Peds Ortho Flashcards
(103 cards)
1
Q
What is Gowers sign
A
- weakness of proximal hip muscles can limit child’s ability to rise from sitting position
- to stand pt uses hands and arms to “climb up” the body
2
Q
Normal gait
A
- heel toe gait
- symmetric arm swing
3
Q
Contractures–>
A
cerebral palsy
4
Q
Decreased muscle tone–>
A
muscular dystrophy
5
Q
Ligamentous laxity is greatest when
A
at infancy
6
Q
What is ligamentous laxity associated with
A
- developmental dysplasia of the hip
- dislocating patella
- pes planus
- injury
7
Q
Congential orthopedic problems in peds
A
- malformation (spina bifida)
- disruption
- deformation (torticollis)
- dysplasia (osteogenesis imperfecta)
8
Q
Acquired orthopedic problems in peds
A
- infection
- inflammation
- trauma
- tumor
9
Q
Where are the ossification centers in peds
A
at the ends of the long bones
10
Q
What is responsible for longitudinal growth of long bones in peds
A
physis
11
Q
What is responsible for circumferential growth of bones in peds
A
periosteum
12
Q
Pediatric bones have more ___ than adults
A
cartilage
13
Q
What does the high amount of cartilage allow for in peds
A
skeletally immature patients to withstand more force before deformation or fracture than adult bone
14
Q
What part of the bone is thicker in kids than adults
A
periosteum
15
Q
Acute limp in kids can be what things
A
- transient synovitis
- contusion
- foot foreign body
- fracture
- osteomyelitis
- arthritis (septic, reactive, lyme)
16
Q
Chronic limp in kids can be what things
A
- rheumatic disease
- apophysitis
- slipped capital femoral epiphysis
- Legg Calve Perthes disease
17
Q
Trendelenburg gait is what
A
normal stance phase, but excessive swaying of the trunk
*drop of the pelvis when lifting leg opposite to weak gluteus medius
18
Q
Antaligic gait
A
- painful limp
- stance phase and stride of affected limb shortened to decrease discomfort of weight bearing on affected limb
19
Q
Waddling gait
A
bilateral decrease in function of gluteus muscles
20
Q
Kids are more likely to require internal fixation with what things
A
- displaced epiphyseal fractures
- displaced intra articular fractures
- fracture in child with multiple injury
- open fracture
- unstable fracture
21
Q
Pedi fracture remodeling occurs through what two things
A
- periosteal resorption
- new bone formation
22
Q
Complications of fractures
A
- overgrowth
- neurovascular injury
- compartment syndrome
23
Q
Injuries to the physis can result in what
A
premature closure
24
Q
Growth plate is most susceptible to what
A
torsional and angular force
25
If there is partial closure of growth plate what is the consequence? Complete closure?
partial--> angular deformity
complete--> limb shortening
26
Salter-Harris for what type of fracture
physeal fracture
27
Common sites of salter-harris fx
- distal radius
- dital tibia
- distal fibula
28
Most common salter-harris fx
type II
29
Salter-Harris type I
fracture through growth plate
30
Salter-Harries type II
fracture through metaphysis and growth plate
31
Salter-Harris type III
fracture though epiphysis and growth plate
32
Salter-Harris type IV
fracture through metaphysis and epiphysis
33
Salter-Harris type V
crushed through growth plate
34
Greenstick fracture results from what
bending force applied perpendicular to shaft
35
How does a toddlers fx present
limping and pain with weight bearing with minimal swelling
36
What is a toddlers fracture
minimally or undisplaced oblique/spiral fractures of tibia without fibula fracture
37
Buckle fracture occurs after what
compression of the bone
38
Does the bony cortex break in a buckle fracture
nope
39
Bowing fracture?
not a true fracture, bone appears to be bent on x-ray
40
Treatment of bowing fracture
reduction requires a lot of force, do under general anesthesia
41
What is helpful in identifying a bowing fracture
comparison view of the other extremity
42
Supracondylar elbow fracture
extra articular fracture of distal humerus at elbow
caused by fall on extension
43
Displacement with a supracondylar elbow fracture?
