Excoriations can become secondarily infected with skin bacteria, usually Staphylococcus and Streptococcus. The body louse functions as a vector for potentially serious infectious diseases, including epidemic typhus, caused by Rickettsia prowazekii; louse-borne relapsing fever, caused by Borrelia recurrentis; and trench fever, caused by Bartonella quintana.These louse-borne infections are rare in the United States. In contrast to body lice, head lice and pubic lice are not associated with transmission of other infections.
Eichenfield LE, Esterly NB, Frieden IJ: Textbook of Neonatal Dermatology, ed 2, Philadelphia, 2008, Saunders
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Yan AC, Baldwin HE, Eichenfield LF, et al: Approach to pediatric acne treat ment: an update, Semin Cutan Med Surg 30:S16–S21, 2011
Kevin D. Walter and J. Channing Tassone 26
To care for the pediatric patient, one must understand the growth and development of the musculoskeletal system as well as common orthopedic terms (Table 197-1). Practitioners
Bone growth center that has a muscular insertion but is not considered a growth plate (example: 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 Equinus Plantar flexion of the forefoot, hindfoot, or entire foot Femoral Increased angulation of the femoral head and neck anteversion with respect to the frontal plane Malformation Defect in development that occurs during fetal life (example: syndactyly) Osteotomy Surgical division of a bone Pes cavus High medial arch of the foot Pes planus Flat foot Rotation, Inward rotation (toward midline)
Rotation, Outward rotation (away from midline) external Subluxation Incomplete loss of contact between two joint surfaces Tibial torsion Rotation of the tibia in an internal or external fashion Valgus/ Angulation of a bone or joint in which the apex is valgum toward the midline (example: knock-knee) Varus/varum Angulation of a bone or joint in which the apex is away from the midline (example: bowlegs) should recognize common mechanisms for congenital and acquired orthopedic disorders (Table 197-2).
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 thelong bones. Articular cartilage allows the ends of the bone toenlarge and accounts for growth of smaller bones, such as thetarsals. The periosteum can provide circumferential growth.Trauma, infection, nutritional deficiency (rickets), inborn errors of metabolism (mucopolysaccharidoses), and other metabolic disorders (renal tubular acidosis, hypothyroid) may affecteach of the growth processes and produce distinct aberrations.