Well Child: Onset of Joint Disorders
– Trauma – Toxic Synovitis – Reflex neurovascular dystrophy – Hemophilia – Slipped Capital Femoral Epiphysis – Pigmented Villonodular Synovitis
Nerves
Wallerian Degeneration
– Discussion: – arises from severe nerve injury (axonotmesis or neurotmesis) – characterized by axonal enlargement into an amorphorous mass, breakdown of the axons, and schwann cell ingestion of fragmented myelin to provide clean endoneural tubes for advancement of regenerating axons; – axonal sprouting … Read more
Volkmann’s contracture
– See: Compartment Syndrome – Discussion: – type of forearm ischemic contracture resulting from brachial artery injury usually associated w/ supracondylar frx of humerus; – may see loss of motor & sensory function, however, classic involvment is w/ anterior interosseous branch of median nerve; – pathology: … Read more
Waddel Criteria
– Discussion: – Waddel determined 5 findings on PE which correlated w/ non organic LBP known as the 5 Waddell criteria; – he noted that most patients w/ documented organic LBP had one or none of Waddell criteria, and that patients who had 3/5 Waddell criteria were much more likely have non organic LBP; … Read more
Vastus Medialis
– See quadriceps muscle; Origin: Lower 1/2 of the intertrochanteric lines, medial lip of linea aspera, upper part of medial supracondylar line, medial intermuscular septum tendons of adductor magnus and adductor longus; Insertion: Medial border of the patella by the ligamentum patella into the tibia tuberosity; Action: Extends the leg at the knee … Read more
Veins of the Lower Extremity
– See: Venous Repair – Discussion: – veins accompany the arteries of the lower limb, and those that parallel the large arteries of leg are paired; – five major venous structures of leg are greater and lesser saphenous veins, posterior & anterior tibial veins, & peroneal veins; – Greater Saphenous Vein: … Read more
Vastus Intermedius
– See Quads Origin: Proximal 2/3 of the anterolateral surface of the femur, lower 1/2 of the linea aspera, upper part of the lateral supracondylar line; Lateral intermuscular septum; Insertion: By tendons of the rectus and vastus muscles into the superior border of the patella and by the ligamentum patella into the … Read more
Vastus Lateralis
– See Quads Origin: upper part of intertrochanteric line, anterior and lower borders of greater trochanter, lateral lip of gluteal tuberosity, upper half of linea aspera, lateral intermuscular septum, and tendon of the gluteus maximus; Insertion: lateral border of the patella by the ligamentum patella into tibia tubercle; Action: extends the … Read more
Vascular Injuries in Supracondylar Frx
– Discussion: – vascular compromise occurs in about 5-20% of children w/ supracondylar frx; – less than 1% will be complicated by compartment syndrome and the resulting sequelae of Volkmann’s contracture; – note that a median nerve palsy, may mask a pending compartment syndrome (because there … Read more
V-Y Local Advancement Flaps
– See: – Nail Bed Injuries – Finger Tip Injuries: – Discussion: – may be used for finger tip amputations which have more dorsal soft tissue loss than palmar loss); – advancement flaps from same finger provide advantage of rapid healing, limited morbidity, and critical sensibility … Read more