Children's Orthopaedics Flashcards
What is meant by skeletal dysplasia?
Medical term for little person
What is the most common type of skeletal dysplasia?
Achondroplasia
Which classification system is used to scale the degree of joint hypermobility of a patient?
Wynne-Davies Classification
- common with skeletal dysplasias
What is Duchenne Muscular Dystrophy?
X linked recessive
Progressive muscular weakness noticed when boy starts to stand
What is the lifespan of a boy with DMD?
~ 20 years
How is DMD diagnosed?
Raised serum creatine phosphokinase
Abnormal muscle biopsy
What is cerebral palsy (CP)?
Neuromuscular disorder appearing before 3yo
Caused by insult to immature brain before, during or after birth
List 5 causes of CP
Genes Intrauterine infection Prematurity Intra-cranial haemorrhage Hypoxia during birth
How does CP lead to bone deformity?
5 steps
Brain injury Increased muscle tone Abnormal posture Muscle contracture Bone deformities
List the 3 features of Lower Motor Neurone inhibition
Spasticity
Hyperreflexia clonus
Co-contraction
Define spasticity
Condition with abnormally increased muscle tone, affects movement and speech
List 4 features of loss of LMN connection
Weakness
Fatigability
Poor balance
Sensory deficits
List 3 treatments for CP
Benzodiazapines (acutely)
Botox injections
Dorsal rhizotomy
What is tiptoe walking?
Child walking on balls of feet
Up to what age is tiptoe walking regarded as normal?
3 years
What are cavus feet?
When a person stands and there is a larger than normal gap between the midfoot and ground
How do cavus feet normally look?
Heel and toes slightly inverted
“claw”/curled toes
What is frontal bossing?
Prominent forehead
- associated with achondroplasia
What is Developmental Dysplasia of the Hip (DDH)?
Dislocation/subluxation of the femoral head
During perinatal period
Affects subsequent development of hip joint
Which sex is more affected by DDH?
Females
List 5 risk factors associated with the development of DDH
Family history Breech position First borns Down's syndrome Talipes etc
List 3 clinical signs of DDH
Lower limb shortening
Asymmetric groin
Thick skin creases ^
Which 2 maneouvres are used to check for the presence of DDH
Ortolani test
Barlow test
After what age can Xrays be used to detect DDH?
4-6 months
- before this, the femoral head is not ossified
How may the body compensate for untreated/severe DDH?
Develops false acetabulum anterior to the physiological one
- results in shorter limb and severe arthritis
What is osteochondrosis?
Aseptic ischaemic necrosis
Primarily in centre of ossification on epiphysis
What is Perthes disease?
Idiopathic osteochondritis of the femoral head
Which age group and sex is most commonly affected by Perthes?
(active + short) Boys
4-9
What is Slipped Upper Femoral Epiphysis (SUFE)?
Femoral physis (growth plate) too weak to support body weight Epiphysis slips under the strain 1/3 cases bilat.
What age group and sex are normally affected by SUFE?
Overweight
Pre-pubescent boys
Which 2 conditions may predispose a child to developing SUFE?
Hypothyroidism
Renal disease
What is a strange but common presentation of SUFE?
ONLY knee pain
also, loss of internal rotation of hip
What is the surgical treatment of SUFE?
Pinning of the femoral head
