Peds Final: Orthopaedics
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What is Developmental Dysplasia of the hip?
Condition in which the femoral head has an abnormal relationship to the acetabulum (frank or partial)
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)
Brachial plexus injury can cause what kind of palsey (most common)?
Erb Palsy (C-5/6)--> waiter's pose
- Almost always corrects itself w/out treatment
- -Caused by metatarsus adductus, tibial torsion, & femoral torsion
When diagnosing a tibial torsion while child in knee position, what degree is considered abnormal?
30degrees, 40 degrees can change patellar dynamics
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
T or F. Septic Arthritis is an orthopaedic emergency.
What are 3 main routes of infection in septic arthritis?
- 1. hematogenous
- 2. contiguous spread
- 3. direct innoculation
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.
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
What are the labs for SCFE?
- -Chem panel
- -Thyroid panel
- -Vit D
What are 2 complications of SCFE?
- 1. Aseptic necrosis
- 2. Late DJD
- **may need bone scan, MRI, CT
- **Txt: ORIF, CRPP
What is a common cause of Ant. inferior iliac spine avulsion?
- -Hip hyperextended and knee flexed
- -Long head of rectus femoris
Discuss Ischial Tuberosity Avulsion.
- -Hamstrings & adductors
- -occur w/ maximal exertion of the hamstring at origin
- -Gymnastics, football, and track
Discuss Sever's Disease (COMMON).
- -Calcaneal apophysitis (growth plate)
- -common in sprinting sports
- -pain in heel
- -tight heel cords
- -overuse injury
- -Treated with rest
Discuss Legg Calve Perthes Disease.
- -Idiopathic osteonecrosis of femoral head in children
- -Age 4-8 but range 2-12
- -unusually unilateral
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
T or F. Spinal curve <25 degrees is NOT scoliosis.
FALSE-- <10 degrees is not scoliosis.
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
What is spondylolysis?
- -Stress fracture in pars interarticularis
- -Often in eskimos, young white males, and hyperextention activities
What is the most common cause of low back pain?
- -most common in L5
- -rapid growth can encourage slippage
What is Osgood-Schlatter?
-Ant tibial tubercle apophyseal traction
T or F. There is usually no pain with Osgood Schlatter?
FALSE: if doesn't hurt--> probably not osgood-schlatter.
What is traction tendinitis with calcification in proximal attachment of patellar tendon?
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
A fracture that crosses both shafts of the growth plate is what SH classification?
What is little league elbow?
Avulsion of medial epicondyle--> traction from wrist flexors (while pitching)
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