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Locomotor > Bones & Joints: paediatrics > Flashcards

Bones & Joints: paediatrics Flashcards

1
Q

When does the head control milestone usually begin and be complete?

A
  • 1 month

- 3 months

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2
Q

When does the sit milestone usually begin and be complete?

A
  • 6 months

- 9 months

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3
Q

When does the stand milestone usually begin and be complete?

A
  • 9 months

- 12 months

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4
Q

When does the walk milestone usually begin and be complete?

A
  • 12 months

- 20 months

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5
Q

What are the deformities children may have?

A 
Angular plane/ coronal:
-Bow legs
-Knock knees
Rotational plane:
-In/out toeing
=Femoral Torsion
=Tibial Torsion
=In the Foot
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6
Q

What are the names for bow legs and knock knees?

A

Genu varum= bow legs

Genu valgum= knock knees

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7
Q

What is the normal change in coronal alignment in growth?

A

Natural bowed legs when born until walking
Walking= straight
2-3 years knock kneed appearance

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8
Q

When does the normal gait pattern develop?

A

7 years
Alignment 6/7 degrees of valgus
Adulthood

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9
Q

How might apparent bow/ knock knees be misleading?

A
  • Apparent bowleg occurs when child stands with hips and knees flexed (external rotation)
  • Child lies down and extends hips and knees, legs are straight
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10
Q

How does pathological forms of genu varum/ valgum present?

A

-Asymmetric
-Resistant to normal change
(rickets)
-Short stature
-Varus > 11 degrees (Blount’s)
-Trauma/ systemic

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11
Q

What are the treatments for coronal deformities?

A
  • Used to be observational, growth, osteotomy (reshape and plate)
  • Now Eight Plate guides growth, gentle
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12
Q

How does Eight Plates work?

A

Titanium plates, stiff, same stiffness as bone so bend with growth
-Apply to one side of growth plate to slow down on one side, correction in deformity as other side grows

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13
Q

How does in/ out toeing in the rotational plane present?

A

-Clumsy
-Tripping/ limping
-“deformed”
-From femur, tibia, foot
(how leg rotates in length= foot position)

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14
Q

What are the angles considered in-toeing and out-toeing?

A

Out-toeing= above 15 degrees

In-toeing below 0 degrees

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15
Q

What is femoral anteversion?

A

-30 degrees
The angle of axis through the condyles
Fit into pelvis, turn hip in, guide to how much hip will internally rotate

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16
Q

How do we measure femoral anteversion?

A

Lie on front to estimate anteversion, leg/knee at 90%, internal hip rotation until feel prominent greater trochanter

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17
Q

What are the pathological forms of the rotational plane?

A
  • Excessive femoral anteversion

- External tibial torsion

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18
Q

What is the normal range of foot progression angle?

A

Max: +15
Ideal: +5
Min: -10 (+15/-15)

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19
Q

What is the normal range of thigh-foot angle?

A

Max: +20-+30
Ideal: -3- +15
Min:-30 to-5
(+15/-15)

20
Q

What is the normal range of external hip rotation?

A

Max: 90 to 55
Ideal: 65 to 38
Min: 45 to 25
(+15/-15)

21
Q

What is the normal range of internal hip rotation?

A

Max: 60 to 55
Ideal: 40 to 43
Min: 15 to 20
(+15/-15)

22
Q

What is persistent in toeing?

A
  • Baby= natural 50 degree anteversion, changes when walking (15 by 7)
  • Persistent femoral anteversion
  • Internal tibial torsion
  • Many resolve with growth/ remain asymptomatic
23
Q

What is miserable malignment?

A

Combination of PFA and ext tib torsion can result in patellar instability
-Symptomatic/ knees

24
Q

What is the pathological form of out toeing?

A

Femoral Retroversion

  • present from birth
  • Osteotomy
25
Q

What are pathological problems in the foot?

A

Metatarsus Adductus
-Medial curve of foot
-Resolves completely with growth
Club foot (CTEV)
-Underdeveloped parts of world badly managed
-Corrective surgery if not treated in childhood
-Many casts gradually correct deformity (first cast unlocks foot into dorsal flexion), cut Achilles
Flat foot (planovalgus)
-Tip toes
-Symptomatic only treatment= insoles
-Subtalar implant (medial weight bearing)

26
Q

Describe limping

A
  • Common presentation in paediatric orthopaedics
  • Often atraumatic
  • 180/100,000
27
Q

What is the normal gait in children in early walking?

