quiz #1 – pediatric orthopedics

  1. when are most orthopedic conditions resolved by
    6 to 12 months
  2. when babies are born they come out looking like__________
  3. metatarsus adductus is most common under ___ years, usually with _______ portion
    • 2
    • tibial
  4. true or false – metatarsus adductus usually occurs bilateral in 50% of the cases
  5. what percent of patients that have metatarsus abductus also have acetabular dysplasia
  6. true or false – metatarsus adductus usually resolves spontaneously
    • true – faster with therapy/shoe modification
    • you can also put the shoes on the other feet
  7. what percentage of cases of metatarsus abductus qualify for surgery
  8. what kind of surgery is this
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    surgery for metatarsus adductus

    • After failed conservative treatment
    • 2 – 4 years tarsometatarsal capsulotomies
    • cut ligament joint capsule
    • 4 year multiple metatarsal osteotomies
  9. what is this condition
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    metatarsus adductus
  10. what is this condition
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    calcaneovalgus foot deformity
  11. is calcaneovalgus foot deformity very common
  12. what is calcaneovalgus foot deformity and what is its treatment
    • dorsi flexed, forefoot abduction, heel valgus
    • treatment is stretching and should be better within six months
  13. what is this condition
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    flexible pes planus
  14. what condition is one of the most aggravating conditions for parents and grandparents
  15. flexible pes planus
  16. true or false – if you have flat feet and it doesn't hurt you probably don't need to do anything
    true – however at the patient has flat feet and they do hurt that is when you need to examine the patient very closely
  17. true or false – a normal foot arch develops in later childhood
  18. what is the treatment for flexible pes planus if symptoms are present
    • consider over-the-counter orthotic – ( hard to find for kids)
    • custom orthotics ( not recommended because of expense)
    • check the quality of shoes and the quality of arch support
  19. when should have flexible pes panus surgery be done
    • pain necessitates it - not cosmetic
    • parents/patient will trade inversion/E version for release of pain and disability
    • A version of arthrodesis usually done
  20. what does arthrodesis mean
  21. what are the two types of rigid flat foot
    • vertical talus (convex pes valgus)
    • tarsal coalition (peroneal spastic flatfoot)
  22. what is vertical talus
    • abnormal position of talus
    • presents a rocker bottom foot
    • present at birth, seen with conditions like arthrogryposis or spina bifida
    • surgery best to realign talus and pin other joints in place (6-2 years)
  23. what is Tarsal coalition
    • abnormal fusion from calcaneous to navicular or calcaneous to talus
    • usually not a problem until teens or 20s after recurrent ankle sprains
    • surgery to disconnect the coalition
  24. what is this condition
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    vertical talus
  25. what is this condition
    Image Upload 12
  26. what is this condition
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    tarsal coalitions
  27. what is the cause of clubfoot (talipes equinovarus)
    cause is unknown – abnormalities of nerves and muscles and/or the blood supply to the foot
  28. how many people out of the thousand will have clubfoot
  29. what is clubfoot
    bones are abnormally shaped and tendons, muscles, and ligaments are tight
  30. what does clubfoot cause
    toeing in
  31. true or false – 50% of patients that have clubfoot will have bilateral deformity
  32. what are the four types of club feet
    • positional
    • teratologic
    • syndromic
    • congenital
  33. explain positional club feet
    a positional clubfoot is a normal foot that was held in an abnormal position in utero. The bone alignment is normal in the foot is usually corrected by stretching or a short course of casting
  34. explain teratologic clubfoot
    is associated with neurological disorders such as spina bifida
  35. explain syndromic clubfoot
    is associated with an overall genetic syndrome such as arthrogryposis. Both teratologic and syndromic clubfeet almost always requires surgery as definitive treatment, although casting does help stretch the soft tissue in preparation for surgery
  36. explain congenital clubfeet
    a congenital clubfoot is a foot with abnormal bone deformity present at birth but not associated with any neuromuscular cause or syndrome
  37. what is the treatment for clubfoot
    the initial nonoperative treatment is manipulation and casting. ( works for some- 15 – 80%)

