Pestana Chap 2 - Orthopedics Flashcards
(113 cards)
Does developmental dysplasia of the hip run in families? When should it ideally be diagnosed?
1) Yes
2) Ideally, right after birth
What does physical exam of a child with developmental dysplasia show?
Children have uneven gluteal folds, and physical examination of the hips shows that they can be easily dislocated posteriorly with a jerk and a “click,” and returned to normal with a “snapping”
If signs of developmental dysplasia are equivocal, what test can be done next to help determine your diagnosis?
Sonogram is diagnostic (do not order x-rays; the hip is not calcified in the newborn)
What is the treatment for developmental dysplasia of the hip and for how long?
Abduction splinting with Pavlik harness for about 6 months
What two areas of the pelvis and lower extremity will develop pain in the presence of hip pathology in children?
1) Hip pain
2) Knee pain
What is Legg-Calve-Perthes disease? When does it present? How does it present?
1) Avascular necrosis of the capital femoral epiphysis
2) It occurs around age 6
3) Insidious development of limping, decreased hip motion, and hip (or knee) pain. Kids walk with an antalgic gait, and passive motion of the hip is guarded
How is diagnosis of Legg-Calve-Perthes reached?
AP and lateral hip x-rays
What is treatment of Legg-Calve-Perthes?
Treatment is controversial, usually containing the femoral head within the acetabulum by casting and crutches
Is slipped capital femoral epiphysis an orthopedic emergency?
Yes
What does the typical patient with slipped capital femoral epiphysis look like? What does he complain of and what is he noted to be doing while ambulating? What is noticeable about the affected side foot when the patient sits with the legs dangling?
1) The typical patient is a chubby (or lanky) boy, around age 13
2) They complain of groin (or knee) pain and are noted to be limping
3) When they sit with the legs dangling, the sole of the foot on the affected side points toward the other foot
What is noticed on physical exam of a patient with slipped capital femoral epiphysis?
On physical exam there is limited hip motion, and as the hip is flexed the thigh goes into external rotation and cannot be rotated internally
What test is diagnostic for slipped capital femoral epiphysis and what is the treatment?
X-rays are diagnostic, and surgical treatment pins the femoral head back in place
Is septic hip an orthopedic emergency?
Yes
In what age group is septic hip seen and how do they present?
It is seen in little toddlers who have had a febrile illness and then refuse to move the hip
How do patients with septic hip hold their leg?
They hold the leg with the hip flexed, in slight abduction and external rotation, and do not let anybody try to move it passively
What lab value is elevated in patients with septic hip?
Sedimentation rate
How is diagnosis of septic hip made? What is done if pus is obtained from this diagnostic test?
Aspiration of the hip under general anesthesia, and further open drainage is done if pus is obtained
In which patients is acute hematogenous osteomyelitis seen in?
Little kids who have had a febrile illness, but it shows up with severe localized pain in a bone (and no history of trauma to that bone)
Why are MRIs preferred over X-rays for diagnosis of acute hematogenous osteomyelitis? How is this condition treated?
1) MRI gives prompt diagnosis, while x-rays will not show anything for a couple of weeks
2) Treat with antibiotics
Up to what age is genu varum (bowlegs) normal? Is treatment needed at this time? What is the most common disease associated with persistent varus beyond age 3? What can be done at this time?
1) Up to the age of 3 years
2) No treatment is needed
3) Blount disease (a disturbance of the medial proximal tibial growth plate)
4) Surgery can be done
Between what ages is genu valgus (knock-knee) normal? Is treatment needed at this time?
1) Between ages 4 and 8
2) No treatment is needed
What is Osgood-Schlatter disease? What age are patients with the disease and how do they present? What does physical exam show?
1) Osteochondrosis of the tibial tubercle
2) It is seen in teenagers with persistent pain right over the tibial tubercle, which is aggravated by contraction of the quadriceps
3) Physical exam shows localized pain right over the tibial tubercle, and there is no knee swelling
How do first responders to Osgood-Schlatter disease manage the condition? What if these measures are unsuccessful?
1) They use conservative managmenet, as suggested by the mnemonic RICE: rest, ice, compression, and elevation
2) These patients are referred to an orthopedic surgeon, who at most would use an extension or cylinder cast for 4 to 6 weeks
At what age is club foot (talipes equinovarus) seen? What do the feet look like?
1) At birth
2) Both feet are turned inward, and there is plantar flexion of the ankle, inversion of the foot, adduction of the forefoot, and internal rotation of the tibia