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Pediatric Orthopedics Flashcards

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1
Q

Scoliosis is a spinal deformity in which there is a lateral curvature in the spine greater than ____ degrees

A

TEN

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2
Q

Five types of scoliosis (which is the most common)?

A 
Congenital (birth)
Infantile (before 3 years)
Juvenile (age 3-10)
Neuromuscular
Adolescent Idiopathic ** Most common (between 10-16)
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3
Q

Four risk factors that make a curve more likely to progress:

A
  • Double curve (v. single)
  • Large curve (30-40 degrees) v small
  • Females v male
  • Peak height velocity (growth spurt)
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4
Q

When is “peak height velocity” (adolescent growth spurt) in girls and boys?

A
  • GIRLS: Tanner 2-3

- BOYS: Tanner 3-5

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5
Q

Scoliosis symptoms in the upper body (3)

A
  • One shoulder is higher than the other
  • One shoulder blade sticks out more than the other
  • One side of rib cage appears larger than the otehr
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6
Q

Scoliosis symptoms in the lower body (3)

A
  • One hip is higher and more prominent
  • Waist appears uneven
  • One leg appears sorter than other
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7
Q

Postural scoliosis symptoms (2)

A
  • Body tilts to one side

- Head is not centered over body

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8
Q

When does the American Academy of Orthopedics say boys and girls should be screened for scoliosis?

A

GIRLS: 11 & 13
BOYS: once at 13

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9
Q

When does the American Academy of Pediatrics say that boys and girls should be screened for scoliosis?

A

10, 12, 14, 16

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10
Q

Which direction do scoliosis curves usually go?

A

90% of curves are to the right

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11
Q

What direction scoliosis curves are concerning?

A

Left thoracic curves

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12
Q

What is the Risser scale?

A

Evaluates skeletal maturity by using an X Ray.

** Scale of 1-5. 5 indicates more skeletal maturity

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13
Q

Three indicators that a scoliosis patient needs an MRI:

A
    • Any indicator of a pathological agent:
  • Pain
  • Neurological changes
  • Bowel and bladder issues
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14
Q

When is bracing recommended?

A

Curve greater than 30 degrees or a curve that is progressing 10-25 degree increase or more

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15
Q

Goal of bracing for scoliosis

A

Prevent curve progression or until curve progression can’t be controlled

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16
Q

Part time or night bracing may be effective for curves less than __ degrees.

A

35

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17
Q

How long should bracing continue for?

A

Until growth stops

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18
Q

What should you assess when administering a PCA?

A
  • Vitals
  • Bowel movemnts
  • NV
  • Is and Os
  • LOC
  • Pruritis
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19
Q

When is surgery indicated for scoliosis?

A
  • When Cobb angle >45 degrees
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20
Q

Pain that re-emerges after healing from a scoliosis surgery could indicate:

A

Pseudoarthrosis

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21
Q

Flat back syndrome was caused by the

A

Harrington Rod

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22
Q

Healing timeframe after a scoliosis surgery

A
  • Substantial fuse: 3 months
  • No restrictions after 6 months
  • Full fusion: 1-2 years
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23
Q

Incidence of club foot

  • Per live births
  • Boys v girls
  • Bilateral v Unilateral
A
  • 1-2 of 1,000 live births
  • Affects boys nearly twice as often as girls
  • Bilateral in 50% of the cases
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24
Q

List five common forms of club foot:

