Bone and joint problems in children Flashcards
When are flat and club foot present
At birth
When is Perthe’s disease seen
4-8
When is SUFE seen
11-16
When is toe walking seen
When child starts walking
Why are children prone to musculoskeletal
Skeleton softer, growing, epiphyseal growth plates can slip
Are musculoskeletal conditions seen more in girls or boys
Boys (growth spurts mean bone and cartilage growth isn’t matched)
Do childrens musculoskeletal problems more commonly affect upper or lower limb
Lower
Why may arch not fully develop in the foot
- Mishapen bones can’t form arch
- Muscle imbalance (weak dorsiflexors so arch collapses)
How may flat foot be tended
Surgery to tighten tendons/ ligaments
Orthotics to mould the foot into more normal shape
By what age should toe walking disappear
Age 2
What are the consequences of habitual toe walking
Shortened plantar flexors
What may persistent toe walking be linked to in older children
Cerebral palsy
Nervous system problems
DMD
How may toe walking to treated?
- Put child in braces to cast foot and ankle to stretch out calf muscles
- Physiotherapy
What is the clinical name for club foot
Talipes equinovarus (looks like a horses hoof and points inwards)
How many babies are born with club foot
1 in 1000
Why is club foot thought to happen
Wrong amount of amniotic fluid, so baby can’t move legs and feet are constrained
What presentation in club foot associated with
Breech (baby can’t turn)
How is club foot treated
Ponseti method: manipulative technique to correct clubfoot without invasive surgery
Which sex is congenital hip dysplasia seen in
Female
What skeletal disorders is congenital hip dysplasia seen in
Clubfoot
Scoliosis
What is the Galeazzi sign
Look at the height of the knee- one will be shorter if hip is dislocated
Only works if unilateral
What is the Barlow test
Adduct and push downwards to try and dislocate hip
Diagnostic of ddh
What is the ortolani test
Abduct hips to try and relocate the hip
Fingers push femur forward into acetabulum
How is ultrasound used to interpret developmental dysplasia of the hip
Measure the alpha angle
It should be less than 60
What diagnostic lines can you see on an x-ray
- See where the femoral head is relative to the acetabulum
- Perkins line- vertical line from anterior inferior iliac spine down. Allows to see position of head relative to acetabulum. 2/3 of head should be medial to this line
How is congenital dysplasia of hip treated
- Closed reduction and immobolisation
What can result is CHD is not treated properly
Femoral nerve compressed
Avascular necrosis
What position does spica cast hold legs in
Flexion and abduction
What is Perthes disease
Self limiting avascular necrosis of the femoral head
How long does Perthes disease last for
18-24 months
Name 4 stages of Perthes disease
Necrosis
Fragmentation
Reossification
Remodelling
How do you treat Perthes disease
- Support femoral head/ hip
- Bed rest
- ## Cast/ braces
What does SUFE stand for
Slipped upper femoral epiphysis
Actual neck of shaft displaces- epiphysis stays where it is
What ages is SUFE most common in
10-17 years
Which hip is more commonly affect ed by SUFE
Left
Aeitology of SUFE
Obesity
Hypothyroidism
Trauma
How does SUFE appear
Femoral head ‘fallen’
Epiphysis looks wider and wrinkly
What is acute on chronic SUFE
Slippage occurs acutely on existing chronic slip
How to treat SUFE
Rest
Analgesia
Surgery to close epiphyseal growth plate
What is Blounts disease
Growth problem of distal tibia causing bow legs
What is osgood-schlatters
Disturbance of endochondral ossification
What is the most common cause of knee pain in children
Osgood- Schlatters
Most likely cause of Osgood- Schlatters
repeated traction from patellar ligament
