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Pediatric Orthopedics

Terms in this set (40)

Legg-Calve-Perthes
Avascular necrosis of the hip
Is Legg-Calve-Perthes more common in women or men?
Men
What is the common age range for Legg-Calve-Perthes?
4-8 years old
Legg-Calve-Perthes treatment
Mild cases - observe
Non-op tx - bracing
Definitive treatment = surgery
What is developmental dysplasia of the hip?
hip joint does not fully develop
Is DDH more common in males or females?
females
Mechanical factors associated with DDH? (4)
1. Breech
2. Torticollis
3. Metatarsus adductus
4. Congenital genu recurvatum
The Ortolani and Barlow tests are most useful when the child is ______ (age)
3 months old or younger
Trendelenberg limp
Painless limp - pt leans towards dislocated side
Late phase DDH
Irreducible after 6 months
Dislocated side appears shorter
Notice asymmetry of thigh creases
Treatment for DDH in early phase (before walking)
Pavlik harness (maybe spica cast)
Treatment for DDH in late phase (after walking)
Subluxation - pelvic/femoral osteotomy
Dislocation - traction with open reduction
Slipped Capital Femoral Epiphysis
Separation of proximal femoral epiphysis through the growth plate often secondary to rapid growth
Head of femur displaced medially & posteriorly
Demographics of patients with slipped capital femoral epiphysis
Male
African American
Puberty age
Most common in obese children
SCFE symptoms
Vague symptoms
Antalgic gait
Pain referred to thigh or medial knee
Osgood-Schlatter's disease
Repetitive injury at attachment of patellar tendon to tibial tuberosity including avulsion
Demographics of Osgood-Schlatter's disease
Usually occurs between 8-15
Often bilateral
More common in males
Athletic children
Scoliosis definition
Lateral curvature of the spine greater than 10 degrees with associated axial rotation
6 types of scoliosis
1. Idiopathic
2. Neuromuscular
3. Congenital
4. Mesenchymal
5. Post-traumatic
6. Space-occupying lesion
Idiopathic scoliosis treatment
Observation for curves <25
Bracing of immature spines for curves 25-45
Fusion surgery in mature spines for curves >45
Neuromuscular scoliosis
Caused by muscle imbalance in growing spine.
Seen in:
Cerebral palsy
MD
Charcot Marie Tooth - a group of disorders that damage the nerves in the arms and legs
Congenital scoliosis
Structural anomaly present at birth
Wedge vertebrae or hemivertebrae
Often have cutaneous manifestations such as sacral dimple or hairy patch
Mesenchymal scoliosis occurs with ______ _____ disorders.
Connective tissue:
Marfan's (severe kyphoscoliosis)
Ehlers-Danlos
Osteogenesis imperfecta
Neurofibromatosis (short, sharp curve)
Scheuermann's disease
Juvenile Kyphosis
- fixed kyphosis
- wedging abnormalities of 3 or more adjacent vertebrae
Age and gender of those with Scheuermann's disease (Juvenile Kyphosis)
Early to middle adolescent men
Pes planus
Flat foot
- normal in infants/toddlers
- May be painful or non-painful
- Most children outgrow this condition
- Arch is flat when standing and returns on tiptoes
Etiology of club foot
Intrauterine positioning
Teratologic
Idiopathic
Neurogenic - spina bifida, cerebral palsy
Club foot treatment
Serial manipulation
Serial casting
Surgery
Metatarsus Varus
Congenital adduction of forefoot at metatarsal joints
Common in premature babies
Genu varum etiology
"Bow-legged"
Normal until age 3
Blount disease
Rickets
Genu valgum etiology
"Knock-knees"
Normal from age 2-6
Idiopathic or seen in connective tissue disorders
Genu varum treatment
Bracing
Surgery - realign/lengthen tibia
Physeal stapling
Genu valgum treatment
Osteotomy
Growth manipulation
Genu Recurvatum etiology
Rare overall
Common in breech births
Genu recurvatum treatment
Early manipulation
Splinting/casting
Surgery when identified late
Tibial torsion
Twisting of the tibia along its axis
Medial = in-toeing
Lateral = out-toeing
Lateral tibial torsion symptoms
Out-toeing
Knock-knees
Medial tibial torsion treatment
Avoid postures such as reverse tailor seat and prone sleeping in knee-chest position
Passive stretching
External rotation splints
Surgery if torsion persists
Lateral tibial torsion treatment
Not associated with postural positioning
Passive stretching
Rotation splints
Surgery if persistent
Sever disease
AKA Calcaneal apophysitis (similar to Osgood-Schlatter's)
- related to growth spurts
- Affects athletic kids most often
- slightly before puberty age
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