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LOCO > 22 - Bone and Joint Problems of Children > Flashcards

22 - Bone and Joint Problems of Children Flashcards

1
Q

How do children with a musculoskeletal problem usually present

A

With a limp

usually the lower limb

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2
Q

What usually causes problems with musculoskeletal in children

A

They are still growing
bones can bend
epiphyseal growth plates open

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3
Q

What does the fat pad develop into as an infant grown

A

Medial longitudinal arch

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4
Q

What is flat feet

A

when the medial longitudinal arch does not develop

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5
Q

What are the reasons for flat foot

A

Misshapen bones

Muscle imbalance - dorsiflexors are weak

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6
Q

How does a child with flat foot present

A

Ankles look like they are ‘weak’ as they turn inwards

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7
Q

Treatment for flat foot

A

Orthodics - insoles to reshape the growing bones

Surgery - to reshape bone

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8
Q

What can habitual toe walking lead to

A

Shortening of the muscles of plantar flexors

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9
Q

By what age to infants usually grow out of toe walking

A

Age 2

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10
Q

What can be a cause for persistant toe walking in older children

A

Cerebral palsy
DMD
NS problems

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11
Q

Treatment for toe walking

A 
Casting the foot + ankle for  6 weeks
to stretch the calf muscle
Physiotherapy 
Surgery 
(to stretch the tight plantarflexors)
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12
Q

What is club foot know as

A

Talipes equinovarus

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13
Q

What is the cause of club foot

A

Calf underdevelopment

Too much/too little amniotic fluid constraining the baby into that position in utero

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14
Q

What would happen to the infant if not treated for club foot

A

As the sole of the foot is inverted the child would walk on the side of their foot

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15
Q

What is club foot associated with

A

Breech position
Ehlers Danlos
Genetic syndromes ie edward’s

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16
Q

Treatment of club foot

A

Ponseti method - uses a cast to correct as bone is still mouldable

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17
Q

How long do you use the ponseti method for club foot

A

use the brace for 12 weeks

every night till 4 y/o

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18
Q

What can cause Congenital Hip Dysplasia

A

Breech postion

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19
Q

Sign of CHD in a baby

A

Extra creases as the head of the femur is not in the acetabulum - higher in the illiac crest

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20
Q

Clinical implication of CHD

A

Shortens the leg

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21
Q

What is the Galeazzi sign

A

Bend the knees to see which is shorter

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22
Q

Barlow test

A

Adduct and push down the baby to try and dislocate the hip

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23
Q

Ortolani test

A

Abduct hip to try relocate the hip

Push femur into acetabulum

24
Q

What would you see in an ultrasound of a baby with CHD

A

The gluteal muscles are pushed more vertically (look like they’re standing)

25
Q

Hilgenreiner’s line

A

horizontal line through top of the epiphyseal growth plate on each side of the pelvis

26
Q

Acetabular index line

A

Through the acetabulum on the ileum and measures the angle

27
Q

Perkin’s line

A

Vertical line from anterior inferior iliac spine downwards

can see the position of the femoral head relative to the acetabulum - it should cover

28
Q

Treatment of CHD

A

Reduction of the femoral head into acetabulum

Pavlik harness

29
Q

What is a pavlik harness

A

A harness used to immobilise a baby with CHD

It causes the hip to be flexed and abducted whilst still allowing movement

30
Q

How long is a baby in a pavlik harness after surgery

A

at least 6 weeks full time

6 weeks part time

31
Q

If pavlik harness doesnt work

A

Hip spica

fixed position of abduction and flexion

32
Q

What is Perthe’s disease

A

Self-limiting avascular necrosis of the femoral head

33
Q

How long does perthe’s disease last

A

18-24 months

34
Q

What happens to the femoral head in perthe’s disease

A

It loses it’s blood supply (necrosis) then regenerates

35
Q

Phases of perthe’s disease

A

1) Necrosis - femoral head dies, shape changes, pain
2) Fragmentation - dead cells absorbed + replaced
3) Reossification - Femoral head grows with new bone cells
4) Remodelling - New bone cells replaced by normal bone cells + remodelling

36
Q

Treatment of perthe’s disease

A

Observation, physiotherapy, bed rest
Plaster/casts
Surgery - osteotomy if older

37
Q

Age of incidence of Slipped Upper Femoral Epiphysis in males

A

13 years

stabilises in 4.5 months

38
Q

Age of incidence of Slipped Upper Femoral Epiphysis in females

A

11.5 years

stabilises in 3.6 months (less severe)

39
Q

What occurs in SUFE

A

The epiphysis is in place but the neck and shaft of the femur displaces

40
Q

Aetiology of SUFE

A

Obesity
Hypothyroidism
Trauma

41
Q

What action can you not do in SUFE

A

Internally rotate

42
Q

What is a pre-slip

A

Wide epiphyseal line

No slippage

43
Q

What is an Acute slip

A

slippage is sudden

44
Q

What is an acute-on-chronic slip

A

Slippage occurs on existing chronic slip

45
Q

What is a chronic slip

A

Most common

steady progressive slippage

46
Q

What changes occur to the chondrocytes in the layers of the growth plate is SUFE

A

Hypertrophic zone is 80% instead of 15-30%

47
Q

Treatment for SUFE

A

Rest
Analgesia
Surgery - closure of the epiphyseal growth plate
(Need to bilaterally fix as the other side will still grow)

48
Q

What is blout’s disease

A

Squashing of the epiphyseal growth plate

The medial part of the proximal tibia fails to develop normally

49
Q

Where are the problems of blout’s disease

A

Proximal part of the tibia

Medial compartment as weight bearing

50
Q

What deformity does bout’s disease cause

A

Tibial varus

Bow legs

51
Q

Treatment for Bout’s disease

A

Brace

Surgery - if early onset or brace fails

52
Q

What is osgood schlatter’s

A

inflammation of the patellar ligament at the tibial tuberosity. It is characterized by a painful bump just below the knee that is worse with activity and better with rest.

53
Q

What is osteochondrosis

A

Disturbance of endochondral ossification

54
Q

How long before symptoms of osgood schlatters dissapear

A

About 1 year

55
Q

Most likely cause of osgood shlatter’s

A

Repeated traction from the patellar ligament on the tibial tuberosity

LOCO (25 decks)

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