Orthopedics Can you kick it? Nurse Practitioner Review

Orthopedic Crash Course for Nurse Practitioners. Review for boards and wards! ANCC and AANP high yield topics by dual boarded, seasoned faculty Jennifer Klimek Yingling

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This was really refreshing. I like how the x-rays and pictures were incorporated. I am a visual learner that really helped

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Important to note with "in-toeing" or metatarsus adductus children usually outgrow. Surgical correction is usually not considered before age 8yrs.

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According to the AAFP: The role of ultrasonography is controversial, but it generally is used to confirm diagnosis and assess hip development once treatment is initiated. Bracing is first-line treatment in children younger than six months

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AAP: When an imaging study is indicated, whether by risk factors or by suspicious physical examination, it is best to defer diagnostic hip ultrasound until age 6 weeks (adjust for prematurity) or plain anteroposterior pelvis radiograph at ages 4-6 months. Ultrasonography may be done earlier in guiding treatment of an Ortolani-positive hip. Initial diagnostic ultrasound usually is deferred until after age 6 weeks because of the high rate of false positives or immature hips, which spontaneously resolve most often by age 6 weeks.
In using imaging for assessment of babies with one or more risk factors but negative physical exam, there is NO PROVEN benefit to ultrasound at 6 weeks vs. radiograph at 4-6 months; the report recommends choosing based on local conditions and availability of experienced, trained pediatric hip sonographers.

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SCFE while often due to rapid growth in puberty, it CAN be seen with minor trauma or fall. Other important distinct features "ice cream scoop" on x-ray. May be seen in obese patients. Pain worse with activity. External rotation of leg is more comforting position at rest.
As stated by Orthopedic Associations "SCFE usually develops during periods of rapid growth, shortly after the onset of puberty. This most commonly occurs between the ages of 12 and 16 in boys, and the ages of 10 and 14 in girls.SCFE may occur suddenly after a minor fall or trauma."