Peds: Ortho

Question 1

What is developmental dysplasia of the hip?

Answer 1

generalized hip laxity

complete hip dislocation

acetabular abnormality

Question 2

What are some risk factors for developmental dysplasia of the hip?

Answer 2

first child

girls > boys

breech presentation

family hx

Question 3

What are some S/S of developmental dysplasia of the hip?

Answer 3

first noticed w/ walking, limp

decreased leg length

assymety of skin folds

loss of motion

Question 4

What are the two tests used to diagnose developmental dysplasia of the hip?

Answer 4

Barlow’s test (dislocation test)

Ortolani test (relocation test)

Question 5

When is a ultrasound performed for possible developmental dysplasia of the hip?

Answer 5

at 6 weeks if female & breech

Question 6

What are some treatments for developmental dysplasia of the hip?

Answer 6

braces/harness (Pavlik) -best used < 6 months old

casting for > 6 months

spica cast for 8-12 weeks

surgical reduction if > 2 yrs

Question 7

Wahat is the goal of treatment for developmental dysplasia of the hip?

Answer 7

to keep the hip located!

Question 8

What is Legg-Calve-Perthes disease?

Answer 8

idiopathic osteonecrosis of the femoral head

Question 9

What can the progression of Legg-Calve-Perthes disease lead to?

Answer 9

loss of blood supply

bone dies (osteonecrosis)

loss of structural rigidity

femoral head collapses

Question 10

What is the typical child like who has Legg-Calve-Perthes disease?

Answer 10

age 2-12

small stature

thing

physically active

rare in blacks

Question 11

What are some S/S Legg-Calve-Perthes disease?

Answer 11

pain & limping (worse w/ activity)

pain radiates to groin/proximal thigh

decreased AROM & ROM

Question 12

How is Legg-Calve-Perthes disease diagnosed?

Answer 12

x ray

initial increased density at femoral head, crescent sign

Question 13

What is the treatment for Legg-Calve-Perthes disease?

Answer 13

observation

femoral head re-vascularizes, usually regenerates in 12-18 months

restrict vigorous activity, NSAIDs, crutches

Question 14

What is slipped capital femoral epiphysis (SCFE)?

Answer 14

slippage of the femoral epiphysis

(usually posteriorly)

Question 15

What is the most common adolescent hip disorder?

Answer 15

SCFE

2-3x more common in boys

Question 16

What are some S/S of SCFE?

Answer 16

onset may be sudden or progressive

pain w/ activity, pain in hip, groin, thigh, knee

limp

decreased hip motion (internal rotation)

possible limb shortening

Question 17

What are some red flags for SCFE?

Answer 17

older child

male

obesity

limp

pain in hip/groin/thigh/knee

Question 18

How is SCFE diagnosed?

What will be seen?

Answer 18

X-ray

‘fuzzy’ irregularities on physis, appears that the epiphysis has slipped/rotated

Question 19

What is the treatment for SCFE?

Answer 19

surgical fixation

NEED to fix this

single cannulated screw into epiphysis

non-weight bearing

slippage WILL progress if left untreated

Question 20

What is transient synovitis of the hip?

Answer 20

sterile effusion of the hip

(inflammation of the hip for no apparent cause)

Question 21

What are some S/S of transient synovitis of the hip?

Answer 21

usually acute onset

worse in AM

limp is initial presentation

pain in groin/thigh

decreased abduction

AFEBRILE

Question 22

How is transient synovitis of the hip diagnosed?

Answer 22

diagnosis of exclusion

joint aspiration if suspecting sepsis

Question 23

What is the treatment for transient synovitis of the hip?

Answer 23

rest

monitor temp

reassurance

full resolution in 3-14 days

Question 24

What is the most common cause for lower extremity rotational disorders?

Answer 24

intrauterine constraint of the fetus

(small uterus, twins, uterine fibroids)

Question 25

What are some symptoms of lower extremity rotational disorders?

Answer 25

usually present by age 2 (walking) noticed by parents first rarely pain, limp, or instability may stumble if severe rotation

Question 26

What is the most common cause of 'toeing in'?

Answer 26

internal tibial torsion

Question 27

Is internal tibial torsion exaggerated with weight bearing?

Answer 27

yes

Question 28

What is the treatment for internal tibial torsion?

Answer 28

no treatment necessary spontaneous resolution

Question 29

What is the most common cause of 'toeing in' after 3 years old?

Answer 29

femoral anteversion

Question 30

What might pes planus be evident in?

Answer 30

external tibial torsion

Question 31

What is the treatment for external tibial torsion?

Answer 31

no treatment necessary surgery for extreme cases

Question 32

What are some of the diagnostics used to assess lower extremity rotational disorders?

