Flashcards in this deck (87)

• The pediatric musculoskeletal system is essential to understand for identifying anatomy and physiology.
  pediatrics anatomy physiology
• Common pediatric orthopedic conditions include transient synovitis, septic arthritis, and osteomyelitis.
  pediatrics orthopedics conditions
• A physeal fracture is one type of fracture that can occur in children.
  pediatrics fractures
• The epiphysis is the end of a long bone associated with joint cartilage.
  anatomy bone
• A child's skeleton is less densely calcified than an adult's and contains a higher percentage of cartilage.
  pediatrics physiology skeleton
• The connection between the metaphysis and physis is a point of weakness in long bones.
  anatomy physiology
• In pediatric patients, fractures are more common than sprains due to stronger ligaments and periosteum.
  pediatrics injuries
• Congenital muscular torticollis (CMT) can affect 4-16% of infants.
  pediatrics torticollis
• Treatment for torticollis involves early identification and comprehensive physical therapy.
  pediatrics treatment therapy
• Late treatment of torticollis may lead to craniofacial deformities and painful limited cervical motion.
  pediatrics torticollis complications
• In Developmental Dysplasia of the Hip (DDH), the femoral head has an abnormal relationship to the acetabulum.
  ddh anatomy hip
• Increased risk factors for DDH include being a first-born female, having a breech presentation at birth, and a family history.
  ddh risk_factors pediatrics
• The Galleazzi sign indicates shortening of one thigh, which can be a sign of DDH.
  ddh signs pediatrics
• The Barlow test involves flexing the hip to 90 degrees, adducting slightly, and applying gentle but firm pressure posteriorly on the knee.
  ddh barlow_test maneuvers
• The Ortolani test involves flexing the hip to 90 degrees, abducting, and applying gentle but firm pressure anteriorly with the index finger.
  ddh ortolani_test maneuvers
• After 3 months of age, limitation of abduction is the most reliable sign of DDH, along with asymmetric thigh folds.
  ddh screening pediatrics
• Ultrasound is used for DDH screening in infants younger than 3-4 months, while radiographs are used for those older than 4 months.
  ddh ultrasound radiography
• Treatment of DDH may involve referral to a pediatric orthopedist, use of a Pavlik harness, or surgery.
  ddh treatment orthopedics
• Untreated DDH can lead to complications such as limp, degenerative disease of the hip, and pain.
  ddh complications orthopedics
• Clubfoot (talipes equinovarus) affects 1 in every 1,000 births worldwide and is more common in males.
  clubfoot statistics pediatrics
• The Ponseti treatment for clubfoot includes serial casting followed by Achilles tenotomy.
  clubfoot treatment ponseti
• In cases of acute inflammatory/infectious issues, consider conditions such as transient synovitis, septic arthritis, or osteomyelitis.
  inflammation conditions pediatrics
• When assessing pain in young children, look for signs such as refusal to walk, irritability, and parental observation of a new deformity.
  pain assessment pediatrics
• Physical exam for pain should include inspecting for swelling, ecchymosis, and joint deformity, as well as palpating for temperature and tenderness.
  exam pain assessment
• A 2-year-old female with a limp and refusal to walk may have experienced a viral illness last week, but no witnessed trauma was reported.
  case_study pediatrics limp
• The condition where a child has been walking with a limp and refusing to walk for 2 days after a viral illness is likely transient synovitis.
  pediatrics diagnosis synovitis
• Transient synovitis is common in children aged 18 months to 12 years and often follows a viral infection.
  pediatrics synovitis viral
• Symptoms of transient synovitis include pain in the hip, thigh, or knee, with a normal or slightly elevated temperature.
  pediatrics symptoms synovitis
• Diagnosis of transient synovitis may include WBC and ESR tests that are normal or slightly elevated, and imaging like X-rays or ultrasound.
  diagnosis imaging synovitis
• In cases of septic arthritis, the joint is typically warm, swollen, and painful on range of motion with micromotion tenderness.
  pediatrics septic_arthritis symptoms
• The most common pathogen causing septic arthritis in infants and children is Staph aureus.
  pediatrics pathogens septic_arthritis
• Osteomyelitis is an infection of the bone, usually caused by bacteria, and commonly affects long bones like the femur and tibia.
