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25 Cards in this Set
- Front
- Back
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Metatarsus Adductus
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Adduction of the forefoot due to uterine positioning
Common(1:1000 births) Mild cases resolve without treatment Moderate or severe treated by serial stretching and casting |
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Congenital Clubfoot
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Congenital Talipes Equinovarus
1:1000 births, etiology unknown Manipulation of the foot (casting) weekly. 7-9 casts (Ponseti method) 15-50% require Achilles tenotomy Denis-Browne shoes and bar (at night when walking) up to 6 yrs |
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Rocker-Bottom Flatfoot
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Congenital vertical talus
Associated with neuromuscular disorders, genetic syndromes, and chromosome abnormalities Cause and incidence is unknown. 50% of cases are bilateral. Surgery usually indicated at 6-12 months of age |
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Cavus Foot
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Elevation of the longitudinal arch
Majority have neuromuscular etiology (tethered cord, Charcot-Marie-Tooth disease) Treated by exercises, stretching, and ankle-foot orthosis |
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Congenital Dysplasia of the Hip
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Abnormality between the femoral head and the acetabulum
Subluxation Dislocation Female > Male (8:1) Screening/Evaluation Barlow Ortolani Ultrasound at 6 weeks Differential DX: Hip click, fracture, infection, Treatment <6 mo: Pavlik harness 6 mo-2yr: adduction splint, closed reduction >2yrs: open reduction |
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Congenital Muscular Torticollis
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Mass within the sternocleidomastoid muscle
Head tilts toward the side of the contracture Differential DX: Congenital anomalies of cervical spine, trauma, viral myositis Treatment Passive stretching Surgical release |
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Internal Tibial Torsion
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Rotation of the leg between the knee and the ankle
Most common cause of in toeing between the ages of 1 and 4 years Resolves without treatment in most cases |
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Increased Femoral Anteversion
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Internal rotation of the hip with patella and foot rotated inward
Most common cause of in toeing after 3 years of age Children commonly sit in the “W” position Rarely requires treatment |
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Genu Varum (Bowleg)
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Normal from infancy through age 2 years
Differential DX: Blount's disease, rickets Most cases initially related to internal tibial torsion Self resolving in most cases |
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Blount's Disease
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Proximal tibial epiphysial dysplasia
Cause is unknown Differential DX: Rickets, genu varum Observation or trial of bracing (2-5 yrs of age) Progressive deformity requires osteotomy |
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Genu Valgum (Knock-Knees)
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Normal from 2-8 years of age
Observation is usually indicated unless excessive tripping or falling Bracing or osteotomy if severe |
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NURSEMAID'S ELBOW
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Subluxation of the annular ligament when force is applied to the arm
Usually occurs in toddlers Differential DX: Fracture, infection, tumor Reduction is done with supination while holding pressure over the radial head. |
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Osgood-Schlatter Disease
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Tibial tubercle in a growing child
Differential DX: Tumor, infection, fracture Self-limited in most patients and resolves with skeletal maturity Treat with rest, knee strap, NSAIDS, heat. |
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Osteochondritis Dissecans OCD
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Bone piece becomes avascular and can separate itself into the joint space
Differential DX: Lesion, infection, fracture Vague knee pain Activity restriction may resolve issue, surgery may be necessary |
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Osteogenesis Imperfecta
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Fractures without significant trauma due to metabolic disorder
Differential DX: Physical abuse, accidental fracture Supportive management |
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Idiopathic Scoliosis
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Lateral curvature of the spine
Females> Males (8:1) Most common in adolescents Differential DX: Leg length discrepancy, congenital scoliosis Treatments depend on severity of the curve Treatment Curves of less than 25 degrees-observe 5-7 degrees of change within 4-6 months or curve (>25 degrees)- brace treatment Severe deformity (>50 degrees)-surgery (spinal fusion) |
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Legg-Calvé-Perthes
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Epiphysis undergoes necrosis, revascularization, removal of necrotic bone, and reossification
18 to 24 months for entire process Treatment usually non-surgical (activity restriction. bracing, PT) |
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Slipped Capital Femoral Epiphysis
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“Displacement of the proximal femoral epiphysis due to disruption of the growth plate” (Hay et al. 2009)
Most common in adolescence/obese males Differential DX: Infection, fracture Surgical treatment: In-situ screw fixation or Dunn osteotomy |
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Septic Arthritis
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Orthopedic emergency
Differential DX: Transient synovitis, Legg-Perthes-Calve disease Image-guided hip aspiration, incision and drainage and culture specific antibiotic therapy required |
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Osteomyelitis
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Staphylococcus aureus-most common cause. Can be seen after systemic illness, open fractures, trauma, or surgery.
Focal tenderness, fever, local swelling, refusal to move joint and redness can be present Site is surgically cleaned and appropriate antibiotic therapy is given (+/-6 weeks) |
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Transient Synovitis
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Post infectious inflammatory arthritis
Pain with limp or an inability to walk Most common in boys (70%) 3- 10 yrs Differential DX: Trauma, septic hip. Treat with rest, NSAIDS Resolves in 5-7 days |
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Tumors
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The majority of bone tumors are benign
Malignant tumors should be managed by orthopedic oncologist S/S: Chronic pain especially at night, fevers, limp |
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Back Pain
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Common in adolescent
Differential DX: Spondylosis, Spondylolisthesis, infection, tumor Imaging (X-ray,MRI) Treated conservatively: Rest, NSAIDS, heat, exercises, posture training |
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Growth Plate Fractures
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Area of growth at the end of bones
15-30% of fractures in childhood, Boys>Girls Growth deformity can occur Orthopaedic surgery may be necessary Close observation for at least a year after fracture |
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Special Pediatric Orthopaedic Considerations
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Down’s Syndrome:
Ligament laxicity atlanto-axial joint- disruption may lead to paralysis (consider neck x-ray before intubation or impact sports). Spinal Bifida: Lower limb deformities Club feet Dislocated hips Lower limb contractures Curvatures of the spine Cerebral Palsy: Tendon or muscle contractures Achilles tightness/toe walking Major joint contractures Muscle weakness Hip dysplasia or dislocation Muscular Dystrophy: Progressive muscle weakness and loss Joint contractures Spine curvatures |