Answer 32

rotational profile foot progression angle measurement of thigh-foot angle measurement of femoral ante/retroversion assessment of foot adductus

Question 33

What is the treatment (in general) for lower extremity rotational disorders?

Answer 33

careful monitoring of rotational measure reassurances referral if no change/improvement

Question 34

What is Osgood-Schlatter disease? What causes it?

Answer 34

inflammation at the tibial tubercle apophysis caused from reptitive trauma/overuse, jumping, repetitive quadriceps contraction pulling on the tibial tubercle

Question 35

What kids does Osgood-Schlatter disease affect?

Answer 35

early adolescence 5x more common in athletic children 2-3x more common in males

Question 36

What are the S/S of Osgood-Schlatter disease?

Answer 36

usually a gradual onset pain worsens w/ jumping, running, kneeling point tender at tibial tubercles, most often bilaterally

Question 37

What is the treatment for Osgood-Schlatter disease?

Answer 37

treat symptoms ice, heat, NSAIDs, active rest, knee pads may take several months for results

Question 38

What is metatarsus adductus?

Answer 38

medially rotated forefoot

Question 39

What is the etiology of metatarsus adductus?

Answer 39

most likely due to position of fetus in utero

Question 40

What are some S/S of metatarsus adductus?

Answer 40

hindfoot & midfoot have no deformity adducted forefoot, may have medial skin crease at TMT joint forefoot is flexible (can be brought back into normal alignment)

Question 41

How is metatarsus adductus diagnosed?

Answer 41

serial weight-bearing photocopies | (measures amount of deviation)

Question 42

What is the treatment or metatarsus adductus?

Answer 42

treatment usually not necessary will spontaneously resolve by age 6 months if not, serial casting

Question 43

What is Talipes equinovarus?

Answer 43

club foot congenital deformity of foot

Question 44

What are some S/S of Talipes equinovarus?

Answer 44

noticeable deformity at birth plantarflexion is usually most severe (inability to dorsiflex heel)

Question 45

How is Talipes equinovarus diagnosed?

Answer 45

physical exam (you can see the deformity) must also assess muscle & nerve function

Question 46

What is the treatment for Talipes equinovarus?

Answer 46

**immediate casting** (before leaving hospital) surgery indicated if no results after 4 months

Question 47

What is scoliosis?

Answer 47

lateral curvature of the spine greater than 10 degrees

Question 48

Which parts of the spine does scoliosis usually affect?

Answer 48

thoracic or lumbar

Question 49

What are some S/S of scoliosis?

Answer 49

usually asymptomatic may notice postural changes/asymmetry

Question 50

How is scoliosis diagnosed?

Answer 50

physical exam- Adam's forward bend test X rays if greater than 5-7 degrees

Question 51

What is the treatment for scoliosis?

Answer 51

must monitor progression while growing 20-40 degrees = brace \> 50 degrees = surgical intervention (fusion or rodding)

Question 52

What is torticolis?

Answer 52

unilateral contraction of the sternocleidomastoid muscle

Question 53

What are some S/S of torticolis?

Answer 53

first noticed at 4-6 weeks old ‘cock robin’ position- tilted toward affected side & rotated away from affected side possible palpable ‘tumor’ in muscle belly decreased cervical motion

Question 54

What is the treatment for torticolis?

Answer 54

passive stretching exercises (usually performed by parents) usually resolves within a year surgical intervention- longer than 18 months, release of SC

Question 55

What is a Type I salter harris fracture?

Answer 55

transverse through the physis

Question 56

What is a Type II salter-harris fracture?

Answer 56

transverse through the physics into the metaphysis

Question 57

What is a Type II salter-harris fracture?

Answer 57

transverse through the physis into the epiphysis

Question 58

What is a Type IV salter-harris fracture?

Answer 58

fracture through the metaphysis, physis, & epiphysis

Question 59

What is a Type V salter-harris fracture?

Answer 59

compression/crush injury to the physis

Question 60

What is something important to remember about X rays?

Answer 60

**always get at least 2 views**

Question 61

What is the treatment for salter-harris fractures?

Answer 61

conservative, cast for 2-3 weeks & repeat X-rays observe for radiographic signs of healing most type I fractures will heal in 4 weeks surgical- displaced fracture, unstable fracture

Question 62

What is the most common injury in children, caused by increased joint laxity?

Answer 62

nursemaid's elbow

Question 63

What is a nursemaid's elbow?

Answer 63

radial head is wedged in annular ligament

Question 64

What is osteogenesis imperfect?

Answer 64

genetically transmitted disease defect in Type I collagen

Question 65

What are some S/S of osteogenesis imperfect?

Answer 65

short stature lax ligaments several bony deformities blue sclera decreased hearing poor dentition

Question 66

What is the treatment for osteogenesis imperfect?

Answer 66

symptomatic, treat fractures routinely modify activity to lessen risk