Flashcards in Pediatrics Deck (71)
Intrauterine crowding and positioning may contribute to:
Torticollis, Club Feet, Intoeing and Developmental Dysplasia of Hip (DDH)
Developmental Dysplasia of Hip (DDH)
A spectrum of disorders describing abnormal development resulting in dysplasia and possible subluxation of dislocation of the hip. The femoral head is pulled up and makes it’s own pseudo-joint.
apply posterior pressure onto hip while holding at knee (so you are pushing from the front), bring leg into adduction, hip subluxes out of acetabulum with posterior pressure and adduction (clunk): “out to the bar- barlow pushes it out”
apply pressure to the posterior acetabulum (you are pushing from the back), hip is reduced back into acetabulum over neolimbus during abduction (clunk): “order in- ortalani pushes it in”
supine, hips flexed, knees bent, affected leg’s knee appears lower
Treatment for Developmental Dysplasia of Hip (DDH)
1st line tx: Pavlik harness: pushes hip back in socket. Operative if too severe of harness fails to help.
Risk Factors for Developmental Dysplasia of Hip (DDH)
First-born Females (4-5X MC), breech delivery (Funky), Firstborn infants, oligohydraminos, FHx DDH, limited Fetal mobility (limited hip abduction). THE FIVE F's!!!
Special Tests for Developmental Dysplasia of Hip (DDH)
Barlow Maneuver, Ortolani Maneuver, and the Galeazzi Test.
Imaging for Extra for Developmental Dysplasia of Hip (DDH)
Radiographs are not generally useful prior to the ossification of the femoral head (between 4-6 mo). US can be helpful!
unilateral SCM contraction that causes ipsilateral head tilt
Risk Factors for Congenital Torticollis
Primiparous mother, heavy male baby in breech position, multiple birth, maternal uterine abnormalities, male gender
Treatment for Congenital Torticollis
PT (stretch the muscle- can take as long as 6-8mo), surgery or botox inj into SCM to relax it.
Congenital Torticollis associated disorders
DDH, Metarsus Adductus, Traumatic Delivery, Plagiocephally
spinal curvature, cobb angle > 10 degrees, not only C shaped curve, also has twisting.
Risk Factors for `Scoliosis
Adolescents, F>M, rapidly progresses during rapid growth, ask girls if they have gotten their period- chance of progression during growth period before period (can help before).
Treatment of Scoliosis
Observation, Bracing (16-23hrs) for those with growth potential and curve magnitude 20-45 degrees. Spinal fusion if curve >45 degrees. Curvature remains fairly stable after skeletal maturity.
Testing: diff height shoulders, protruding shoulder blade, diff length arm, protruding side of back when bending over. Measure COBB angle.
Identify upper and lower end vertebrae, draw lines extending along vertebral borders, measure cobb Angle directly or geometrically.
Which type of curve is most common for Scoliosis?
Rightward thoracic curves
Physiologic Bowing, bowing for first two years it is normal
Risks for Genu Varum
Early walkers, overweight children
Diagnosing Genu Varum
Differentiate btwn Blount’s dz (proximal tibia physis abnormality, stops growing on medial side), ricketts, skeletal dysplasias.
Genu Varum in adolescents over 10
Less severe, unilateral, usually due to obesity
(knock-knees); 5-7 degrees of valgus is normal in adults & children older than 6-7yrs age.
Complication of Genu Valgum
May result in “miserable malalignment syndrome”: contributing to patellofemoral dysfunction.
Treatment of Genu Valgum
Typically improves with growth, lateral aspect has most pressure
Goal for Genu Valgum
Goal is to differentiate between what it "normal" and what is pathological (Ricketts, tumors, skeletal dysplasia)
The feet turn inward instead of pointing straight ahead. It is commonly referred to as being "pigeon-toed."
Causes of Intoe:
1. Feet are turning in: metatarsus adductus (flat feet),
2. Lower legs are turning in: tibial torsion,
3. Hips/Thighs are turning in: femoral anteversion.