Pediatric orthopedics

Question 1

What is anisomieli?

Answer 1

Means length discrepancies between limbs. Usually used for leg length discrepancy.

Question 2

What are normal variations in leg length discrepancies?

Answer 2

Discrepancies of 0,5-1,5 cm.

Question 3

What is measured to determine of there is a leg length discrepancy?

Answer 3

The length from the spina iliaca anterior superior to the medial malleolus (while the patient lies in a supine position).

Question 4

Besides measurements, how can a leg length discrepancy be determined through clinical examination?

Answer 4

The patient should be standing without bending their knees, and then bend forward so you can see if the sacral plateau is leveled. If the sacral plateau is tilted, plates of known height are placed under the short leg until the sacral plateau is leveled.

Question 5

What are causes of scoliosis?

Answer 5

Idiopathic (unknown cause).
Neuromuscular scoliosis, e.g. cerebral palsy or Duchenne muscular dystrophy.
Syndrome associated, e.g. achondroplasia, Marfan syndrome, Down syndrome, neurofibromatosis, and osteogenesis imperfecta.
Functional cause, e.g. leg length discrepancy.

Question 6

What are options for treatment of scoliosis?

Answer 6

Back brace and surgery.

Question 7

What is talipes equinovarus?

Answer 7

Also known as club foot. It is a birth defect where one or both feet are rotated inward and downward.

Question 8

What are options for treatment of talipes equinovarus?

Answer 8

Ponseti method (conservative, relies on casting together with manipulation) (recommended treatment in Norway), cutting the Achilles tendon (percutaneous achillestenotomy), and bracing.

Question 9

Is talipes equinovarus more comon in girls or in boys?

Answer 9

It is more common in boys.

Question 10

How common is it for talipes equinovarus to be bilateral?

Answer 10

50 % of cases are bilateral.

Question 11

What are the three main classes of developmental dysplasia of the hip?

Answer 11

Dysplasia, subluxation and luxation.

Question 12

How is developmental dysplasia of the hip diagnosed?

Answer 12

Clinical examination: Gluteal skinfold, leg lenght discrepancy, and Ortolani and Barlow tests. (Frog tests and adduction test.)
Imaging examination: Ultrasound (or x-ray) will confirm the diagnosis.

Question 13

How is developmental dysplasia of the hip treated?

Answer 13

Abduction with the help of “Frejkas pute” etc.
Surgery and casting.
Traction and casting.

Question 14

Is developmental dysplasia of the hip more common in girls or in boys?

Answer 14

It is more common in girls.

Question 15

What is Calve-Legg-Perthes disease?

Answer 15

It is an avascular, transitory condition in caput femoris of unknown cause.

Question 16

What are symptoms of Calve-Legg-Perthes disease?

Answer 16

Limping.

Pain in knees and/or hips.

Question 17

How is Calve-Legg-Perthes disease treated?

Answer 17

Treatment should always be performed by an orthopedist. Running and jumping should be avoided. Physical therapy is an option. Surgery if loss of containment.

Question 18

What is slipped slipped capital femoral epiphysis?

Answer 18

It is a condition that occurs in teens and pre-teens who are still growing. For reasons that are not well understood, the ball at the head of the femur (thighbone) slips off the neck of the bone in a backwards direction.

Question 19

Is Calves-Legg-Perthes disease more common in boys or girls?

Answer 19

It is more common in boys.

Question 20

How is slipped capital femoral epiphysis treated?

Answer 20

It is treated with surgical pin fixation.

Question 21

What are symptoms of slipped capital epiphysis? What group of children have an especially high risk of slipped capital femoral epiphysis?

Answer 21

Pain in hip or knee.

Overweight/obese children are at high risk.

Question 22

What is coxitis simplex? What are common symptoms of coxitis simplex?

Answer 22

Also called transient synovitis. It is an inflammatory, self-limiting, irritation in the hip joint. It causes pain, limp and sometimes refusal to bear weight.

Question 23

What is the most common cause of acute onset limping in children of preschool age?

Answer 23

Coxitis simplex (transient synovitis).

Question 24

What is the cause of coxitis simplex?

Answer 24

The exact cause is unknown, but the condition is often preceded by a recent viral infection (most commonly an upper respiratory tract infection).

Question 25

How is coxitis simplex (transient synovitis) differentiated from septic arthritis?

Answer 25

Kocher's criteria:
Fever (>38,5 degrees Celsius). 
Inability to bear weight.
SR > 40.
WBC > 12.
CRP > 1mg/dL.