Pediatric Ortho Flashcards Preview

Clin Med II MHM - FINAL > Pediatric Ortho > Flashcards

Flashcards in Pediatric Ortho Deck (76):
1

Definition of torticollis

-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)

2

When does congenital torticollis MC occur?

Following breech deliveries

3

What can congenital torticollis be associated with?

-Hip dysplasia
-Clubfoot

4

What happens to the SCM in congenital torticollis?

Fibrosis of SCM causes a palpable "mass"

5

When does the SCM mass resolve in congenital torticollis?

-A few weeks after birth
-SCM is shortened and contracted after

6

What happens if congenital torticollis is left untreated?

-Plagiocephaly (facial asymmetry/skull deformity)
-Changes in cervical vertebrae

7

How is congenital torticollis diagnosed?

-Clinically (based on PE and palpable mass of SCM)
-Xray of cervical spine is recommended

8

Conservative treatment of congenital torticollis

-Stretching exercises
-Doc band to help improve secondary plagiocephaly

9

Surgical treatment of congenital torticollis

-For pts who fail conservative tx or are diagnosed late
-Release of SCM (traction/casting and exercises)

10

Define plagiocephaly

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

11

Risk factors for plagiocephaly

-Position in womb
-Multiple births
-Premature
-Torticollis
-Sleeping on the back

12

Treatment of plagiocephaly

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

13

Define scoliosis

Lateral curvature with rotation of the spine in upright position

14

MC cause of scoliosis?

Idiopathic (80%)

15

Classifications of scoliosis

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

16

Who is most affected by scoliosis?

Adolescent girls (including serious curvatures)

17

What is the MC type of curvature in scoliosis?

Right thoracic

18

How large does curve have to be in scoliosis?

Greater than 10 degrees

19

What is the most serious complication of scoliosis?

Cardiopulmonary dysfunction

20

Clinical presentation of scoliosis

Usually asymptomatic
Pain is RARE and if present is a red flag

21

What is the Cobb angle?

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

22

What is the Risser sign?

Sensitive indicator of skeletal maturity
Ossification progression from lateral to medial (SI joint)

23

When do respiratory symptoms occur in scoliosis?

Spinal curvature over 60 degrees

24

General treatment of scoliosis

-Early detection is key to preventing progression
-Referral is mandatory for all patients

25

Non-surgical treatment of scoliosis

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

26

Surgical treatment of scoliosis

Will correct the curve BUT reduces flexibility
Deformity correction AND spinal fusion

27

When is spinal bracing indicated in scoliosis?

-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

28

When is surgical treatment indicated in scoliosis?

Curves over 45 degrees

29

Define nursemaid's elbow

"Pulled elbow"
Head of radius subluxes distally through annular ligament

30

Who is MC affected by nursemaid's elbow?

Children 1-3 yo
Rare after 6 yo

31

Treatment of nursemaid's elbow

-Reduction
-Immobilization NOT recommended except for recurrent cases

32

Define little league elbow

-Traction injury to medial epicondylar physis
-Caused by repetitive throwing

33

Pathophys of little league elbow

Repetitive valgus stress

34

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

Widening of apophysis

35

Treatment of little league elbow

Complete rest from throwing
PT is helpful
Prevention is key

36

Define development dysplasia of hip (DDH)

-Spectrum of hip disorders in young children
-98% reversible
-MSK abnormalities increase the risk

37

When is the hip fully formed?

11th week of gestation

38

Prognosis of DDH

Early diagnosis and intervention!

39

Hallmark sign of DDH

Restricted hip abduction

40

What is the Barlow Maneuver?

-To examine for DDH in infants
-Hip is purposefully dislocated and then reduced (via Ortolani maneuver)

41

What is the Ortolani maneuver?

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

42

Imaging in DDH

-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

When is the most opportune time to treat DDH?

Birth to 6 wks old

44

What is the gold standard treatment for DDH?

Pavlik harness
-Maintains hip flexion of 100 degrees, prevents adduction
-Worn several weeks

45

Define Legg Calve Perthes Disease (LCPD)

Disruption of blood supply to femoral head resulting in AVN

46

Who is MC affected by LCPD?

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

47

Stages of LCPD

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

48

Gold standard for diagnosing LCPD?

AP and lateral frog X-ray

49

Treatment of LCPD

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

Define slipped capital femoral epiphysis (SCFE)

-Displacement of proximal femoral epiphysis due to disruption of the growth plate
-Results in upward and anterior displacement of femoral neck

51

Clinical features of SCFE

-Bilat in up to 25% cases
-Primarily gradual onset
-Trauma or hormonal

52

Who is MC affected by SCFE?

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

53

Imaging of SCFE

AP and lateral x-ray of BOTH HIPS
-Klein's line
-Ice cream scoop slipping off cone

54

Treatment of SCFE

-Refer immediately to ortho surgeon
-Non wt bearing w/crutches

55

Prophylaxis of SCFE

-Pinning of contralateral hip
-Controversial, not recommended

56

Define transient synovitis of hip

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

57

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

Transient synovitis of hip

58

Who is MC affected by transient synovitis of hip?

Males
Peak age 5-6 yo

59

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

In toeing

60

Define genu varum

Bow leg (tibial rotation toward midline)

61

Define Blount's disease

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

62

Define genu valgum

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

63

Etiologies of toeing in

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

64

Define Osgood-Schlatter's disease

-Inflammation of patella tendon attachment to tibial tubercle apophysis
-Potentially partial avulsion
-20% occur bilaterally

65

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

Early adolescent males (especially athletic)

66

What is a common cause of knee pain in adolescents?

Osgood-Schlatter's disease

67

Treatment of Osgood-Schlatter's disease

Conservative - rest, ice, NSAIDs

68

What is Sever's disease?

Calcaneal apophysitis - similar to Osgood-Schlatter's
-Low grade inflammation at insertion of Achilles tendon
-Often bilateral

69

Who is MC affected by Sever's disease?

Boys 8-14 yo
High impact sports, activities

70

Treatment of Sever's disease

Conservative - ice, rest, NSAIDs, heel cups

71

What is talipes equinovarus?

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

72

What features must be present to diagnose club foot?

-Plantar flexion of foot at ankle joint (equinus)
-Inversion deformity of heel (varus)
-Medial deviation of forefoot (varus)

73

Treatment of club foot

Stretch contracted tissues followed by casting to hold correction

74

Define osteogenesis imperfecta

-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

Clinical presentation and diagnosis of osteogenesis imperfecta

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

76

Treatment of osteogenesis imperfecta

Bisphophonates to decrease fractures
Surgery to correct deformities
Preventive measures