ch. 19 orthopedics
Terms
undefined, object
copy deck
- developmental dysplasia of hip (DDH)
- abnl relationship b/t femur head & acetabulum --> instability/dislocation
- DDH - associated anomalies (4)
-
1.clubfoot
2.congenital torticollis
3.metatarsus adductus
4.infantile scoliosis - DDH - severity levels (3)
-
1.subluxtable
2.dislocatable
3.dislocated - Barlow test
- posterosuperior dislocation of hip w/adduction & posterior pressure
- Ortolani maneuver
- abduction w/resulting "clunk" as femur head relocates
- Galeazzi sign
-
-hold ankles
-knees bent, hip flexed
-chcekc foreshorening of affected limb - x-rays in 0-3 month olds
- no good b/c bones have not ossified yet
- Pavlik harness
- Tx for DDH - keeps hip abducted & flexed
- DDH - most serious complication
- avascular necrosis of femur head (usually in kids w/o Tx > 6 months)
- DDH - later risks (1)
- degenerative hip arthritis
- metatarsus adductus
- in-toeing of forefoot w/o hindfoot abnl
- metatarsus adductus - etiology
- intrauterine positioning
- intact plantar & dorsiflexion - metatarsus adductus or talipes equinovarus?
- metatarsus adductus
- fixed plantar flexion hindfoot - metatarsus adductus or talipes equinovarus?
- talipes equinovarus
- DDH - causes
-
1. fetus positioning
2. restricted fetal movement - T/F: U/S better to rely on than XR for DDH?
- U/S - good by 4-6 wks
- DDH Tx
-
Pavlik harness (< 6 mos)
body cast (older kids) - T/F: DDH can stabilize w/in 1st 4 months?
- true
- metatarsus adductus - Tx
-
mild cases - stretching exercises
severe cases - serial bracing/casting - clubfoot criteria
-
1.tibia medial rotation
2.fixed plantar flexion
3.foot inversion
4.forefoot adduction - clubfoot - Tx
-
bracing/serial casting
surgery - limp - consider what factor for differential?
- age
- limp in age 3-10: differential
-
1.Legg-Calve-Perthes
2.toxic synovitis
3.JIA - avascular necrosis of femoral head
- Legg-Calve-Perthes disease
- painless / mildly painful limp + referred pain to thigh/knee + limited ROM + nl XR
- Legg-Calve-Perthes disease
- L-C-P disease - Tx
- bracing or surgery
- L-C-P disease - prognosis dependent on...
- amt & area of ischemic necrosis
- L-C-P disease - most serious acute complication
- femoral head collapse
- SCFE - what is it?
- gradual/acute separation of proximal femoral growth plate
- SCFE radiographic studies place child in X position
- frog-leg lateral position
- inflammation, swelling, tenderness over tibial tuberosity
- Osgood-Schlatter disease
- causes of Osgood-Schlatter disease
-
mechanical forces
tendonitis of distal insertion of infrapatellar tendon
1.repetitive stress
2.trauma - Osgood-Schlatter disease - Tx
-
1.activity modification
2.stretching
3.casting up to 6 wks (severe cases) - test for scoliosis
- Adam forward bending test
- kyphosis
- increase in posterior convexity of thoracic spine
- Scheuermann disease
- wedge-shaped vertebral bodies requiring bracing
- XR studies for spinal curvature
- standing PA & lateral
- Tx for curvature < 25
- observation
- Tx for curvature 25-45
- bracing
- Tx for curvature >40
- spinal fusion
- curvature > 50 have associated...
-
decreased vital capacity
low functional pulmonary reserve - T/F: idiopathic scoliosis is associated w/pain & fatigue
- false
- T/F: bracing corrects curvature & halts progression
- false (only halts progression)
- achondroplasia - what is the reason?
- cartilage calcification & remodeling disorder
- bones in children qualities
-
1.more porous
2.more substantial periosteum - greenstick fx
- force breaks one side of bone, bends the other
- spiral fx - common in what age group?
- toddlers (tibia)
- torus / buckle fx
- at metaphysis (compression load)
- epiphyseal growth plate fx classification
- salter-harris type
- blue sclera
- oi
- AKA radial head subluxation
- nursemaid's elbow
- strong jerking of pronated hand --> ?
- radial head subluxation
- fever + refusal to move limb = suspect ?
- osteomyelitis
- osteomyelitis peak ages
-
1.neonates
2.age 9-11 - T/F: toxic synovitis gives tender joint, but can still bear weight
- true
- OI types w/blue sclera
- OI type 1,2
- osteomyelitis: most common sites
- tibia, femur
- osteomyelitis: tx
- IV abx 4-6 wks
- septic arthritis: most common site for infants vs. older children
-
infants: hip
older children: knee - osteomyelitis: more sensitive dx test
- bone scan (than plain films)