1
Q
Staheli’s Test
A
- Child placed prone, legs hanging over the table. Examiner extends one limb at a time trying to get limb to neutral.
- If child can’t get to neutral, may be fixed flexion contracture.
2
Q
Thomas’s Test
A
- Tests for flexion contracture (illiopspoas)
- Child supine, with knees to chest. Allow one leg to extend.
3
Q
Ober’s Test
A
Tests for hip abduction contracture
4
Q
Ely’s Test
A
Tests for Rectus Femoris contracture
5
Q
Ryder’s Test
A
- Measures femoral antetorsion
- Normal is 10˚ internally rotated
- If femur is ext rotated, there is retrotorsion
- If femur is int rotated, there is antetorsion
6
Q
APGAR score
A
Skin Color:
0 - blue
1 - body pink, extrem blue
2 - completely pink
HR:
0 - asystole
1 - 100 bpm
RR:
0 - absent
1 - slow/irregular
2 - good (>60 bpm)
Stimulation Response
0 - no response
1 - facial grimace
2 - sneeze/cough
Muscle Tone
0 - limp/no tone
1 - some flexion of extrems
2 - active motion
6
Q
What APGAR score indicates extreme distress
A
1-2 (highest score = 10)
7
Q
Barlow’s Test
A
To identify a hip that is fully located (or subluxed), but which can be additionally subluxed or fully dislocated
9
Q
When to take APGAR score
A
@ 1 min, 5 min, then q 5 min until normalize
10
Q
Ortoloni’s Test
A
To identify a hip that is doslocated but reducible
11
Q
Palmen’s Sign
A
A finding of subluxation
12
Q
Telescoping Sign
A
To identify a dislocated mobile proximal femur
13
Q
Galeazzi’s Sign
A
To identify an apparently short femur in hip dislocation
14
Q
Allis’ Sign
A
Tests for shortening in the limb
15
Q
Trendelenberg’s Test
A
Tests for weakness of the hip abductors (especially gluteus medius)
16
Q
Gower’s Sign
A
Identifies weak hip extensors
17
Q
Confusion Sign
A
- Have pt do maneuver unrelated to ankle dorsiflexion, but it will produce reflex ankle
- Seen in children that are neurologically abnormal, with spasticity
18
Q
Calcaneovarus deformities
A
ankle = calcaneus FF = supinated (adducted/varus)
19
Q
Causes of Calcaneovarus
A
- NM in nature
- tibialis anterior = only muscle really working well (adducted/varus)
- weakness in posterior, lateral, and other anterior muscle groups
20
Q
Difference b/w calcaneovarus and calcaneus deformity
A
calcaneus deformity = no forefoot malposition (all anterior muscle groups functioning)
Similarities:
- also NM in nature
- neither are talipes (congenital) deformities
21
Q
Triad of Talipes Calcaneovalgus
A
- Ankle Calcaneus
- STJ pronation
- TN subluxation (NOT dislocated – i.e., how to differentiate from vertical talus, in which TNJ is dislocated!)
- note: ankle in calcaneus with PF to neutral only until ~6 mo… after 6mo, ankle in equinus and PF 20 deg (OBLIQUE TALUS AND TALIPES CALCANEOVALGUS = ONE IN THE SAME AFTE 6 MONTHS)
- i.e., ankle equinus, STJ pronated/subluxed, FF abducted
22
Q
Etiology of Talipes Calcaneovalgus
A
- congenital (in utero positioning - packaging defect) **most common
- neurological (paralysis below L5)
23
Q
Tx of Talipes Calcaneovalgus
A
- serial casting followed by orthotics (UCBL or Type C Heel Stabilizers)
24
Q
Causes of rigid pediatric flatfoot
A
- Congenital Convex Pes Valgus (Vertical Talus)
- Tarsal Coalition
- Severe Talipes Calcaneovalgus (more common than CCPV*)
25
Oblique Talus - flexible or rigid?