  pediatrics osteomyelitis infection
• Diagnosis of osteomyelitis may require blood/bone aspirates for culture and possibly IV antibiotics and surgical debridement.
  diagnosis treatment osteomyelitis
• Physeal fractures account for 18-30% of pediatric fractures and are common in adolescence, peaking at 11-12 years.
  pediatrics fractures physeal
• The Salter-Harris Classification categorizes physeal injuries and includes Type I which is an epiphyseal separation through the physis.
  pediatrics classification fractures
• Type I physeal injury is an epiphyseal separation through the physis.
  injuries physeal imaging
• Type II physeal injury involves a fracture through a portion of the physis but exiting across the metaphysis.
  injuries physeal imaging
• Type III physeal injury includes a fracture through the physis exiting across the epiphysis into the joint.
  injuries physeal imaging
• Type IV physeal injury is characterized by a fracture through the metaphysis, physis, and epiphysis.
  injuries physeal imaging
• Type V physeal injury is a crush injury to the physis.
  injuries physeal imaging
• Salter-Harris type II is the most common type of physeal injury.
  injuries salter-harris classification
• Salter-Harris type IV has the highest rate of growth disturbance at 64%.
  injuries salter-harris classification
• Salter-Harris type III and IV may require surgery.
  injuries salter-harris surgery
• Torus or buckle fractures are a stable fracture caused by a compressive load.
  injuries fractures imaging
• Greenstick fractures are the most common fracture pattern in children, involving an incomplete fracture at the metaphyseal diaphyseal junction.
  injuries fractures children
• A bowing fracture is an incomplete fracture where the bone bends to the point of plastic deformity without interrupting the cortex.
  injuries fractures deformity
• A toddler fracture is characterized by a hairline, non-displaced spiral or oblique fracture of the tibia in kids typically under 4 years old.
  injuries fractures children
• A supracondylar fracture is a fracture of the distal humerus above the condyles, typically due to a fall on an outstretched arm.
  injuries fractures humerus
• In a supracondylar fracture, it is essential to assess neurovascular function and consult orthopedics emergently.
  injuries fractures emergency
• Nursemaid’s elbow is a subluxation of the radial head that occurs after the forearm or wrist is jerked with longitudinal and pronational forces.
  injuries elbow subluxation
• Nursemaid’s Elbow is a subluxation of the radial head that occurs after the forearm or wrist is jerked with longitudinal and pronational forces, such as when playing airplane.
  pediatrics nursemaids_elbow injury
• In Nursemaid’s Elbow, the affected arm is typically held in a slightly flexed position and the child refuses to use the arm. Diagnosis involves history and exam, while radiographs are usually normal.
  pediatrics diagnosis nursemaids_elbow
• The treatment for Nursemaid’s Elbow includes reduction and splinting if recurrent. To prevent recurrence, it is important to educate adults.
  pediatrics treatment nursemaids_elbow
• When considering injuries in children, think about the mechanisms of injury and ensure they correspond to the history, exam, and developmental level of the child.
  pediatrics injury clinical_pearls
• Fractures in children may not always be seen on initial films and can be very subtle. Always think fracture before sprain.
  pediatrics fractures clinical_pearls
• In chronic conditions, gait abnormalities can include in-toeing and out-toeing. Internal tibial torsion is common in children under 5, while femoral anteversion is common from ages 4-7.
  pediatrics gait_abnormalities chronic_conditions
• Genu varum (bowed legs) is a normal variant in toddlers, typically resolving by 3. Pathology may be suspected if the condition is unilateral, associated with pain, or follows a previous fracture/trauma.
  pediatrics gait_abnormalities genu_varum
• Genu valgum (knock knees) is a normal variant in children aged 3-6, typically resolving by 7. Pathology may be suspected if it is unilateral, associated with pain, or follows a previous fracture/trauma.
  pediatrics gait_abnormalities genu_valgum
• Legg-Calvé-Perthes Disease is characterized by idiopathic avascular necrosis of the femoral head, primarily affecting males aged 4 to 9 years.
  pediatrics legg_calve_perthes disease
• In Legg-Calvé-Perthes Disease, the main symptom is a limp with little to no pain, and the hip shows limited internal rotation and abduction. Diagnosis is through X-ray and bone scan.
