22. Paediatric orthopedics (Robson) Flashcards
Flat foot is often described by parents as their child having what?
Weak ankles
Flat foot - ankles turn inward or outward?
Inward
Flat food - what arch of the foot is missing?
Medial longitudinal arch
Two causes of flat food?
Muscle imbalance - need physiotherapy
Incorrect shape of the tarsal bones - need shaving
Habitual toe walking normally disappears at what age?
Two
Three conditions linked to persistent toe walking?
Cerebral palsy
Duchene muscular dystrophy
Other nervous system problems
Toe walking can cause a problem in which muscle group?
Planterflexors - hypotonic
Treatment for toe walking? x2
Casting foot and ankle for six weeks to stretch the calf muscle
Surgery to release tight calf muscles
Club foot is also known as?
Talipes equinovarus
Club foot is more common in males or females?
Males
Five risk factors for club foot
Breech presentation Connective tissue disorders Oligohydramnios Edwards syndrome - trisomy 18 Family history
Treatment for club foot is?
Ponsetti method
Why is the ponsetti method successful?
Baby still has woven bone - can manipulate this
How long does the ponsetti method take?
Period of five weeks
Congenital hip dysplasia is more common in males or females?
Females
Risk factor for CHD? x2
Breech presentation
Scoliosis
Hormone that may be involved in the development of CHD is?
Relaxin
How will a baby with CHD present? x2
Extra crease around the hip joint at the gluteal aspect when in crawl position
Shorter and externally rotated leg
Two tests to diagnose CHD?
Barlow test
Ortolani test
What is the Barlow test?
Brings legs from abduction to adduction and push down to see femoral head slip from acetabulum
What is the Ortolani test?
Bring legs from adduction out to abduction to see movement of the femoral head
What is the Galeazzi sign in CHD diagnosis?
Flex both the knees - leg length discrepancy
Why can x-rays not be used to diagnose CHD?
Femoral head is not ossified until about three months SO cannot see it on an x-ray
What is used to image CHD?
Ultrasound
Treatment for CHD?
Pavlick harness
Relation of head of the femur to Perkin’s line?
Head of the femur should be medial to perkins line
Relevance of Perkin’s line to CHD?
If the head of the femur is lateral to Perkin’s line - CHD
Two potential adverse effects of the Pavlick harness?
Avascular necrosis
Femoral nerve palsies - temporary
Indication for use of the pavlick manouvre?
Child less than 6 months old
Treatment of CHD over 6 months old?
Surgery - open reduction
Untreated CHD will present as?
Horizontal neck of femur - shortened leg with limited movement
What is Perthes’ disease?
Self-limiting avascular necrosis fo the femoral head
Artery involved in Perthes’ disease?
Acetabular branch of the obturator artery
Four stages of Perthe’s disease?
Necrosis
Fragmentation
Reossification
Remodelling
Non-surgical treatment for Perthes’ disease? x3
Swimming/cycling to build surrounding muscles
Bed rest
Plaster cast/brace
Surgical treatment for Perthes’ disease and indication for use
Osteotomy
Older children
Purpose of plaster cast/brace in Perthes’ disease treatment?
Want to keep the femoral head inside the acetabulum
What form of exercise is not recommended for an individual with Perthes’ disease?
Running
Slipped upper femoral epiphysis SUFE more common in male or female?
Male
Which hip is most commonly affected in SUFE?
Left
What is SUFE?
Slippage of the epiphyseal growth plate
Four risk factors for the development of SUFE?
Obesity
Hypothyroidism
Increased/decreased androgens
Trauma
What movement cannot be performed at the hip in someone with SUFE?
Cannot perform internal rotation
Between what years does SUFE tend to occur?
10-17
What line is drawn to diagnose SUFE?
Klein’s line - superior portion of femoral neck
Relevance of Klein’s line to diagnose SUFE?
Klein’s line should cross at least some portion of femoral head
Three treatments for SUFE
Rest
Analgesia
Surgery
What is Blount’s disease?
Compression of the growth plate of the knee
Presentation of Blount’s disease?
Bow legs
What is Osgood-Schlatters disease?
Endochondral ossification disturbance fo the knee - self limiting
Common cause of Osgood-Schlatters?
Underdevelopment of quads
Drugs given for treatment of Osgood-Schlatters?
NSAIDs
What is the acetabular angle?
Angle between Hilgenreiner’s line and acetabular index line?
Acetabular angle between 0-1 years?
<34
Acetabular angle between 1-4 years?
<28
Acetabular angle >4 years?
<25
