Idiopathic (80%)

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15
Q

Classifications of scoliosis

A

Structural: fixed, nonflexible, does NOT correct w/side bending
Non-structural: Flexible and corrects w/side bending

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16
Q

Who is most affected by scoliosis?

A

Adolescent girls (including serious curvatures)

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17
Q

What is the MC type of curvature in scoliosis?

A

Right thoracic

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18
Q

How large does curve have to be in scoliosis?

A

Greater than 10 degrees

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19
Q

What is the most serious complication of scoliosis?

A

Cardiopulmonary dysfunction

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20
Q

Clinical presentation of scoliosis

A

Usually asymptomatic

Pain is RARE and if present is a red flag

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21
Q

What is the Cobb angle?

A

Angle of spinal curvature in scoliosis (identified on x-ray)

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22
Q

What is the Risser sign?

A

Sensitive indicator of skeletal maturity

Ossification progression from lateral to medial (SI joint)

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23
Q

When do respiratory symptoms occur in scoliosis?

A

Spinal curvature over 60 degrees

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24
Q

General treatment of scoliosis

A
  • Early detection is key to preventing progression

- Referral is mandatory for all patients

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25
Q

Non-surgical treatment of scoliosis

A

Will NOT fully correct curve, but will prevent progression and maintain flexibility

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26
Q

Surgical treatment of scoliosis

A

Will correct the curve BUT reduces flexibility

Deformity correction AND spinal fusion

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27
Q

When is spinal bracing indicated in scoliosis?

A
  • In curves less than 20 degrees IF they are progressing
  • In curves 20-40 degrees (esp skeletally immature pt)
  • 23 hrs/day for 2 years or longer
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28
Q

When is surgical treatment indicated in scoliosis?

A

Curves over 45 degrees

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29
Q

Define nursemaid’s elbow

A

“Pulled elbow”

Head of radius subluxes distally through annular ligament

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30
Q

Who is MC affected by nursemaid’s elbow?

A

Children 1-3 yo

Rare after 6 yo

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31
Q

Treatment of nursemaid’s elbow

A
  • Reduction

- Immobilization NOT recommended except for recurrent cases

32
Q

Define little league elbow

A
  • Traction injury to medial epicondylar physis

- Caused by repetitive throwing

33
Q

Pathophys of little league elbow

A

Repetitive valgus stress

34
Q

What would an x-ray of little league elbow show?

A

Widening of apophysis

35
Q

Treatment of little league elbow

A

Complete rest from throwing
PT is helpful
Prevention is key

36
Q

Define development dysplasia of hip (DDH)

A
  • Spectrum of hip disorders in young children
  • 98% reversible
  • MSK abnormalities increase the risk
37
Q

When is the hip fully formed?

A

11th week of gestation

38
Q

Prognosis of DDH

A

Early diagnosis and intervention!

39
Q

Hallmark sign of DDH

A

Restricted hip abduction

40
Q

What is the Barlow Maneuver?

A
  • To examine for DDH in infants

- Hip is purposefully dislocated and then reduced (via Ortolani maneuver)

41
Q

What is the Ortolani maneuver?

A

Gentle reduction of dislocated hip (used w/Barlow maneuver in infants)

42
Q

Imaging in DDH

A
  • Not reliable in children under 6 wks old
  • US is 1st line in 6 wks to 4 mo children
  • X-ray is 1st line in children over 6 mos
43
Q

When is the most opportune time to treat DDH?

A

Birth to 6 wks old

44
Q

What is the gold standard treatment for DDH?

A

Pavlik harness

  • Maintains hip flexion of 100 degrees, prevents adduction
  • Worn several weeks
45
Q

Define Legg Calve Perthes Disease (LCPD)

A

Disruption of blood supply to femoral head resulting in AVN

46
Q

Who is MC affected by LCPD?

A

4-10 yo
Males 4:1
Bilateral in 15% cases

47
Q

Stages of LCPD

A
  1. Early (6 months)
  2. Regenerative/fragmentation (1-2 years)
  3. Reossification
48
Q

Gold standard for diagnosing LCPD?

