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Peds:Ortho
Peds: Ortho Exam 1
73
Anatomy
Graduate
02/21/2012

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Term
hip abductor weakness is seen with:
Definition
- cerebral palsy
- hip dysplasia
Term
joint laxity pts have increased risk for:
Definition
- dysplasia
- dislocating patella
- flat feet
- injury
Term
Prone extension test looks for:
Definition
hip flexion contracture
Term
L2,L3:
Definition
quads
Term
L5,S1:
Definition
gastrocnemius
Term
Infant and Juvenile Scoliosis(ages3-10 y/o):
Definition
- Observe < 25 degrees
- Orthsosis > 25 degrees
- Operate > 40 degrees
Term
Adolescent scoliosis:
Definition
- Observe to 30 degrees
- Orthosis 30-40 degrees
- Operate greater than 40 degrees or rapidly progressing curvature
Term
complications of osteomyelitis:
Definition
- Systemic infection like bronchopneumonia and/or septic pericarditis
- pathological fractures
- growth disturbances
Term
Septic arthritis neonatal presentation:
Definition
- few clinical signs
- loss of spontaneous movement of limb
- posturing of joint at rest
- fever often absent and may not appear ill
Term
Septic arthritis infant and child presentation:
Definition
- local and systemic signs
- joint is swollen, tender, and child resists movement
Term
study used to follow progression of treatment with septic arthritis:
Definition
CRP

(ESR can also be used but is not reliable in neonates)
Term
Dx of septic arthritis:
Definition
- joint aspiration
- cloudy fluid, leukocytes > 50,000, with PMNS predominating
Term
most common isolates with septic arthritis:
Definition
- Staph
- Strep
- Kingella kingae
Term
Tmt of septic arthritis:
Definition
- Parenteral abx for 3-21 days followed by 4 weeks of oralabx
- Serial needle aspiration for joint drainage, if response slow consider the following 2:
- Open drainage (mandatory for hip)
- Arthroscopic drainage
Term
what type of drainage is required for hip septic arthritis?
Definition
open drainage
Term
nursemaids elbow tmt:
Definition
supination and flexion
Term
MOI for distal radius fracture:
Definition
falling on outstretched arm
Term
Type I Salter Harris:
Definition
fracture through growth plate
Term
Type II Salter Harris fx:
Definition
fracture in growth plate and metaphysis
Term
Type III Salter Harris fracture:
Definition
- fracutre through epiphysis and growth plate
Term
Type IV Salter Harris fracture:
Definition
- fracture through metaphysis and epiphysis
Term
Type V Salter Harris fracture:
Definition
crushed growth plage
Term
symptoms of organic causes of limp:
Definition
- pain night and day
- pain on weekends and vacations
- pain with PROM
- pain that interrupts play
- pain isolated to joint
- unilateral pain (RED FLAG)
- limps or refuses to walk
- pain fits with local anatomic explanation
- concurrent signs and symptoms of systemic disease
- acute onset last 3 months
Term
MCC of hip pain or limp in children less than 2 years old:
Definition
congenital hip dysplasia
Term
DDx of hip pain/limp in all ages:
Definition
- Osteomyelitis
- Septic Arthritis
- Malignancies
Term
For kids less than 2 y/o, ddx of hip pain/dysplasia:
Definition
- osteomyelitis
- septic arthritis
- malignancies
- congenital hip dysplasia
- toddler's fractures
- tibial stress fracture
- cerebral palsy
Term
DDx of hip pain/limp in kids ages 3-5:
Definition
- Osteomyelitis
- Septic arthritis
- Malignancy
- Transient/toxic synovitis (most common)
- Leukemia
Term
MCC of hip pain/limp in kids ages 3-5:
Definition
Transient/toxic synovitis
Term
transient/toxic synovitis:
Definition
- idiopathic benign hip joint inflammation
- MCC of hip pain/limp in kids ages 3-5
Term
MCC of hip pain/limp in ages 5-9:
Definition
Legg-Calve-Perthes Disease
Term
less than 2 y/o MCC of limp: congenital hip dysplasia
3-5 MCC of hip pain/limp: transient synovitis
Ages 5-9 MCC of hip pain: Legg-Calve-Perthes
Ages 11 to 16 MCC of hip pain: Slipped Capital Femoral Epiphysis
Definition
Term
MCC of hip pain/limp in children ages 11 to 16:
Definition
Slipped Capital Femoral Epiphysis
Term
DDx of hip pain/limp in ages 5-9:
Definition
- Legg-Calve-Perthes
- Muscular Dystrophy
- Osteomyelitis
- Malignancy
- Septic arthritis
Term
Ages 11 to 16 ddx of hip pain/limp:
Definition
- SCFE
- Legg-Calve-Perthes
- Tarsal coalition
- Juvenile RA
- Osteochondritis Dissecans of the knee
- Discoid meniscus
Term
imaging that should be done on any limping child:
Definition
x-ray
Term
club foot aka:
Definition
Talipes Equinovarus
Term
Adjectives to describe club feet:
Definition
- Equinus (plantarflexion)
- Adductus
- Varus
- Medial rotation
Term
differnce b/w club foot and metatarsus varus:
Definition
club foot has equinus
Term
Forefoot deformities:
Definition
- Metatarsus adductus
- Metatarsus varus
Term
Metatarsus adductus is a common __ __ deformity presenting with __ of the __foot border.It is __ and resolves __. This is a form of __ __. May be called __ __ or __ __ due to the activity of the abductor hallicus muscle.
