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48 Cards in this Set

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  • Back
Avascular necrosis of the femoral head
Legg-Calve-Perthes disease
A 5 yo boy has developed progressive limping. At first painless, it now hurts to run & walk. The pain is in the anterior thigh. The pain is relieved by rest. Parents recall no trauma
At what age range should Legg-Calve-Perthes be considered?
4-12 years
What gender most commonly gets Legg-Calve-Perthes?
Boys (4:1)
What are the associations with Legg-Calve-Perthes?
Low birth weight
Undescended testes
What is the presentation of Legg-Calve Perthes?
Limping that is at first painless, but can proceed to pain that is worsended by activity & relieved by rest

Pain is reported in the groin, hip, thigh, or knee
What is the diagnostic test for Legg-Calve-Perthes?
radiographs show wide articular space, then necrosis.

Follow-up films during reconstitution reveal a flattened femoral head; later it becomes spherical
What is the treatment for Legg-Calve-Perthes disease?
Self-healing process

Goal of therapy is to MAINTAIN JOINT MOBILITY
-this is done via CONTAINMENT = maintaining the hip in the acetabulum
What is a complication of Legg-Calve-Perthes?
Describe Developmental Dysplasia of the Hip (DDH)

What are some associated conditions? (4)
Occurs in the newborn period but should be considered up to 3 years of age

20% of patients have a + family hx

Ligamentous laxity, maternal estrogens, breech position, & torticollis
What signs are useful in diagnosing DDH?
Barlow, Ortolani, & Galeazzi signs
Displacement of the femoral head from the femoral neck b/c of a stress fracture thru the femoral capital epiphyseal plate
Slipped Capital Femoral Epiphysis
What are the associations with SCFE? (3)
Obesity, deficient gonadal development, & hypothyroidism
An obese kid presents with groin pain referred to the anteromedial knee & thigh, limp, & accentuated external rotation
Slipped Capital Femoral Epiphysis
What do radiographs show in SCFE?
medial displacement of the epiphysis

Bare upper portion of the femoral neck

Wide growth plate
ABnormal curvature of the spine caused by misalignment in the frontal plane = ?
a 12 yo girl is seen for routine physical exam. She voices no complaints. Exam is remarkable for asymmetry of the posterior chest wall on bending forward. One shoulder appears higher than the other when she stands up
What is the best way to screen for scoliosis?
Adams test = forward bending

Radiographs are the gold standard for evaluating suspected scoliosis
When is surgery considered in Scoliosis?
> 45 degrees
What is recommended to slow down progression of the curves in Scoliosis?
What are 3 complications of Scoliosis?
1. Degenerative joint disease

2. Cardiorespiratory disease

3. Poor self-esteem
Congenital Scoliosis is caused by vertebral anomalies such as __________. It is associated with these 3 things

GU anomalies (renal agenesis horseshoe kidneys, obstructive uropathy)
Congenital heart disease
Spinal Dysraphism

**early surgical treatment is indicated b/c of the underlying pathophysiology
What syndromes are associated with scoliosis?
1. Neurofibromatosis
2. Marfan
4. Goldenhar = malar/maxillary hypoplasia, microtia (small ear), hemivertebrae
Talipes Equinovarus
A newborn is noted to have a foot that is stiff & slightly smaller than the other one. The affected foot is medially rotated & very stiff, with medial rotation of the heel
What are associated disorders of Talipes Equinovarus?
1. developmental hip dysplasia
2. Amniotic bands = congenital disorder caused by entrapment of fetal parts (usually a limb or digits) in fibrous amniotic bands while in utero
3. Spina bifida
4. Arthrogryposis = rare congenital disorder that causes multiple joint contractures and is characterized by muscle weakness and fibrosis
What gender is Clubfoot (Talipes Equinovarus) more common in?
What is the treatment for Talipes Equinovarus?
Serial casting & surgery
The forefoot is adducted, but the hindfoot is normal; the forefoot can be brought to the neutral position. Observation, passive range of motion, & casting may treat this condition
Metatarsus Adductus (Metatarsus Varus)
Tibial torsion is usually secondary to _____. Treatment is not necessary b/c this condition resolves on its own
in utero positioning
This is more common in children older than 2 years & is more common in girls. It is affected by sitting position. Rx is usually an attempt to correct sitting position
Femoral Anteversion
What does Retinoblastoma have an association with?
This bone tumor can be induced by exposure to radiation
Where is Osteosarcoma most commonly found?
Long bones at the METAPHYSIS
-distal femur
-proximal humerus
-proximal tibia
This bone tumor usually presents with pain at the tumor site; limitation of motion & a palpable, visible tumor are other findings. Deep bone pain awakening an adolescent at night should make one suspicious.
Bone tumor with "sunburst" appearance
What are common sites of metastatis for Osteosarcoma?
Lung & bone
What is treatment for Osteosarcoma?
Surgery & Chemo
What present a worse prognosis for Osteosarcomas?
Pelvic tumor
"Onion skin" periosteal elevation
Ewing Sarcoma
What is the treatment for Ewing Sarcoma?
Surgery, radiation, chemo
Ewing Sarcoma
This occurs when there is no longitudinal arch of the foot. It is a variation of normal feet. It is usually seen in children older than 6 years of age, is usually asymptomatic & requires no treatment
Pes Planus = flat feet
What is Pes Planus sometimes associated with?
1. Heel cord contractures

2. Cerebral palsy
This arises from the capsule or tendon sheaths & appears as a painless NONPULSATILVE SWELLING on the posterior aspect of the knee. It becomes more prominent on knee extension. Rx is usually not necessary b/c it resolves spontaneously. Excision is recommended for large, painful lesions. DDx includes Lipoma, aneurysm, neuroma, & rarely tumors
Popliteal cyst (Baker cyst)
Traction apophysitis of the TIBIAL TUBERCLE caused by overuse
Osgood Schlatter disease
This presents with localized tenderness & swelling over the tibial tubercle
Osgood Schlatter disease
This occurs after sudden traction on the arm, usually in kids younger than 4 years old. The child cries immediately & won't move the arm. The arm is held paritally flexed at the elbow & pronated
Radial head subluxation (Nursemaid's elbow)
How do you correct Radial head subluxation?
reduction by gentle supination w/ pressure over the radial head