Bone And Joint Problems Of Childhood Flashcards
Common MSK problems of childhood
Flat foot
Club foot
Toe walking
CDH
Perthe’s
SUFE
blounts
Osgood schlatter
Why are babies born with flat feet
Fat pad in medial arch
Arch develops as fat pad used for growth
What condition is suggested by parents describing a child as having ‘weak ankles’
Flat foot
In children with flat foot does the ankle appear to turn inwards or outwards
Inwards
What causes the arch to not develop in flat foot
Muscle imbalance
Abnormal shaped tarsals
Treatment of flat foot
Usually doesn’t require treatment
Orthotics
Surgery
At what age does toe walking disappear in most children
2yrs
What conditions can lead to toe walking in children over 2
Cerebral palsy
Duchenne muscular dystrophy
Nervous system problems
Toe walking treatment
Casting foot and ankle - stretch calf muscles
Physiotherapy
Surgery - release tight calf muscles
How long is the foot and ankle kept in a cast to treat toe walking
~6wks
What is talipes equinovarus more commonly known as
Club foot
Which 2 fixed deformities make up club foot/talipes equinovarus
Varus
Equinus
Which muscles are underdeveloped in club foot
Calf muscles
Is club foot usually bilateral or unilateral
50:50
What other conditions is club foot associated with
Breech presentation
Connective tissue disorders
Oligohydramnios
Edwards syndrome + other genetic conditions
Family history
Club foot treatment
Poseti method - manipulative technique using a sequence of casts and braces around foot to return foot and knee to normal position
When does congenital hip dysplasia form
Present at birth
Congenital hip dysplasia risk factors
Female
Breech delivery
Family history
Oligohydramnios
1st born
Other skeletal disorders
What condition is suggested by a ‘double crease’ on an infants leg/hip
Congenital hip dysplasia
What is the most common outcome in untreated congenital hip dysplasia
Spontaneously resolves in 2-8wks
3 tests used to diagnose congenital hip dysplasia
Barlow test
Ortolani test
Galeazzi sign
Barlow test
Adducting the hip and pushing down while palpating for the head falling out the back of the acetabulum
Ortolani test
Hip abducted to try and relocate hip, hip popping back into acetabulum felt
Galeazzi sign
Knees not level when infant lying down with knees fully flexed
why is ultrasound more useful for assessing congenital hip dysplasia than x ray
Femoral head not ossified until 4-6months
What angle is used to grade congenital hip dysplasia
Alpha angle
Alpha angle
Angle between line of iliac margin and line of joint inclination
Normal alpha angle
> 60*
What alpha angles show grade I, grade IIa/b, grade IIc, and grade III/IV congenital hip dysplasia
I - >60* - normal
IIa/b - 50-59*
IIc - 43-49*
IIIa/b / IV - <43
What line goes between the inferior aspects of both triradate cartilages of the acetabulums, through the epiphyseal growth plates
Hilgenreiner line
Perkins line
line drawn perpendicular to Hilgenreiner line, intersecting the lateral most aspect of the acetabular roof
What does the acetabular index line measure
Acetabular inclination
What 3 lines are used in radio graphical assessment of congenital hip dysplasia
Hilgenreiners line - horizontal
Perkins line - vertical
Acetabular index line - diagonal
Congenital hip dysplasia treatment
Pavlik harness - closed reduction and immobilisation
Closed reduction with Hip spica - Pavlik not working or child 6months+
Open reduction - femoral Osteotomy - child 18mo+
Why does a Pavlik harness hold the hip flexed and abducted, and how long is it worn for
Deepest insertion of femoral head into acetabulum
At least 6wks full time then 6 weeks part time
How long is a hip spica used for closed reduction on congenital hip dysplasia
12 weeks
What does untreated congenital hip dysplasia lead to
Leg length discrepency
Perthes disease
Self limiting avascular necrosis of the femoral head
What age and gender does perthes disease usually affect
4-8yrs
Male
What causes perthes disease
Blood vessels to femoral head shut down
Why does perthes disease cause widening of the femoral neck
Femoral neck gets all blood supply for head of femur
4 stages of perthes disease
Necrosis - portion of femoral head dies
Fragmentation - dead bone cells absorbed and replaced producing varied femoral head shapes
Reossification - new bone cells
Remodelling - new bone cells replaced by normal bone cells
Which stage of perthes disease causes pain, stiffness, and inflammation
Necrosis
Perthes disease treatment
Under 5/mild - observation, physio, bed rest, cast/brace abduction
Older - Osteotomy surgery
What does SUFE stand for
Slipped upper femoral epiphysis
How does SUFE age of onset and severity vary between sexes
Boys - more common + 13yrs + less severe + lasts 4.5 months
Girls - 11.5yrs + more severe + lasts 3.6 months
SUFE age range
10-17 yrs
Which part of the femur moves in SUFE
Neck and shaft of femur
How does the epiphysis move in relation to the femur in SUFE
posteriorly and medially
Appears like head is falling off neck+shaft
What leads to SUFE
Salter Harris type 1 fracture
Obesity
Hypothyroidism
Decr/incr androgens -> adolescent growth spurt
Trauma
4 types of SUFE
pre slip - wide epiphyseal line no slippage
Acute - sudden slippage
Acute on chronic - slippage acutely on existing chronic slip
Chronic - steady progressive slippage
SUFE treatment
Rest
Analgesia
Surgical closure of epiphyseal growth plate
Corrective Osteotomy
Blount’s disease
Growth disorder of the proximal tibia causing tibia Varus (bowed tibia) and knees bowing outwards
What is thought to cause blounts disease
Effect of weight on epiphyseal growth plate and medial part of proximal tibia develops abnormally
Age ranges of infantile juvenile and adolescent blounts disease
I 1-3yrs
J 4-10yrs
A 10+yrs
Blounts disease risk factors
Obesity
Walking early
Genetic factors
Blounts disease treatment
Brace
Osteotomy
Gradual distraction
Osgood schlatters disease
Self limiting Overuse syndrome causing Osteochondrosis of tibial tubercle in young athletic population
How long does Osgood schlatters disease last
~1yr
Most common causes of Osgood schlatters
Repeated traction from patellar ligament on tibial tuberosity
Avulsion fracture to part of tibial tuberosity
Osgood schlatters signs and symptoms
Pain tenderness and swelling at point of insertion of patellar ligament
Osgood schlatter treatment
Rest
Avoidance of activities that cause pain
NSAIDs
Strapping and bracing to support knee
