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Flashcards in Pediatric orthopedics Deck (10):

Slipped capital femoral epiphysis (SCFE)

-Femoral neck slips out from femoral head
-Etiology is unknown, obesity (mechanical) very likely
-Most common in 10-16 yo boys
-Related factors: obesity, african american
-Presentation (delayed Dx common): hip, thigh, KNEE pain
-Limp/can't bear weight
-PE: obligate external rotation of the femur upon hip flexion
-To confirm Dx get X-rays: AP and later, and of both hips
-Rx is surgery: pins in situ


Leg-calve-perthes (LCP) disease

-Idiopathic avascular necrosis of femoral head in children
-Usually 4-8 yo, often boys
-Related factors: hematologic (coagulopathies)
-Presentation: limp, w/ groin, hip, thigh or knee pain (usually activity related)
-Dx: X-rays (later/AP of both hips), sometimes MRI
-Younger age of onset is better prognosis
-Majority of hips will not require Rx other than symptomatic and supportive care, other Rx controversial


Scoliosis 1

-Abnormal lateral curvature of spine (>10 deg)
-Most common type: adolescent idiopathic scoliosis
-Mostly in children 10-16, no underlying cause/complants
-Normal neuro exam
-Dx of exclusion, more often affects girls
-Congential scoliosis: failure of spine to form completely or separate properly (hemivertebrae)


Scoliosis 2

-Also neuromuscular scoliosis (cerebral palsy, muscular dystrophy, spina bifida)
-Early signs of scoliosis: uneven shoulders, prominent shoulder blades, uneven waist line, lumbar prominence, leaning to one side, adam's forward bending test
-Complications: pulmonary compromise (>100 deg), decreases thoracic volume
-Rx: observation, bracing (25-45 deg, less than 12-13), surgery (>45 deg)


Fractures in children

-Causes: blunt trauma (abuse, falls, MVA)
-Common sites: fingers, distal radius, UE much more common than LE
-Epiphysis: head of long bone, metaphysis is below the epiphysis
-Btwn these two is the physis, or the growth plate
-Physis fractures classified by the salter-harris scale


Salter-harris classification of fractures

-1: S=Same. Fracture of the cartilage of the physis
-2: A=Above. Fracture above the physis (metaphysis side)
-3: L=Lower. Fracture is below the physis, in the epiphysis
-4: T=Through. Fracture is thru the metaphysis, physis, and epiphysis
-5: ER: Erased (crushed): physis has been crushed


Growth disturbances from fractures

-Physeal injury
-Premature shortening of bone
-Malangulation of bone
-But fractures can remodel in children: there is asymmetric growth of physis, and concavity filled (resorption of one side and growth of the other)


Supracondylar humerus fracture

-Most common operative fracture (6-7 yr)
-10% risk of neuromuscular injury
-Most common is anterior interosseous nerve, can check by having them give the ok sign
-Flexion type of complication: damage to ulnar nerve
-Rx: nails to re-align the humerus


Infections of synovium and bone in children

-Osteo/septic arthritis: usually staph aureus
-In neonates: group B strep
-In sexually active teens: Nisseria gonorrhea
-Kocher criteria: to help differentiate septic arthritis and transient synovitis
-5 predictors: fever, non-weight bearing (NWB), WBC>12, ESR>40, and CRP>2
-More than 3 and it is most likely septic arthritis


Natural hx of knee alignment in children

-Varus then valgus then normal