A
  • Talipes Equinovarus (95% of cases)
  • Talipes Equinovalgus
  • Talipes Calcaneovarus
  • Talipes Calcanovalgus
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25
Six possible causes of club foot
- Intrauterine positioning - Neuromuscular or muscle abnormality - Genetic predispostion - Arrested fetal development of skeletal and soft tissue - Concurrent congenital abnormalities - Amniotic banding
26
What is amniotic banding?
Fibrous amniotic bands can float around and wrap around a baby's extremity
27
Three categories of clubfoot and brief description
1) Positional: Due to intrauterine crowding, responds to simple stretching and casting 2) Syndromic (Tetralogic: Associated with other congenital abnormalities; more severe form 3) Congenital (idiopathic / true club foot: Most common. Occurs in otherwise healthy infants.
28
Six other symptoms of club foot:
- Clubbed foot is smaller than non-clubbed foot - Shortened achilles tendon - Underdeveloped calf muscle - Empty heel bed (regressed bone) - Transverse plantar crease - Normal leg length -
29
Time frame of clubfoot casting
- Every few days for the first 1-2 weeks, then every 2 weeks until maximum is achieved (cast and stretch, cast and stretch)
30
What happens if you overcorrect club foot?
Rocker bottom foot
31
Two treatments after casting
- Denis Browne Splint | - Corrective shoes
32
When is surgical intervention required for club foot?
- Between 3-12 months if child has not been corrected
33
Factors dictating prognosis of club foot
- Severity of deformity - Age of child at initial intervention - Compliance with treatment - Development of bones / muscles / nerves
34
What is the likelihood of recurrence with clubbed foot?
25% chance
35
Contusion
Damage to soft tissue, subcutaneous structure and muscle
36
Sprain
Severe trauma to a joint causing a ligament to be partially or completely torn
37
Strain
Injury to the muscle near the musculotendinous junction, as a result of forceful contraction of the muscle
38
Dislocation v Subluxation
- Both refer to the displacement of bones that form a joint | - Subluxation = partial dislocation
39
Management of sports injury (2)
- RICE (no heat) | - Immobilization
40
Sater-Harris Classifications (3)
TYPE I: A complete physeal fracture with or without displacement TYPE II: Physeal fracture that extends through the metaphysis, producing a chip fracture TYPE III: A physeal fracture that extends through the epiphysis *** Could impair bone deveopment
41
What is the weakest part of the bone?
Ephyseal plate
42
RDA for calcium - adolescents
1500 mg / day
43
Stages of bone healing (5)
1) Hematoma (1st 24 hours) 2) Cellular proliferation 3) Callus formation 4) Ossification 5) Consolidation and remodeling
44
Speed of bone healing in children adn reason
Rapid due to thick periosteum
45
Therapeutic management for fractures (2)
- Closed (simple) reduction: Surgical | - Open reduction: Immobilization device used
46
When is the Petichie rash a cause for concern in kids?
When it appears anywhere below the nipple.
47
When should you go to the ER for compartment syndrome?
If patient in cast is complaining of pain and can't extend fingers!
48
Three things to assess in patient with cast
- Capillary refill & finger/ toe color - Tingling, numbness in fingers, toes - Swelling
49
Cause of compartment syndrome
- Swelling caused by trauma and immobilizing device
50
What happens in compartment syndrome? Where does it occur?
- Compression of compartments with vessels and nerves | - Occurs in tibia, fibula, radius, ulna
51
Four potential complications of fractures
- Infection - Neurovascular injury - Mal-union or delayed - Leg length discrepancy
52
______ is an infection of bone
Osteomyelitis
53
Where does osteomyelitis occur?
In metaphyseal region of long bones
54
When is osteomyelitis most common?
Between 5 and 14 years
55
Two forms of osteomyelitis:
- Exogenous | - Hematogenous
56
What is exogenous osteomyelitis?
Direct inoculation from outside bone, like in surgery
57
What is hematogenous osteomyelitis?
Spread of organism from existing infection. Acute: Less than 2 weeks, subacute: more than 2 weeks after other infection.
58
When is Staphlococcus aureus most common?
Children over 5 yeras
59
Two bone infections associated with sickle cell
Salmonella, S. aureus
60
What two bone infections are most common in neonates?
E. Coli and B Strep
61
When does Pseudomonas most often occur?
Puncture wounds in kids over 6 years
62
Four lab tests to diagnose bone infection
- Leukocytosis, elevated ESR - Elevation in C-Reactive Protein - Blood Cultures - Bone cultures
63
How can you visualize a bone infection?
CT Scan, MRI | **Not visible on an X-Ray for 2-3 weeks after symptoms show up
64
Therapeutic management of bone infections
Long term IV antibiotics * 2 weeks IV * 4-6 weeks oral afterward
65
Why do you put an osteomyelitis patient on bed rest?
Infection --> Weak bone --> Increased risk for fractures. **Immobilization of affected limb**

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