Orthopedics FNP 2 final exam questions 100% correct answers to pass!

Positional plagiocephaly: Flattening of the occiput (usually unilateral) by mechanical factors acting on the head in utero or during early infancy "Plagiocephaly" = "oblique head" in Greek If present at birth is a result of in utero or intrapartum molding Premies have higher incidence of skull deformity attributable to molding after birth Gravitational forces on the skull can cause plagiocephalic deformity Incidence is 1:300 live births, can be as high as 50% of healthy infants 1y Significant increase d/t increased supine positioning when sleeping = decreased number of SIDS! Prevention: tummy time, alternate head position when lying on back May have to consider skull forming helmet Hard to differentiate from craniosynostosis Craniosynostosis: Early closure of one or more cranial sutures or absence of a cranial suture - sagittal suture is the most commonly one affected If 1 suture is involved, think of associated genetic disorders = crouzon, apert, pfeiffer Growth along the open suture produces progressive skull deformity in one or more directions Skull is usually flat over the closed suture Assess for symmetry of cheek bones, ear placement, forehead (unilateral bulging is common) May need skull x-ray Will get progressively worse each time you see them. Ask pediatric neuro what imaging they want- but usually head x ray will need to be ordered. 00:02 01:28 Congenital torticollis: Contraction of the neck to one side If present at birth, may be the result of developmental or traumatic lesions of the sternomastoid muscle or congenital abnormalities of the cervical spine If present later on, may be d/t trauma, inflammatory processes, spinal syrinx, or central nervous system neoplasm Causes: Muscular torticollis: most common; usually d/t injury during delivery; there's increased pressure which can cause fibrosis and ischemia - can sometimes feel a small lump on the affected side. Larger infants are more at risk. Can result in contracture type injury due to contracture of the sternoclydomastoid muscle. Occasionally surgery is needed to release muscle. Also positional deformation, hemivertebra of c spine, unilateral atlanto-occipital fusion, klippel-feil syndrome, unilateral absence of sternocleidomastoid, pterygium colli Treatment: gentle neck stretching, physical therapy - refer to ortho if no improvement; very rare necessity for surgery. Possibly get X ray if there was no trauma during birth. Nursemaid's elbow: Occurs when longitudinal traction is applied to the upper extremity with the elbow in extension The annular ligament can slide over the radial head and become trapped Also known as subluxation of the radial head Child will appear to be grouchy and irritable, they will not be using the affected arm d/t pain Treatment: rotate hand/arm with a slight tug or extension from body (if successful child will start using arm again) - do not do this maneuver if a fracture is possible; this disorder should be outgrown by 4-5y. Don't ty to reduce if you have any reason to suspect there could be fracture Scoliosis A structural lateral curvature of the spine greater than 10 degrees Several classifications: Idiopathic: caused by equilibrium dysfunction, familial, or asymmetric growth (infantile, juvenile, and adolescent) Paralytic: secondary to muscle imbalance from neuromuscular problems Congenital: structural anomaly present at birth Post traumatic: following injury or radiation Tumors Other: metabolic disturbances 2-3% incidence Female to male ratio increases with increasing curve magnitude; hormones (puberty) can increase the progression of curvature If curve is 20 degrees or less, chance of progression is low Curve 20-45 degrees, increased risk of progression especially during growth Scoliometer = if curve is 5 degrees then order x-ray = X-ray confirms diagnosis The Adam's test: have patient bend over and touch toes to assess for differing heights of ribs/shoulders/scapula Goal is to prevent increasing deformity, sometimes bracing and surgery are needed, but spontaneous resolution is possible in some children Osgood-Schlatter disease: A type of overuse, repetitive microtrauma that causes pain and point tenderness over the tibial tubercle Can have decreased ROM Usually unilateral Diagnosis is based on history and PE, x-rays are usually not needed Can last up to 2 years; mostly self-limiting Pain decreases during as adolescents as growth slows Pain is common during and after activity Treatment: ice, PT, ROM exercises, knee immobilizers are not necessary in most cases, avoid NSAIDs. Can require surgery in extreme cases. Some orthos will stop activity until inflammation subsides.