Peds Final: Orthopaedics

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  1. What is Developmental Dysplasia of the hip?
    Condition in which the femoral head has an abnormal relationship to the acetabulum (frank or partial)
  2. What is Barlow's and Ortolani's Sign?
    Barlow: hip flexed and thigh adducted while pushing posteriorly , causing femoral head to dislocate posteriorly (+)

    Ortolani: Hip is flexed 90 degree while leg held in neutral rotation, hip abducted by lifting leg anteriorly (+ is "clunk" as dislocated femoral head reduces into the acetabulum)
  3. Brachial plexus injury can cause what kind of palsey (most common)?
    Erb Palsy (C-5/6)--> waiter's pose
  4. Discuss "intoeing".
    • Almost always corrects itself w/out treatment
    • -Caused by metatarsus adductus, tibial torsion, & femoral torsion
  5. When diagnosing a tibial torsion while child in knee position, what degree is considered abnormal?
    30degrees, 40 degrees can change patellar dynamics
  6. What is your main concerns w/ a limping child and what labs were you draw?
    • Hx: trauma, recent viral infection
    • Lab: CBC, ESR, CRP
    • Xray: complete
    • ***worry about septic hip
  7. T or F.  Septic Arthritis is an orthopaedic emergency.
  8. What are 3 main routes of infection in septic arthritis?
    • 1. hematogenous
    • 2. contiguous spread
    • 3. direct innoculation
  9. Discuss nursemaid elbow.
    Radial head subluxation from under annular ligament. usually prior to age 6. Results from traction on arm. Child will hold close and pronated, generally won't use.
  10. What is necessary to have a slipped capital femoral epiphysis.
    Have to have open growth plate. Avg age is 12yo, obesity is risk factor and most common in left hip
  11. What are the labs for SCFE?
    • -ESR
    • -CRP
    • -Chem panel
    • -Thyroid panel
    • -Vit D
  12. What are 2 complications of SCFE?
    • 1. Aseptic necrosis
    • 2. Late DJD

    • **may need bone scan, MRI, CT
    • **Txt: ORIF, CRPP
  13. What is a common cause of Ant. inferior iliac spine avulsion?
    • -Hip hyperextended and knee flexed
    • -Long head of rectus femoris
  14. Discuss Ischial Tuberosity Avulsion.
    • -Hamstrings & adductors
    • -occur w/ maximal exertion of the hamstring at origin
    • -Gymnastics, football, and track
  15. Discuss Sever's Disease (COMMON).
    • -Calcaneal apophysitis (growth plate)
    • -common in sprinting sports
    • -pain in heel
    • -tight heel cords
    • -overuse injury
    • -Treated with rest
  16. Discuss Legg Calve Perthes Disease.
    • -Idiopathic osteonecrosis of femoral head in children
    • -Age 4-8 but range 2-12
    • -unusually unilateral
  17. What symptoms of Legg Calve Perthes Disease?
    • -Limping 3-6 weeks
    • -Activity worsens limp
    • -Pain may be in groin or proximal thigh
    • PE: restricted abduction
    • XRAY: Crescent sign--> may need MRI
  18. T or F.  Spinal curve <25 degrees is NOT scoliosis.
    FALSE-- <10 degrees is not scoliosis.
  19. What are the txts for scoliosis based on degree of curvature?
    • <20 degrees--> observe and xray q 6mo
    • 25-40--> treat with brace
    • >45--> fix with rods
  20. What is spondylolysis?
    • -Stress fracture in pars interarticularis
    • -Often in eskimos, young white males, and hyperextention activities
  21. What is the most common cause of low back pain?
    • Spondylolisthesis
    • -most common in L5
    • -rapid growth can encourage slippage
  22. What is Osgood-Schlatter?
    -Ant tibial tubercle apophyseal traction
  23. T or F.  There is usually no pain with Osgood Schlatter?
    FALSE: if doesn't hurt--> probably not osgood-schlatter.
  24. What is traction tendinitis with calcification in proximal attachment of patellar tendon?
  25. What are 4 special points about Salter Harris Classification of fractures.
    • 1. ONLY for peds
    • 2. Have to have open growth plates
    • 3. Girls close sooner than boys
    • 4. Girls usually close 1 yr after menses onset
  26. A fracture that crosses both shafts of the growth plate is what SH classification?
    -Class IV
  27. What is little league elbow?
    Avulsion of medial epicondyle--> traction from wrist flexors (while pitching)
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Peds Final: Orthopaedics

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