Definition
- intrauterine positional deformity
- convexity of the lateral foot border
- benign and resolves spontaneoulsy
- form of in-toeing
- Monkey toeing or Search toeing
Term
2% of pts with metatarsus adductus also have __ __.
Definition
hip dyplasia
Term
both metatarsus adductus and metatarsus varus are forms of ___.
Definition
in-toeing
Term
managment of metatarsus varus:
Definition
- infant: cast
- young child: long leg cast series
- older child: nothing or osteotomy
Term
causes of In-toeing:
Definition
- Metatarsus adductus
- Metatarsus varus
- Internal tibial torsion
- Internal femoral torsion
Term
Causes of Out-toeing:
Definition
- Infantile external hip rotational contracture
- External tibial torsion
- External femoral torsion
Term
2 ways besides pain and altered function to distinguish physiological flatfeet from pathological flatfeet:
Definition
- notice an arch with no weight on feet= physiologic
- when patient does a heel raise, an arch forms= physiologic
Term
Causes of pathological flatfeet:
Definition
- Heel cord contracture
- Tarsal coalitions
- Verticaltalus
- Neuromuscular (C.palsy)
- Cutting of post tib tendon
- Club foot overcorection
- Obesity
- Overloaing with external tibial torsion
- Ankle valgus
Term
Most severe cases of vertical talus cause __ __ and __ of the __, which can be surgically fixed late in year one. This is also a cause of ___.
Definition
- hindfoot equinus
- dorsiflexion of the forefoot
- flattfeet
Term
causes of Bowlegs (genu varum):
Definition
- Osteochondral dystrophy
- Rickets
- Tibia vara
Term
causes of genu valgum (knock knees):
Definition
- Osteochondral dystrophy
- Rickets
- Post-traumatic
Term
bowlegs common in __ year olds.knock knees more common in __ to __ year olds. What is the managemetn for this?
Definition
- 2 year olds
- 3 to 4 year olds
- take a picture and follow up in 3-6 montsh
Term
Bow legged(genu varum) are more at risk for __ compartment syndrome.
Definition
medial
Term
Knock kneed pts (genu valgum) are more at risk for __ compartment syndrome.
Definition
lateral
Term
Osgood-Schlatter's is a __ ___ more common in __. However it presents __ in girls.Pain over __ __,relieved with rest. There is a prominent __ __ possibly with __ and __.
Definition
- traction apophysitis
- boys
- younger in girls (10-11) (boys 13-14)
- tibial tuberosity
- tibial tubercle
- swelling and redness
Term
Sever Disease is an __ at the insertion of the __ __ into the __.
Definition
- apophysitis
- achilles tendon
- calcaneus
Term
Galeazzi test:
Definition
- look at difference in knee height
- test for congenital hip dysplasia
Term
management of hip dysplasia under 6 months of age:
Definition
Pavlik harness
Term
CHD management b/w 6 and 18 months old:
Definition
- reduce hip under general anesthesia + immobilization with spica cast
Term
CHD treatment over 18 months old:
Definition
- Operation: Salter osteotomy: femoral and pelvic osteotomy at same time
Term
baby age 0-1 month how long do harness for CHD:
Definition
3.6 months
Term
baby 1-3 month, how long do you harness?
Definition
7 months
Term
baby3-6 months, how long do you harness?
Definition
9.3 months
Term
SCFE tmt:
Definition
- like a hip fracture
- 30% get AVN
- arthritis
Term
Legg-Calve-Perthes Disease is __ __ of the __ __ __. There is vascular interruption to __ __, the __ __ is NOT affected.There are __ changes due to subchondral fracture.
Definition
- osteonecrosis of the capital femoral epiphysis
- vascular interruption to subchondral bone
Term
Legg-Calve-Perthes prsent for weeks but child often doesn't complain.Symptoms include:
Definition
- hip or groin pain, may be referred to thigh
- mild to intermittent pain in anterior thigh/knee
- limp
- no history of trauma
Term
Legg-Calve-Perthes physical exam:
Definition
- Decreased ROM
- Painful gait
- Atrophy of thigh muscles secondary to misuse
- Muscle spasm
- Leg length inequality d/t collapse
- Thigh atrophy
- Short stature:have dleayed bone age
- Roll test
Term
Roll Test:
Definition
- for LCP
- have pt supine, roll affected leg into internal and external rotation
- should invoke guarding/spasm, espcially with internal rotation
Term
LCP workup:
Definition
Hip Xrays:
- AP
- Lateral
- Frog leg
Term
LCPD treatment:
Definition
- Rest, bracing
- Surgery
- Ortho consult
Term
Spondylolysis is a __ defect of the __ __. Spondylolisthesis is if the vertebrae __ __ on the vertebrae below it.
Definition
- radioluscent defect of the pars interarticularis
- slips forward
Term
Scottie Dog sign:
Definition
seen on oblique view with Spondylolisthesis
Term
Spondylolysis tmt:
Definition
- reduce activity- often heal if acute acute, manage with NSAIDS
Term
Spondylolisthesis:
Definition
if severe fusion is required
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