22 - Bone and Joint Problems of Children Flashcards
How do children with a musculoskeletal problem usually present
With a limp
usually the lower limb
What usually causes problems with musculoskeletal in children
They are still growing
bones can bend
epiphyseal growth plates open
What does the fat pad develop into as an infant grown
Medial longitudinal arch
What is flat feet
when the medial longitudinal arch does not develop
What are the reasons for flat foot
Misshapen bones
Muscle imbalance - dorsiflexors are weak
How does a child with flat foot present
Ankles look like they are ‘weak’ as they turn inwards
Treatment for flat foot
Orthodics - insoles to reshape the growing bones
Surgery - to reshape bone
What can habitual toe walking lead to
Shortening of the muscles of plantar flexors
By what age to infants usually grow out of toe walking
Age 2
What can be a cause for persistant toe walking in older children
Cerebral palsy
DMD
NS problems
Treatment for toe walking
Casting the foot + ankle for 6 weeks to stretch the calf muscle Physiotherapy Surgery (to stretch the tight plantarflexors)
What is club foot know as
Talipes equinovarus
What is the cause of club foot
Calf underdevelopment
Too much/too little amniotic fluid constraining the baby into that position in utero
What would happen to the infant if not treated for club foot
As the sole of the foot is inverted the child would walk on the side of their foot
What is club foot associated with
Breech position
Ehlers Danlos
Genetic syndromes ie edward’s
Treatment of club foot
Ponseti method - uses a cast to correct as bone is still mouldable
How long do you use the ponseti method for club foot
use the brace for 12 weeks
every night till 4 y/o
What can cause Congenital Hip Dysplasia
Breech postion
Sign of CHD in a baby
Extra creases as the head of the femur is not in the acetabulum - higher in the illiac crest
Clinical implication of CHD
Shortens the leg
What is the Galeazzi sign
Bend the knees to see which is shorter
Barlow test
Adduct and push down the baby to try and dislocate the hip
Ortolani test
Abduct hip to try relocate the hip
Push femur into acetabulum
What would you see in an ultrasound of a baby with CHD
The gluteal muscles are pushed more vertically (look like they’re standing)
Hilgenreiner’s line
horizontal line through top of the epiphyseal growth plate on each side of the pelvis
Acetabular index line
Through the acetabulum on the ileum and measures the angle
Perkin’s line
Vertical line from anterior inferior iliac spine downwards
can see the position of the femoral head relative to the acetabulum - it should cover
Treatment of CHD
Reduction of the femoral head into acetabulum
Pavlik harness
What is a pavlik harness
A harness used to immobilise a baby with CHD
It causes the hip to be flexed and abducted whilst still allowing movement
How long is a baby in a pavlik harness after surgery
at least 6 weeks full time
6 weeks part time
If pavlik harness doesnt work
Hip spica
fixed position of abduction and flexion
What is Perthe’s disease
Self-limiting avascular necrosis of the femoral head
How long does perthe’s disease last
18-24 months
What happens to the femoral head in perthe’s disease
It loses it’s blood supply (necrosis) then regenerates
Phases of perthe’s disease
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
Treatment of perthe’s disease
Observation, physiotherapy, bed rest
Plaster/casts
Surgery - osteotomy if older
Age of incidence of Slipped Upper Femoral Epiphysis in males
13 years
stabilises in 4.5 months
Age of incidence of Slipped Upper Femoral Epiphysis in females
11.5 years
stabilises in 3.6 months (less severe)
What occurs in SUFE
The epiphysis is in place but the neck and shaft of the femur displaces
Aetiology of SUFE
Obesity
Hypothyroidism
Trauma
What action can you not do in SUFE
Internally rotate
What is a pre-slip
Wide epiphyseal line
No slippage
What is an Acute slip
slippage is sudden
What is an acute-on-chronic slip
Slippage occurs on existing chronic slip
What is a chronic slip
Most common
steady progressive slippage
What changes occur to the chondrocytes in the layers of the growth plate is SUFE
Hypertrophic zone is 80% instead of 15-30%
Treatment for SUFE
Rest
Analgesia
Surgery - closure of the epiphyseal growth plate
(Need to bilaterally fix as the other side will still grow)
What is blout’s disease
Squashing of the epiphyseal growth plate
The medial part of the proximal tibia fails to develop normally
Where are the problems of blout’s disease
Proximal part of the tibia
Medial compartment as weight bearing
What deformity does bout’s disease cause
Tibial varus
Bow legs
Treatment for Bout’s disease
Brace
Surgery - if early onset or brace fails
What is osgood schlatter’s
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.
What is osteochondrosis
Disturbance of endochondral ossification
How long before symptoms of osgood schlatters dissapear
About 1 year
Most likely cause of osgood shlatter’s
Repeated traction from the patellar ligament on the tibial tuberosity