    • The surgical treatment
    • necessary for rigid deformities
    • releases ligaments to move bones
    • osteotomy to move bones
    • arthrodesis to fuse bones
  38. what is this condition
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    Severs disease
  39. explain the characteristics of Severs disease
    • presidents with Heel pain
    • apophysitis
    • girls and boys, usually at about eight – 14 years of age
  40. what is the treatment or intervention for severs disease
    • relative rest
    • heel cup
    • over-the-counter inserts orthotics
    • shoe changes may be necessary to control this condition
    • stretching of the lower lands ( all muscle groups – easy on gastroc and soleus) - unload insertion of gastroc
  41. what sports is Severs disease common in
    basketball, soccer, volleyball
  42. what does this graph represent
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    • the way the bones in the lower extremity develop
    • be able to draw this graph and explain it
  43. what is another name for genu varum
  44. true or false – genu varum will spontaneously resolve in 95% with walking
  45. true or false – genu varum will convert to to knock knee, then resolve at age 4 –7
  46. what is this condition
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    Blount's disease (tibia varum)
  47. what is blount's disease
    • differential growth of the upper medial tibial epiphysis – maybe from abnormal pressure
    • more common in obese patients
    • early walkers
  48. true or false – Blount's disease will get worse, not better
  49. true or false – Blount's diseaseis more common in African Americans


    it is also more common in females
  50. what is this condition
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    genu valgum or knock knee
  51. when does genu valgum present and when does it resolve
    • 3–5
    • 5-8
  52. true or false – causes of genu valgum other than physiologic or posttraumatic are unusual
  53. what is this condition
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    tibial torsion
  54. what are the characteristics of tibial torsion
    • cause of toeing in
    • tibia is normally rotated externally in relation to the femur by 20°
    • diagnosis – has internal tibial rotation this tibia internal rotation is more than 10° – 20°
    • no evidence that in toeing causes adult trouble
  55. how should tibial torsion be treated
    • treat with reassurance
    • results with growth and development
    • shoes, stretching not helpful
  56. what do these diagrams help assess
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    Image Upload 28
    internal tibial torsion
  57. what is this condition
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    Osgood schlatter disease
  58. what is this condition
    Image Upload 32 Image Upload 34
    a severe case of Osgood schlatter disease
  59. explain the basic characteristics of Osgood schlatter disease
    • present with knee pain
    • pain with running, jumping
    • apophysitis
    • girls and boys, usually at about 8 – 14 years of age
    • exam: tender over tibial tumor tuberosity, tight rectus femoris
  60. what is intervention for Osgood schlatter disease
    • relative rest/activity modification
    • stretching of the lower limbs ( all muscle groups – ( easy on rectus femoris – decrease load on TT)
    • can be intermittent until late teens
    • bad cases – needs screws
  61. what is a red flag for toddlers fracture
    the infant doesn't want to walk

    antalgic gait
  62. what is the age range of toddlers fracture
    1 –5
  63. what is a common cause of toddlers fracture
    jumping off the couch
  64. what is this condition
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    toddlers fracture
  65. what three things should be done for toddler fracture during an examination
    • palpate tibia
    • ambulation observation
    • x-ray
  66. what is intervention for toddler fracture
    casting 3 – 4 weeks
  67. if the patient has medial knee pain you should then always check another joint. What is that joint
  68. what does DDH stand for
    developmental dysplasia of the hip
  69. what are some of the characteristics of developmental hip dysplasia
    • usually in the firstborn child
    • occurs more often in girls
    • breach presentation at birth
  70. developmental hip dysplasia usually occurs in what leg
    left leg – for reasons unknown
  71. what is a positive ortolani or barlow test
    popping in and out of the femoral head into the acetabulum
  72. what is this condition
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    developmental hip dysplasia
  73. what is a sign called and what is it used to assess
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    • telescoping sign
    • developmental hip dysplasia
  74. but kind of harness is this
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    pavlik harness

