ORPEDIC NURSE CERTIFICATION: AN A+ QUESTIONS AND
ANSWERS PLAYBOOK
Hammer and Claw Toes
-Hammer toe is a deformity of PIP joint on 2nd to 5th toes causing toe to be permanently bent,
resembling a hammer
-Claw toe is a similar deformity with dorsiflexion of the proximal phalanx on the MTP joint
combined with flexion of both PIP and DIP joints.
-Complaints include burning on bottom of foot and pain and difficulty walking when wearing
shoes
-Conservative treatment includes passive manual stretching of PIP joint and use of metatarsal
arch support.
-Surgical correction consists of resection of base of middle phalanx and head of proximal
phalanx, bringing raw bone ends together
-Kirschner wire maintains straight position
Morton's Neuroma
-Neuroma in web space between 3rd and 4th metatarsal heads, causing sharp, sudden attacks
of pain and burning sensations
-Tx: surgical excision
Gower's sign
Difficulty rising to standing position; has to walk up legs using hands; occurs in Muscular
dystrophy
Cerebral Palsy
-A loss or deficiency of motor control with involuntary spasms caused by permanent brain
damage present at birth
-TX: Physical therapy, Speech therapy, assistive devices, muscle relaxers for muscle spasms
Developmental dysplasia of the hip (DDH)
-S/S: asymmetrical gluteal and thigh folds. limited abduction of hips. Barlow and ortolani tests
given. Trendelenburg sign used in toddler. complaint of clicking sound with diaper changes
-Tx: Closed reduction. Pavlik harness used in newborns. Closed reduction with anesthesia if
harness unsuccessful followed by cast. If diagnosed beyond two years old then open surgical
reduction followed by placement of body Spica cast
Ortolani's sign
-TESTING: congenital dislocation of hip of infant
-POSITION: (supine) flex infant's hips and grasp legs so thumbs are against the insides of the
, knees and thighs and the fingers are placed along the outsides of the thighs to the buttocks;
thighs are abducted and pressure is applied against the greater trochanters; resistance will
begin to be felt to abduction and lateral rotation at approximately 30- 40 deg
(+) TEST: feel a "click" or "jerk"
***only valid for the first few weeks after birth
Barlow's sign
w/ baby supine the hips and knees are flexed, with the thumb on the lesser trochanter in the
grown and the middle finger of the same hand on the greater trochanter laterally, gently apply
pressure down on the knee while simultaneously applying lateral pressure with the thumb
the dislocatable hip becomes displaced with a palpable clunk as the head slips over the
posterior aspect of the acetabulum; this is a provocative test which actively dislocates an
unstable hip
Pes Cavus
-Abnormally high arch of the foot
-"Clawfoot"
-May indicate a neuromuscular disorder, muscle spasm, spinal etiology
-Tx: orthotics and arch supports, possible surgery
Congenital Torticollis
characterized by a unilateral contracture of the sternocleidomastoid muscle. causative factors
include malposition in utero, breech position and birth trauma. usually dx'd within first three
weeks of life. lateral flexion to same side as contracture, rotation toward opposite side.
treatment conservative for the first year with emphasis on stretching, active ROM, position and
caregiver education. possible surgery.
Pigeon Toe
-A condition which causes the toes to point inward when walking
-Under the age of 2 self limiting
-Age 3 and above need surgery
talipes equinovarus
-(clubfoot) congenital deformity of the foot in which it is plantar flexed and inverted
-Neuromuscular disease and hip dysplasia
-Tx: manual manipulation followed by splinting or casting. prognosis good with early treatment
Bowlegs
ANSWERS PLAYBOOK
Hammer and Claw Toes
-Hammer toe is a deformity of PIP joint on 2nd to 5th toes causing toe to be permanently bent,
resembling a hammer
-Claw toe is a similar deformity with dorsiflexion of the proximal phalanx on the MTP joint
combined with flexion of both PIP and DIP joints.
-Complaints include burning on bottom of foot and pain and difficulty walking when wearing
shoes
-Conservative treatment includes passive manual stretching of PIP joint and use of metatarsal
arch support.
-Surgical correction consists of resection of base of middle phalanx and head of proximal
phalanx, bringing raw bone ends together
-Kirschner wire maintains straight position
Morton's Neuroma
-Neuroma in web space between 3rd and 4th metatarsal heads, causing sharp, sudden attacks
of pain and burning sensations
-Tx: surgical excision
Gower's sign
Difficulty rising to standing position; has to walk up legs using hands; occurs in Muscular
dystrophy
Cerebral Palsy
-A loss or deficiency of motor control with involuntary spasms caused by permanent brain
damage present at birth
-TX: Physical therapy, Speech therapy, assistive devices, muscle relaxers for muscle spasms
Developmental dysplasia of the hip (DDH)
-S/S: asymmetrical gluteal and thigh folds. limited abduction of hips. Barlow and ortolani tests
given. Trendelenburg sign used in toddler. complaint of clicking sound with diaper changes
-Tx: Closed reduction. Pavlik harness used in newborns. Closed reduction with anesthesia if
harness unsuccessful followed by cast. If diagnosed beyond two years old then open surgical
reduction followed by placement of body Spica cast
Ortolani's sign
-TESTING: congenital dislocation of hip of infant
-POSITION: (supine) flex infant's hips and grasp legs so thumbs are against the insides of the
, knees and thighs and the fingers are placed along the outsides of the thighs to the buttocks;
thighs are abducted and pressure is applied against the greater trochanters; resistance will
begin to be felt to abduction and lateral rotation at approximately 30- 40 deg
(+) TEST: feel a "click" or "jerk"
***only valid for the first few weeks after birth
Barlow's sign
w/ baby supine the hips and knees are flexed, with the thumb on the lesser trochanter in the
grown and the middle finger of the same hand on the greater trochanter laterally, gently apply
pressure down on the knee while simultaneously applying lateral pressure with the thumb
the dislocatable hip becomes displaced with a palpable clunk as the head slips over the
posterior aspect of the acetabulum; this is a provocative test which actively dislocates an
unstable hip
Pes Cavus
-Abnormally high arch of the foot
-"Clawfoot"
-May indicate a neuromuscular disorder, muscle spasm, spinal etiology
-Tx: orthotics and arch supports, possible surgery
Congenital Torticollis
characterized by a unilateral contracture of the sternocleidomastoid muscle. causative factors
include malposition in utero, breech position and birth trauma. usually dx'd within first three
weeks of life. lateral flexion to same side as contracture, rotation toward opposite side.
treatment conservative for the first year with emphasis on stretching, active ROM, position and
caregiver education. possible surgery.
Pigeon Toe
-A condition which causes the toes to point inward when walking
-Under the age of 2 self limiting
-Age 3 and above need surgery
talipes equinovarus
-(clubfoot) congenital deformity of the foot in which it is plantar flexed and inverted
-Neuromuscular disease and hip dysplasia
-Tx: manual manipulation followed by splinting or casting. prognosis good with early treatment
Bowlegs
