Children's orthopaedics 0 complex needs - CP, spine, gait, spina bifida and ctev

Question 1

How do we classify Complex exceptional needs?What is arthrpgryposis and feurofibromatosis?

Answer 1

-issues with:
-self care, hearing, vision, communicating, thinking (learning and mental functions), motor

Under 19 with:
-severe impairment in at least 4 of the above and enteral (tube to stomach)/parentenal (tube to vein) feeding
OR
- at least 2 categories and ventilation/CPAP

AND for at least 6 months and ongoing

Question 2

3 physiologic causes of cp

Answer 2

Spastic, athetoid, ataxia. (and MIXED)

SO. It can affect 3 areas: cerebrum, basal ganglia and the cerebellum.

If it affects the cerebrum, it constantly causes flexion of the muscles and contractility and so will present as spastic. This is the most common cause.

If it affects the basal ganglia, it will oresent as athetoid - this is when there are rnadom jerks and movements produced by the body which aren’t as well controlled. Think all the wires are getting mixed up and confused.

Then there is ataxia. remember ataxic gait? V unbalanced. Wide stance. cerebellum is where the problem is so struggles with balance and coordination.

After we have classified them this way, we can also classify in terms of where is affected, eg monoplagia, diplagia (2 legs), hemiplagia and quadriplagia.

Also, can then classiy them in terms of their gross motor function classification.

Question 3

spacisisty meaning, What are the progression of spacisity in How do we analyse gait?

Answer 3

Stiffness and contractedness of a muscle.

Dynamic contractures -> It can be reversiable (eg when stretched)
Fixed muscle contractures -> Irreversible (tendons become short)
Joint subluxation/dislocation -> And likely to cause injury/dislocation, usually secondary to bone changes and joint degenaration.

Gait analysis is by: observation, video, emg/energy expenditure.

Question 4

What is the main hip problem likely ot arise in cp?

Answer 4

Hip dislocation

Question 5

What are the non surgical interventions in CP?

Answer 5

Systemically can give:
-Baclofen (muscle relaxant, decreases excitability by reducing calcium conduction and activates gabab receptors). Think -> sit back on that lofa (relax)
-Diazepam (binds to GABAA receptors and so depresses the nervous system. Its the thing you can shove up butts in community if someone doesn’t stop siezing)

Intramuscularly can give botox (botulinum toxin) or baclofen through “intra-thecal pump” -> into the spine area.

Question 6

club foot i mainly male/fmale?

Answer 6

males

Question 7

How can we diagnose club foot before firth?

Answer 7

via ultrasound

Question 8

what makes scoliosis alikely to progress?

Answer 8

if thye present before they start their periods (premenarchal)
under 12 at time of presentation
BIg ass curvature of the spine. The bigger the worse the prognosis. 60+ degress always had bad outlook really. Over 20 does in 10-12 yo and over 30 for 13-15

Question 9

Wjat are the classification of scoliosis? (and sub classification of idiopathic)

Answer 9

Congenital

IDeopathic - infantile (under 3), juvenile (3-10) and Adolescent (over 10(!)

Neuromuscular

Question 10

What is the adams forward flexiontest?

Answer 10

Bend over forwards. Should be able to see scoliosis more if it is a structural scoliosis

Question 11

s pain ususlly in socliosis?

Answer 11

no

Question 12

How do we investigate scoliosis?

Answer 12

xray (AP, erect, whole spine). Then an MRI usually to try and find out the underlying cause

Question 13

With scoliosis we can identify the cause with what scan? What underlying causes are there?

Answer 13

MRI.

Cord abnormalities
Tethering, syrinx, diastematomyelia
Vertebral anomalies
failures of formation and segmentation
Tumours

Question 14

Why do we brace and not surgery fpr management of scoliosis?

Answer 14

because surgery would mean that there would be no more growth of the spine!! So although braces are a real faff, it can be better to do this whilst they are growing!

Question 15

How do we check that the neurological functioning of the spinal cord is ok during siurgery?

Answer 15

With neuropeeps

Question 16

Complications of scoliosis surgery?

Answer 16

Damage to the spinal chord or vascular supply. Growth issues, degen changes later

Question 17

What is crankshaft phenomenon?

Answer 17

a progressive rotational and angular spinal deformity that can occur after posterior spinal surgery, has been reported in pediatric patients with idiopathic, congenital, and neuromuscular scoliosis.