    • the intent is usually in this harness for about six months to one year
    • six months is the optimal window to treat DDH
  75. what is the most common cause of in toeing in children > 2 years old
    internal femoral torsion
  76. true or false - normal anteversion moves from 30° to 15° as mature
  77. internal femoral torsion is more common in males or females? What is the ratio
    • females
    • 2:1
  78. true or false – pressure is usually spontaneous around school age for internal femoral torsion
  79. what is this condition
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    idiopathic femoral anteversion
  80. what is this condition? can we fix it?
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    • idiopathic femoral anteversion
    • no because this is bone malformation
  81. what special test can be used to identify idiopathic femoral anteversion
    Craigs test
  82. what is legg-Calves-Perthes disease?
    • avascular necrosis of the femoral head
    • interruption of blood supply to the femoral headresults in collapse, fragmentation of the hip joint
  83. what is the age range for legg-Calves-Perthes disease
    4 – 10 years
  84. is legg-Calves-Perthes disease more common in males or females? What is the ratio
    • males
    • 4:1
    • bilateral in 25%
  85. how does legg-Calves-Perthes disease present
    • presents with hip pain or a limp. 30% of cases the pain may initially be referred to the thigh or knee
    • decreased hip internal rotation
  86. true or false – 25% of untreated cases of legg-Calves-Perthes disease will result in serious the formation of the hip joint
  87. can legg-Calves-Perthes disease result in early-onset of osteoarthritis in adulthood
  88. what is the progression oflegg calves perthes disease
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    • necrosis
    • fragmentation
    • healing
    • remodeling
  89. the percentage of legg-calves-perthes disease have a negative outcome
  90. what percentage of legg-calves-perthes disease have a positive outcome
  91. true or false – patients with legg-calves-perthes disease are more likely to have osteoarthritis in the future
  92. what is a good prognosis for legg-calves-perthes disease
    • age less than six years at the onset of symptoms
    • less than 50% of had involvement
    • no stiffness or shortening on exam
  93. what is a bad prognosis for legg-calves-perthes disease
    • age more than seven years at the onset of symptoms
    • more than 50% of had involvement
    • significant stiffness or shortening on examination
  94. what is intervention for legg-calves-perthes disease
    containment of the necrosis or fragmentation. Femoral head malleable contain the femoral head deep within acetabulum until healing occurs

    Correction osteotomy for cases that have entered the healing or remodeling stages. unlikely to remodel by containment
  95. what is this kind of brace used for
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    legg-calves-perthes disease

    • Puts the for moral head into the acetabulum without allowing much movement
    • patient is allowed weight bear
    • brace can be on for up to two years
    • they are messy and require a lot of maintenance
  96. if a patient has legg-calves-perthes disease or any other hip pathology where will the pain be located
    in the groin
  97. what is this condition
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    slipped capital femoral epiphysis
  98. what is age range for slipped capital femoral epiphysis
    most common cause of hip pain and adolescent age group 10 – 15 years old
  99. what is slipped capital femoral epiphysis
    • progressive slip of the femoral head
    • obese children
    • positive family history
  100. is slipped capital femoral epiphysis more common in males or females
    • males
    • 2:1
  101. what happens if slipped capital femoral epiphysis is left untreated
    untreated it may result in severe limb shortening, fixed external rotation and stiffness of the hip
  102. what is the treatment for slipped capital femoral epiphysis
    • insert a single cannulated screw percutaneously under x-ray control
    • post-operative recovery is generally rapid, but a of protected weight-bearing with crutches for six weeks is recommended
  103. how long does it take for children to heal from a fracture
    4 to 6 weeks
  104. how long does it take for an adult the heal from a fracture
    6 to 8 weeks
  105. don't forget to go over the case studies in the PowerPoint
Card Set
quiz #1 – pediatric orthopedics
pediatric orthopedics