posterior displacement of the distal component
44
Treatment for supracondylar elbow fracture
Conservative
- long arm cast
- analgesics
- serial radiographs q2wks
ORIF- two lateral pin technique with medial pin
45
Presentation of nursemaids elbow
pronated and painful elbow
46
Treatment for nursemaids
pressure on radial head and gentle supination while flexing the elbow
47
Galeazzi fracture dislocation
- fracture of distal radius
| - dislocation of distal radioulnar joint
48
What causes a galeazzi fracture
FOOSH w/ flexed elbow
49
Monteggia fracture dislocation
- fracture of ulna shaft (displaced and overlapped)
| - dislocation of radial head (anteriorly)
50
Standard of care for Monteggia fracture dislocation
ORIF
51
Mnemonics for Galeazzi/Monteggia
```
Grimus
G: Galeazzi
R: radius
I: inferior
M:Monteggia
U:ulna
S:superior
```
52
Why is the blood supply to the hip unique in peds
blood vessels are extraosseous and lie on the surface of the femoral neck, entering epiphysis peripherally
53
What three things are under the category of developmental dysplasia of the hip
- hip that is dislocated and irreducible
- unstable (dislocatable and reducible)
- dysplactic, but withing the acetabulum
54
Risk factors for DDH
- first born
- female
- breech birth
- positive family history of hip dysplasia or early total hip replacement
55
Associated diagnoses with DDH
- congential knee dislocations
- congenital muscular totricollis
- metartarsus adductus and/or clubfoot
56
Presentation of DDH
- toe walking, can be unilateral
- limb length inequality
- waddling gait
- hyperlordosis
57
Tests for DDH
- galeazzi test
- barlow test
- ortolani test
58
Treatment of DDH
-pavlik harness
-abduction orthosis
-if all conservative measures fail of >6mnth at diagnosis:
closed reduction
open reduction if above failed
spica cast to hold hips in place
59
Legg-Calve Perthes
idiopathic osteonecrosis of capital femoral epiphysis
60
Presentation of LCP
- boy
- small for age
- delayed bone age
- very active or hyperactive
- pain may be non specific
- mild limp
- usu no hx of trauma
61
What are the four stages of LCP
Necrosis: initial period of ischemia/loss of blood supply to femoral head
Fragmentation: re-absorption of bone w/ femoral head collapse
Re-ossification: new bone re-growth to reshape the femoral head
Remodeling: femoral head reshapes itself into spherical shape
62
PE for LCP
- limp
- limited motion--> abduction and internal rotation
- atrophy of quad
- leg length inequality due to collapse of femoral head
63
Imaging for LCP
AP pelvis and frog lateral
64
Treatment of LCP
- reduce activities
- crutches, walker, wheelchair
- NSAIDs
- referral to peds ortho for surgical intervention
65
Slipped capital femoral epiphysis
disorder of proximal femoral physis that leads to slippage of epiphysis relative to femoral neck
66
Risk factors for SCFE
- obesity
- males more than females
- occurs during period of rapid growth
67
Clinical presentation of SCFE
- can be bilateral
- groin/thigh pain most common
- knee pain
- gait: external rotation or trendelenburg
- decreased hip motion
68
Xrays for SCFE
ap hip and frog lateral
69
Treatment for SCFE
- percutaneous in situ fixation
- stabilize epiphysis from further slippage
- promote closure of the proximal femoral physis
70
Most common cause of hip point in children
transient synovitis
71
What does transient synovitis of the hip typically follow
an URI =/- fever
72
Clinical presentation of transient synovitis of the hip
- rapid onset of limping and subsequent refusal to walk/bear weight
- limited ROM d/t pain and spasm, hip held in flexion
73
What must you exclude for a diagnosis of transient synovitis of the hip
septic arthritis
74
Hip aspiration for transient synovitis?
only when the ESR is >20mm/hr
75
Treatment of transient synovitis of the hip
- bed rest
- gradual increase of activity
- NSAIDs
76
Prognosis of transient synovitis of the hip
symptoms resolve and range of motion returns to normal
77
Osgood-Schlatter?
transient apophysitis in adolescents
78
Characteristic pain of Osgood-Schlatter
pain over the tibial tuberosity relieved with rest
can be bilaterally
79
PE for Osgood-Schlatter
-prominent tibial tubercle
+/- swelling, redness
80
Treatment of Osgood-Schlatter
- rest
- ice
- NSAIDs
- reassurance
81
Sever's disease aka
calcaneal apophysitis
82
When does Sever's disease occur
during adolescence particularly during a growth spurt
83
What causes pain in Sever's disease
repetitive stress on the groth plate as foot strikes the ground
84
Clinical presentation of Sever's
- heel pain bad enough to cause a limp
- usu first noticed after sports
- pt will often report new cleats or foot wear
85
Treatment of Sever's
- RICE
- DC sports if sx severe
- gel heel pads or heel inserts
- NSAIDs
- stretching of Achilles'
86
Growth plate with physiologic genu varum?
normal
87
Worrisome clinical features of genu varum
- lateral thrust during gait
- short stature
- ligament laxity
- abnormal location of the deformity
- apparent enlargement of the elbow, wrists, knees and ankles
88
When do you do xrays with genu varum
- asymmetry
- atypical age
- worsening deformity
89
Pathological bow legs?
- osteochondral dystrophy
- rickets
- tibia varum
90
Risk factors for Blount's disease
- early walking
- obesity
- family history
91
Signs of rickets
- short stature
| - enlargement of elbow, wrists, knee, ankles
92
Genu valgus--->
knock knees
93
What should be considered if a child is walking on their toes
- cerebral palsy
- tethered cord
- achilles tendon contracture
- possible leg length discrepancy
94
Treatment of idiopathic toe walking
- physical therapy
- serial casting
- surgical heel cord lengthening
95
What must be ruled out before a patient can be diagnosed with idiopathic toe walking
- neuromuscular disorder
- cerebral palsy
- autism
96
Club foot is what kind of rotation
equinus, adductus, varus and medial rotation
97
Treatment of club foot?
surgery or serial casting
98
Diagnosis of club foot should prompt what
a search for other MS problems
99
3 types of scoliosis
- idiopathic: most common
- congenital: vertebral abn
- neuromuscular: underlying d/o
100
Cobb angle great than what = scoliosis
10 degrees
101
What should you observe for when doing a PE for scoliosis
-one shoulder being higher than the other
larger space from arm to side of body
-uneven waist crease
-uneven hip levels
102
What is the Risser staging used for
used to grade skeletal maturity based on level of ossification and fusion of iliac crest apophyses
103
Treatment for scoliosis
<25: observe
25-45: brace
>50: surgery