fully flexible triplane pronation foot
26
Congenital Convex Pes Valgus - other names
- rock-bottom flatfoot
- persian slipper
- vertical talus
27
Difference b/w CCPV and Talipes Calcaneovalgus
- CCPV - DISLOCATED STJ
28
Most common cause of CCPV
- Myelomeningocele
29
Bone/Joint Abnormalities of CCPV
- TNJ dislocation (navicular wedged b/w dorsal talar neck and anterior tibia)
- ankle in equinus, but foot in calcaneus (b/c talus extremely PF, but foot looks DF on AJ)
- talar neck hypoplastic ("Washington monument"), small talus
- calcaneus in equinus
- elongated spring ligament
- tight anterior compartment tendons, triceps surae, and peroneals
30
Treatment of CCPV
- Dobb's Technique = serial casting based on reversal of Ponsetti technique
- do serial casting and then limited midfoot release if necessary
- late initiation of tx worsens prognosis
31
Talipes Equinovarus (TEV) - 3 components
- ankle and foot equinus
- STJ varus (STJ supinated)
- FF adductus (and in some degree of cavus, 1st met PF)
32
Etiology of TEV
- idiopathic ** most common form
- unknown, probably genetic
- males > females (females get it wore when present)
33
Arterial abnormality seen in TEV
80-85% - anterior tibial artery abnormality - usually does not develop distal to lower 1/3 of leg
34
Pathological anatomy TEV
- ankle/foot equinus
- STJ varus
- talar neck short & deviated medially/plantarly
- navicular is down, medial, and proximal on the talar head (SUBLUXED) and 2/3 the size of normal - follows abnormal position of talus and may be so medial that forms false articulation with anterior aspect of medial mall
- can't palpate the talar head medially b/c of navicular covg
- calcanus in varus and rotated so that distal portion almost directly inferior to talar head (medially and downward)
- severe capsular/ligamentous contractures
- invoved foot is smaller involved leg is smaller (look at calf musculature)
- no sinus tarsi (talar head fills it)
- redundant skin over talar head, thin and hyperpigmented -- caused by the uncovering of the dorsolateral aspect of talar head (long standing pressure of head against skin)
35
Gold standard of TEV correction
PONSETTI TECHIQUE = manipulation and serial casting (MUST BE ABOVE THE KNEE)
- supinate the FF to remove the 1st ray cavus and get FF parallel to RF
- correct FF and STJ as unit
- correct AJ equinus only after (PQ AT tenotomy! not lengthening)
** long term shoe/bar splinting - Dobb's brace = what is used today (or can use Filauer bar if non-ambulatory or when sleeping/resting)
36
When to do surgery on TEV
- salvage px
- wait until at least 9 mo of age (so they can tolerate)
- if pt not corrected by serial casting/manipulation before 1 year - want to consider sx before start standing on the deformity
* usually need to d posterio-medio-latero-plantar release
37
Cincinnati incision
big incision - from 1st met base up to Tendo Achilles to cuboid/5th met base
38
Clinical Picture of Met Adductus
- mets 2-5 adducted due to bowing of prox shaft; vs. distal medial cuneiform is malaligned so that it directs medially (not 1st met)
- concave medially w/ apex at 1st TMTJ and deep vertical skin crease
- convex laterally w/ apex at 5th met base (prominent)
- regular hindfoot
- hallux varus may be present
- wide 1st interdigital space
- contracted abductor hallucis
39
4 Findings that constitute the screening for met adductus
1. simple inspection
2. passive overcorrection
3. active overcorrection (note: response involutes after 1 yr)
4. evaluation standing (deformity usually worse)
40
Most common cause of met adductus
most likely intra-uterine packing
| * also genetic component
41
Which is easier to fix met adductus type: flexible or rigid?
rigid
42
When should you definitively decide to treat met adductus
if it has not spontaneously corrected by 6-8 months
43
Gold standard treatment of met adductus
- manipulation and serial casting, change weekly (as long as
44
Indications for met adductus surgical intervention
- persistant hallux varus
- age > 3
- recurrence
- failure of non-op tx
45
Heyman, Herndon, and Strong Px
- TMTJ lig (only medial, dorsal, and plantar) release with 2nd met osteotomy
* * for younger children
46
Fowler Px
- used mostly for skewfoot when need deformity correction in all three planes
- includes: 1. opening wedge osteotomy of medial cuneiform, 2. abducting osteotomies of lesser mets, 3. possible lateral column lengthening, 4. possible varus osteotomy of calcaneus
47
Berman-Gartland Px
- crescentic osteotomies to abduct metatarsals (base osteotomies)
* older children (b/c ca no longer remodel cartilage as you can w/ HHS) with persisting deformity
* * be careful w/ 1st met -- need to make 1.5 distal to base due to open physis
48
Stereotypical Blount's Dz Pt
- short, fat, early walker
- African American
- Female
49
is Blount's real AVN
no
50
Current theory on Pathophysiology of Blounts Dz
- progressive upper medial tibial physeal dysfunction (may be due to early loading / walking of someone already in varoid position)
- decrease growth medial side, cntnd growth laterally
51
Xray findings Blounts
- beak on medial side w/ flattening
| - tibiometaphyseal (Levine-Dennen's Angle) >16 = suggestive for Blounts (
Clerkships
flashcards
Decks in class (9)
# Cards
