29: Paediatric Orthopaedics - Complex needs, CTEV and Scoliosis Flashcards
what do we mean by complex needs?
A child with multiple and complex disabilities has at least two different types of severe or profound impairment such that no professional, agency or discipline has a monopoly in the assessment and management.
A child or young person (< 19) is defined as having complex exceptional needs (CEN) if:
- severe impairment in at least 4 categories (learning and mental function, communication, motor skills, self-care, hearing or vision) together with enteral/parenteral feeding OR
- severe impairment in at least 2 categories and ventilation/CPAP AND
- impairments are sustained for more than 6 months and ongoing
what is cerebral palsy (CP)?
- CP refers to a group of permanent, non-progressive movement disorders that appear in early childhood.
- This condition occurs due to damage to a child’s CNS, particularly areas involving motor control.
CP causes
Antenatal/intrapartum and postnatal causes
Antenatal/Intrapartum causes:
- hypoxic-ischaemic encephalopathy
- infection
Postnatal causes:
- meningitis
- trauma
- haemorrhage
- medication toxicity
- Kernicterus (bilirubin induced encephalopathy)
- A portion of CP cases remain idiopathic.
what are the different categories of motor disorders in CP?
- spastic (pyramidal system, motor cortex)
- athetoid (extrapyramidal system, basal ganglia)
- ataxia (cerebellum and brainstem)
- mixed (combo of spasticity and athetosis)
describe the stages of the gross motor function classification system (GMFCS) used in CP
- level 1: walks without limitations
- level 2: walks with limitations
- level 3: walks using a hand-held mobility device
- level 4: self-mobility with limitations, may use powered mobility
- level 5: transported in a manual wheelchair
The higher the GMFCS level, the higher the risk of what in CP patients?
hip dislocation
CP management
Multi-disciplinary team:
- physio
- occupational therapy
- speeck and language therapy for swallowing assessments
- dieticians
Medical management:
- baclofen and diazepamused to manage muscle spasms
- botox injections may help with contractures
Surgical management:
- orthopaedic surgery for MSK deformities, injuries or tendon releases
- general surgery may be neccessary for example for fitting a PEG tube
what is the most common congenital deformity?
congenital talipes equinovarus (club feet)
list some traditional treatment options for club feet
- strapping, positional talipes only
- serial casting
- Dennis Browne boots
- surgery: postero-medial release, percutaneous tenotomy of achilles tendon (90% will need this)
- llizarov frame
what degree of scoliosis is clinically significant?
> 10 degree deviation
describe the difference between non-structural vs structural scoliosis
- non-structural = due to an extrinsic cause e.g. a leg length discrepany, a hip problem etc. Resolves when causal factor is addressed.
- Structural scoliosis = abnormal rotation of the vertebrae and is an intrinsic spinal problem. Has a propensity to progress.
what factors determine whether scoliosis has a high risk of progressions?
- premenarchal
- < 12 y/o at presentation
- size of curve at presentation
how do you classify scoliosis by aetiology?
- congenital (abnormalities of vertebrae formation)
- idiopathic
- neuromuscular
- others: post-trauma, degenerative, infective, syndrome etc.