A

AP and lateral frog X-ray

49
Q

Treatment of LCPD

A

Based on age

  • Less than 6 yo w/mild disease: symptomatic care
  • Over 6 yo: abduction brace to keep femoral head w/in acetabulum (worn continuously for up to 2 years)
50
Q

Define slipped capital femoral epiphysis (SCFE)

A
  • Displacement of proximal femoral epiphysis due to disruption of the growth plate
  • Results in upward and anterior displacement of femoral neck
51
Q

Clinical features of SCFE

A
  • Bilat in up to 25% cases
  • Primarily gradual onset
  • Trauma or hormonal
52
Q

Who is MC affected by SCFE?

A

Boys 10-17 yo
African Americans
Hypothyroid
Obese or tall/thin

53
Q

Imaging of SCFE

A

AP and lateral x-ray of BOTH HIPS

  • Klein’s line
  • Ice cream scoop slipping off cone
54
Q

Treatment of SCFE

A
  • Refer immediately to ortho surgeon

- Non wt bearing w/crutches

55
Q

Prophylaxis of SCFE

A
  • Pinning of contralateral hip

- Controversial, not recommended

56
Q

Define transient synovitis of hip

A 
Self limited, nonspecific synovial inflammation of hip joint
Results in joint effusion
Cause unknown (viral infection maybe)
57
Q

What is the MC cause of hip pain in children under 10 yo?

A

Transient synovitis of hip

58
Q

Who is MC affected by transient synovitis of hip?

A

Males

Peak age 5-6 yo

59
Q

What is the MC angular/rotational deformity of the legs?

A

In toeing

60
Q

Define genu varum

A

Bow leg (tibial rotation toward midline)

61
Q

Define Blount’s disease

A
  • Pathologic, developmental bow legs
  • Caused by disrupted growth of upper medial tibial epiphysis
  • MC in obese early walkers, African Americans, fam hx
62
Q

Define genu valgum

A

Knock knee (tibial rotation away from midline)
3-8 yo
May be caused by skeletal dysplasia and rickets
Out-toeing

63
Q

Etiologies of toeing in

A

Metatarsus adductus/varus of foot in infants
Internal tibial torsion in toddler
Increased femoral torsion in child over 10 yo

64
Q

Define Osgood-Schlatter’s disease

A
  • Inflammation of patella tendon attachment to tibial tubercle apophysis
  • Potentially partial avulsion
  • 20% occur bilaterally
65
Q

Who is MC affected by Osgood-Schlatter’s disease?

A

Early adolescent males (especially athletic)

66
Q

What is a common cause of knee pain in adolescents?

A

Osgood-Schlatter’s disease

67
Q

Treatment of Osgood-Schlatter’s disease

A

Conservative - rest, ice, NSAIDs

68
Q

What is Sever’s disease?

A

Calcaneal apophysitis - similar to Osgood-Schlatter’s

  • Low grade inflammation at insertion of Achilles tendon
  • Often bilateral
69
Q

Who is MC affected by Sever’s disease?

A

Boys 8-14 yo

High impact sports, activities

70
Q

Treatment of Sever’s disease

A

Conservative - ice, rest, NSAIDs, heel cups

71
Q

What is talipes equinovarus?

A

Club foot
MC in males
3 categories: idiopathic, neurogenic, a/w abnormal syndromes

72
Q

What features must be present to diagnose club foot?

A
  • Plantar flexion of foot at ankle joint (equinus)
  • Inversion deformity of heel (varus)
  • Medial deviation of forefoot (varus)
73
Q

Treatment of club foot

A

Stretch contracted tissues followed by casting to hold correction

74
Q

Define osteogenesis imperfecta

A
  • Rare genetic CT disorder characterized by multiple and recurrent fractures
  • Type 1 MC
  • Type 2 results in fetal death
  • Can look similar to child abuse
75
Q

Clinical presentation and diagnosis of osteogenesis imperfecta

A

Blue sclera, hyperextensibility of ligaments, Wormian bones (accessory skull bones)
Genetic testing and x-ray findings

76
Q

Treatment of osteogenesis imperfecta

A

Bisphophonates to decrease fractures
Surgery to correct deformities
Preventive measures

Clin Med II MHM - FINAL (16 decks)

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