  pediatrics legg_calve_perthes diagnosis
• Sever Disease, also known as calcaneal apophysitis, presents as heel pain in a growing child, often worsening with activity. It typically occurs during rapid growth in puberty.
  pediatrics sever_disease heel_pain
• In Sever Disease, pain results from a microfracture caused by the pull of the Achilles tendon against the relatively weaker structure of the apophysis, usually affecting young athletes.
  pediatrics sever_disease athletes
• Management of Sever Disease includes a physical exam to localize findings and radiography to exclude other causes of heel pain, such as tumor or osteomyelitis.
  pediatrics sever_disease management
• Sever Disease management includes physical exam to localize findings and radiography to exclude other causes of heel pain like tumor or osteomyelitis.
  medicine orthopedics severdisease
• Chronic conditions in adolescent years include Osgood-Schlatter disease, Patellofemoral syndrome, Slipped capital femoral epiphysis (SCFE), and scoliosis.
  medicine orthopedics adolescents
• A 13-year-old female volleyball player with right anterior knee pain and a painful lump may be diagnosed with Osgood-Schlatter disease.
  medicine orthopedics osgoodschlatter
• Osgood-Schlatter disease is characterized by fibrocartilage microfracture of the patellar ligament at the tibial tubercle insertion.
  medicine orthopedics osgoodschlatter
• In Osgood-Schlatter disease, activity-related pain lasts 12-24 hours and is accompanied by tenderness and a prominent bump at the tibial tubercle.
  medicine orthopedics osgoodschlatter
• Radiographs for Osgood-Schlatter disease show a prominent, irregular tubercle to rule out other forms of leg pain including malignancy.
  medicine orthopedics osgoodschlatter
• Patellofemoral Pain Syndrome presents as pain around or behind the patella, with symptoms like clicking, popping, and buckling sensations.
  medicine orthopedics patellofemoralpain
• Patellofemoral Pain Syndrome is most common in female adolescents and is often caused by overuse or patellar malalignment.
  medicine orthopedics patellofemoralpain
• Management of Patellofemoral Pain Syndrome includes RICE, avoidance of aggravating activities, physical therapy, and possibly a patellar-stabilizing knee brace.
  medicine orthopedics patellofemoralpain
• A 14-year-old male with a 3-month history of limp and right knee pain may have a condition requiring further evaluation for SCFE.
  medicine orthopedics scfe
• Slipped Capital Femoral Epiphysis (SCFE) is characterized by the femoral head slipping off at the growth plate, more common in males (14-16 yrs) than females (11-13 yrs).
  medicine orthopedics scfe
• Imaging for SCFE requires AP and frog leg views of the pelvis, with comparison of both hips as the slip may be subtle.
  medicine orthopedics scfe
• The treatment goal for SCFE is strict non-weight bearing to prevent further slippage, with possible screw placement or pinning.
  medicine orthopedics scfe
• An 11-year-old female with a difference in shoulder height may indicate scoliosis, requiring further evaluation.
  medicine orthopedics scoliosis
• Inspection abnormalities in scoliosis include asymmetry of the scapulae and iliac crests.
  medicine orthopedics scoliosis
• The Adams forward bend test is used to assess the range-of-motion of the spine in cases of suspected scoliosis.
  medicine orthopedics scoliosis
• Scoliosis affects 1 in 25 girls and 1 in 200 boys.
  scoliosis statistics health
• The Adams forward bend test is used to assess range-of-motion (ROM) of the spine by having the patient bend forward like they’re trying to touch their toes.
  scoliosis diagnosis test
• Asymmetry in the scapulae and iliac crests can indicate scoliosis.
  scoliosis symptoms physical_examination
• Imaging for scoliosis should be reserved for those with a high pretest probability and is not recommended for screening itself.
  scoliosis imaging guidelines
• The Cobb angle is used to determine the severity of scoliosis: Mild is 10-25 degrees, Moderate is 25-50 degrees, and Severe is 50 degrees+.
  scoliosis cobb_angle severity
• Mild scoliosis may respond to scoliosis specific exercise, while Moderate scoliosis may require bracing.
  scoliosis treatment exercise
• Severe scoliosis, characterized by a curve of 50 degrees+, typically requires surgery to prevent further progression.
  scoliosis surgery treatment
• The exam of the chest and trunk for asymmetry is considered a proxy for spine deformity.
  scoliosis diagnosis examination