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harris final
| Question | Answer |
|---|---|
| Intoeing gait is caused from | metatarsus adductus (foot deformity) internal tibila torsion ( rotational deformity) excessive femoral anteversion ( rot deformity) |
| roational profile for exam of intoeing gait | foot progression angle evaluation of foot prone hip rot thigh foot rot (angle) |
| morphologci features of MTA | adducted forefoot concave med foot border convex lat foot border |
| MTA coption orrectable tx | stretching reverse last shoes/straight last shoes education |
| MTA not correctable passively tx option | stetching casting reverse last shoes surgical release |
| MTA Surgical options | release adductor hallucis mdial release tarsometrsal capsulotomies multiple metatsal osteomies lateral closing cuboid osteomis opeing cuneform osteotomy |
| Internal Tibial Tosion tx | NONE rotational tibial osteotomy if >10yrs old medial thigh foot angle >10 degrees |
| Excessive femoral anteversion | medial foot progression angle medial hip rot > 70 degrees most resolve by ten yrs of age |
| tx for excessive femoral anteversion | none rotational femoral osteotomy .>10 yrs 80 degrees of prone medial hip rotation |
| genu varum | physilogic bow legs Blount's Disease |
| Genu Valgum | knock knees |
| nomal knee alignment at birth | 10-15 degrees varus |
| normal knee alginment at 18 months | neutral |
| 30-36 months | genu valgum (outgrow in another 18 months part of normal growth |
| Physiologic bowlegs (varum) | bilateral genu varum in child greater than 2 associated ITT natural hx (spontaneous resolution) |
| tx for physiolocal bow leg | none |
| Tibial vara (BLOUNTs disease | proressive varus and ITT defomity of the proximal tibia |
| etiology of Blount's disease | pathologic compression on the proximal medial tibial results in abnormal growth and development of proximal medial epiphis and pramture physeal closure |
| who get blount's disease | fmale>males overwight children early walkers african americans |
| Knocked knees | genu valgum |
| types of knock knees | physiologic metabolic skeltal dyplasia post traumatic (Cozens adolescence |
| physicologic gen valgum | normal development 3-5 ys old child |
| metabolic knocked knees | x-linked hypophosphatemia renal osteodystophy |
| genu valgu post traumatic (cozen) | s/p proximal tibial metphsis overgorwoth with valgus deformity increasing leg length excellent remoldeling potential |
| genu valgum adolescence | 10-11 yr old females 12-13 males knee pain (medial) large stature |
| genu valgum tx | hemiephysiodesis guided growth stapling and 8-plating |
| common foot deformities | calcaneovalgus talipes equinovarus pes planus toe walking |
| calcaneovalgus | present at birth characterized by forefoot valgus and heel df allowing the dorsal suface to touch the anterior tibia |
| etiology fo calcaniovalgus | inuterine molding |
| tx for calcaneovalgus | observation passive stretching seral casting (rarely) rule out tibial bowing |
| talipes equinovarus | clubfoot: present at birth forefoot adduction and supinated heel pf |
| etilogy for clubfoot | multifactoral interuterine |
| morphologic features | dimples oever talus forefoot adduction heel vaur ankle equinus shorter extremitiy smaller calf short smaller foot |
| clinical feature of club foot | cave principle cavus adductus varus equinus |
| tx for club foot | treatable but no correctable nonsurgical-->ponseti method (manipulation serial casting 3 months holding splints ) |
| treatment results of clubfoot | abnomal foot decreased size calf atrophy decreased motion pes planus MTA flat top of talus dorsal cubluxation of forefoot |
| treatment for pes plantus | none |
| toe walking causes | idiopathic cp myelodysplaia muscular dystrophy |
| toe walking | bilateral always contracture develops limits df |
| idopathic toe walking clincal feature | cariable toe walking altered choe wear decreased df normal neuro exam |
| ideopathic toe walking rx | non operative ( stretching casting bracing and botox reoccurence common) operative achilles tendon lengthening decreased strength reoccurance rare |
| common hip conditons | transient synovitis and septic arthritis developmetnal dysplasia legg clave perthes slipped capital femoral epiphysis |
| transient synovitis and septic arthritis | pain decreased ROM refusal to bear weight |
| transient synovitis | age 3-8 no/low fever no systemic illness inflammatory |
| septic arthritis | ant greater then 2 fever system ilness infectious |
| tx for transent synovitis | NSAID |
| septic arthrits tx | I & D (incision and drainage) sensitive antibiotic |
| Developmental hip dysplasia | wasterbasket term encompassing all forms of hip instability including subluxation and dilocation |
| developemental hip dysplasia incidence | incidence; 1-6 in 100 births 40-60 in left hip 20 bilateral famales> males |
| developmentall hip dysplasia risk factors | first born female positive familiy hx breech presentatino musculoskeletal abnomality |
| etilogy of developmetn hip dysplasia | multifactorial (genetic disorder, hormonal factors and mechanical factors |
| dx fo hip dysplasia | physical is more important thanradological exam dynamic us |
| DHD physical exam | ortolani barlow galeazzi |
| ortonlani | reduces a dislocated hip |
| barlow | dilocated hip |
| galeazzi | leg length shot leg is dislocated |
| tx for hip dysplasia birth to 6 months | birth to 6 months pavik harness |
| DHD tx 6-18 months | limited abduction galeazzi test telescoping true shortenign gait abnomalities |
| complication with DHD | avascualr necrosis with Leg length discrepancy coxa brevis coxa valga DJD |
| legg clve perthes disease | condition of the immature hip caused by necrosis of al or part of the femoral head which subsequently deforms as necrotic bone is replaced by living bone |
| stage of leff calve perthes | necrosis 5-7 months fragmetnation 7-months reossification 20-38 months remolding ( until maturity |
| clinical feature of legg perthes | painful limp groin pain anteriomedial thigh and knee waddling gait atrophic extremtiy decreased ROM ( mid flexion contracture) limited internal rotation and abduction |
| tx for Legg calve perthes | mainatin ROM head contaitnment (abd orthosis or maybe femoral pelvic osteotomy |
| exercises for legg calve perthes | butterfly knee to chest standing straddle hip extension prone |
| prognosis for legg calve perthes | femoral head deformity jt incongruity impingement 86 percent have symptom of DJD before the age of 65 |
| slipped capital femoral epiphysis (SCFE) | posterior and medial displacement of the |
Created by:
klkoester
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