A 
Short stride length
Fast cadence (number of steps per min)
Low velocity
Widened base of support
-Until 30-36 months= poor balance and abductor strength so cannot maintain single leg stance
-Mature gait age 7
28
Q

What causes a limp?

A
  • Pain
  • Mechanical problem
  • Neuromuscular problem
29
Q

Describe the age distribution of limping

A 
0-3= DDH (development dysplasia in hip)
3-6= Transient Synovitis
10-15= SUFE

4-8= Perthes’

0-15= Tumours and Septic Arthritis= neuromuscular

30
Q

What are the pain characteristics of a history of limping?

A
  • Acute= trauma, infection
  • Constant= malignancy, chronic infection
  • Morning pain/ pain after inactivity= inflammatory joint disorders
  • Night pain= malignancy, osteoid osteoma, benign growing pains
31
Q

What do we examine in limping?

A
  • Gait
  • Spine
  • Asymmetry
  • Deformity
  • Swelling
  • Tenderness
  • Examine all joints
  • Rotational profile
32
Q

What is Transient Synovitis?

A

Irritable hip
Non-specific, short-term inflammatory synovitis with synovial effusion of the hip joint
-Aspirate

33
Q

What is the clinical presentation of Transient Synovitis?

A
  • Painful hip/ thigh/ knee
  • Often associated with viral infection= immune response
  • Synovial fluid effusion
  • Hip held in flexion, lateral rotation and abduction
  • Exclusion of other conditions
34
Q

What are the investigations for Transient Synovitis?

A

(Excluding Sepsis)

  • Full blood count
  • ESR, CRP
  • X rays- AP and frog lateral
  • Ultrasound
  • MRI, bone scan, etc
35
Q

What is Developmental Dysplasia (DDH)?

A
  • 1-5/1000 births
  • Hereditary influence
  • Breach after 32 weeks or Caesarean
  • 1st Born
  • Oligohydramnios
  • Female: male= 5:1
36
Q

What do we see on examination in DDH?

A

-Barlow’s= leg in flexion, push down on knee (brutal) until clunk
-Ortolani= abduction until clunk (out hips) back into joint
DISLOCATED HIPS
-Skin crease asymmetry
-Leg length discrepancy
-Reduced abduction (cant do frog position)

37
Q

How do we treat DDH?

A 
Pelvic harness treatment
Halter, Stirrups
Anterior (Flexor) Stirrup-strap
Posterior (Abduction) Stirrup-strap
-Allows hip to sit down into position
-3 months
-Can need surgery
38
Q

What is Perthes Disease?

A
  • Avascular osteonecrosis of femoral epiphysis caused by poorly understood non-genetic factors
  • Boys> girls 4:1
  • 4-8 years in majority
  • Lower social class= increased risk
39
Q

What are the principles of Perthes Treatment?

A
  • Prevention of stiffness
  • Contain femoral head in acetabulum
  • Surgical treatment required in certain circumstances
  • Outcome depends on how well femoral head remodels
  • Varus osteotomy
40
Q

What is Slipped Upper Femoral Epiphysis (SUFE)?

A
  • Males (3:1) 13-16 years
  • In females younger, not after menarche
  • Bilateral in 42%
  • Obese or tall and slender
  • Rapid growth
  • 7% risk of a 2nd family member involved
41
Q

What are the clinical features of SUFE?

A
  • Acute/ chronic/ Acute on Chronic
  • Pain groin, thigh, knee
  • Limp
  • Antalgic gait
  • Externally rotated and adducted limb
42
Q

What are the red flags of examination?

A
  • Neonate with painful paralysed looking arm or leg= septic arthritis/ infection
  • Asymmetry of spin or limbs= scoliosis/ DDH
  • School age child with limp= Perthes disease
  • Knee pain in adolescent= SUFE or tumour
  • Back pain= discitis
43
Q

Describe infection

A
  • Cellulitis
  • Osteomyelitis
  • Septic arthritis
  • Usually requires emergent referral for investigation +/- aspiration
44
Q

Describe Discitis

A
  • Presentation can be subtle
  • MRI usually required
  • Epidural abscess is surgical emergency
45
Q

What should raise suspicion of non accidental injury?

A
  • Pre-existing disability
  • Vague history from parents
  • Injury inconsistent with history
  • Delay in presentation
  • Multiple bruises of varying age
  • Multiple fractures
  • Burns

Locomotor (20 decks)

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