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Orthopedics Assessment
It is important to understand the growth and development of the musculoskeletal system as well as common orthopedic terms ( Table 197.1 ). Providers should recognize common mechanisms for congenital and acquired orthopedic disorders ( Table 197.2 ).
Table 197.1
Common Orthopedic Terminology
| ABDUCTION | MOVEMENT AWAY FROM MIDLINE |
|---|---|
| Adduction | Movement toward or across midline |
| Apophysis | Bone growth center that has a muscular insertion but is not considered a growth plate (e.g., tibial tubercle) |
| Arthroscopy | Surgical exploration of a joint using an arthroscope |
| Arthroplasty | Surgical reconstruction of a joint |
| Arthrotomy | Surgical incision into a joint; an “open” procedure |
| Deformation | Changes in limb, trunk, or head due to mechanical force |
| Dislocation | Displacement of bones at a joint |
| Disruption | Normally developing structure that is destroyed, removed, or stops developing |
| Equinus | Plantar flexion of the forefoot, hindfoot, or entire foot |
| Femoral anteversion | Increased angulation of the femoral head and neck with respect to the frontal plane |
| Malformation | Defect in development that occurs during fetal life (e.g., syndactyly) |
| Osteotomy | Surgical division of a bone |
| Pes cavus | High medial arch of the foot |
| Pes planus | Flat foot |
| Rotation, internal | Inward rotation (toward midline) |
| Rotation, external | Outward rotation (away from midline) |
| Subluxation | Incomplete loss of contact between two joint surfaces |
| Tibial torsion | Rotation of the tibia in an internal or external fashion |
| Valgus/valgum | Angulation of a bone or joint in which the apex is toward the midline (e.g., knock-knee) |
| Varus/varum | Angulation of a bone or joint in which the apex is away from the midline (e.g., bowlegs) |
Table 197.2
Mechanisms of Common PediatricOrthopedic Problems
| CATEGORY | MECHANISM | EXAMPLE(S) |
|---|---|---|
| CONGENITAL | ||
| Malformation | Teratogenesis <12 wk of gestation | Spina bifida |
| Disruption | Amniotic band constriction | Extremity amputation |
| Fetal varicella infection | Limb scar/atrophy | |
| Deformation | Neck compression | Torticollis |
| Dysplasia | Abnormal cell growth or metabolism |
|
| ACQUIRED | ||
| Infection | Pyogenic-hematogenous spread | Septic arthritis, osteomyelitis |
| Inflammation |
|
|
| Trauma | Mechanical forces, overuse | Child abuse, sports injuries, unintentional injury, fractures, dislocations, tendinitis |
| Tumor | Primary bone tumor | Osteosarcoma |
| Metastasis to bone from other site | Neuroblastoma | |
| Bone marrow tumor | Leukemia, lymphoma | |
Growth and Development
The ends of the long bones contain a much higher proportion of cartilage in the skeletally immature child than in an adult ( Figs. 197.1 and 197.2 ). The high cartilage content allows for a unique vulnerability to trauma and infection (particularly in the metaphysis).
The physis is responsible for the longitudinal growth of the long bones. Articular cartilage allows the ends of the bone to enlarge and accounts for growth of smaller bones, such as the tarsals. The periosteum provides for circumferential growth. Trauma, infection, nutritional deficiency (e.g., rickets), inborn errors of metabolism (e.g., mucopolysaccharidoses), and other disorders (e.g., renal tubular acidosis, hypothyroid) may affect each of the growth processes and produce distinct aberrations.
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