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RW Musculoskeletal > Children's Orthopaedics > Flashcards

Children's Orthopaedics Flashcards

1
Q

Which kind of growth occurs in long bones?

A

Endochondral ossification

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2
Q

Which kind of growth increases the diameter of long bones?

A

Appositional growth

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3
Q

In a basic description, how does endochondral ossification occur?

A

Occurs at the epiphyseal plate, where there a multiple layers. Chondrocytes multiply in one layer, then the eventually die in lower layers as the surrounding matrix is calcified, when they then are ossified at the diaphyses.

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4
Q

By what age should babies normally be walking?

A

14-17 months

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5
Q

Genu varum

A

bow legged

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6
Q

Genu valgum

A

knock kneed

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7
Q

When is genu varum normal and abnormal?

A

Normal: <2y
Abnormal: unilateral, severe, short stature or painful

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8
Q

When is genu valgum normal and abnormal?

A 
Usually normal (peak around 3.5y)
Abnormal: Painful, asymmetric or severe
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9
Q

What is Blounts Disease, typical appearance and treatment?

A

Growth arrest of medial tibial physis of unknown aetiology (?weight overload).
Typical Beak-like protrusion on x-ray.
Hemiepihysiodesis is the surgical treatment

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10
Q

What are some of the possible causes of intoeing?

A

Femoral neck anteversion (increases internal rotation of hip), Internal Tibial Torsion,
metatarsus adductus or combination

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11
Q

Why are we all born with flat feet but normally don’t have it in adulthood?

A

We develop a medial arch once walking when tibialis posterior strengthens

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12
Q

What are the 2 types of flat feet?

A

Flexible or fixed (rigid). Rigid is much more serious

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13
Q

What are the possible causes of flexible flat feet?

A

Generalised ligamentous laxity (hypermobility) or tightness gastrocsoleus complex

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14
Q

What are the possible causes of fixed flat feet?

A

Tarsal coalition

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15
Q

Which score is used to measure hpermobility?

A

Beughtin score (out of 9)

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16
Q

What must you check in anterior knee pain?

A

Hips

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17
Q

Talipes

A

A deformity in which the foot is twisted out of normal position

18
Q

What causes positional talipes?

A

Intrauterine position

19
Q

What is the difference between physiological and pathological talipes?

A

Physiological is correctible

20
Q

What is the difference between equinus and calcaneus talipes?

A

Equines is plantar-flexed, while calcaneus is dorsiflexed

21
Q

What is Congenital Talipes Equinovarus more commonly known as?

A

Club foot

22
Q

What are the 3 main types of spina bifida?

A

1) Occulta (spine is still closed)
2) Meningocele (meninges have pushed out of spine)
3) Myelomeningocoele (meninges and spinal cord has pushed out of spine)

23
Q

What are the 5 main causes of limp?

A

1) Antalgic (pain in the limb so minimise stance phase)
2) Trendelenberg (pelvis tilts so need to tilt body for foot clearance)
3) Short leg
4) Tip toe
5) Neurologic

24
Q

What are the 3 subtypes of causes of tip toe gait?

A

1) Habitual
2) Structural (tight achilles)
3) Neurological eg. spasticity, spina bifida, cerebral palsy etc

25
Q

Cerebral Palsy

A

a group of non progressive disorders in which disease of the brain causes an impairment of motor function.

26
Q

Spina Bifida

A

a condition where the spine does not develop properly, leaving a gap in the spine.

27
Q

What causes cerebral palsy?

A

Neurological problems that can either occur prenatal (prematurity), perinatal (birth trauma e.g., asphyxia) or postnatal (eg. infection or cereal haemorrhage)

28
Q

What are the topographical classifications of cerebral palsy?

A

Hemiplegia (unilateral0 walkers), diplegia (bilateral- standers) or totally body involvement (sitters)

29
Q

What is the management of cerebral palsy?

A

Can either use drugs/surgery acting at the dorsal horn or surges such as hamstring/gastroc lengthening to optimise walking/sitting

30
Q

Which score is used in cerebral palsy?

A

Gross motor function score

31
Q

What are the main risk factors for DDH?

A

Breech position and family history

32
Q

What are the 3 instability tests to screen for DDH?

A

Barlow (sublux the hip), Ortolani (relocate the hip) and Galeazzi (lie the baby feet to bum and if knees aren’t level it is +ve)

33
Q

True or False: instability tests can be used for the first year of life

A

False, they are unreliable after 6 weeks

34
Q

What is the investigation of choice for DDH in >3 months and < 3months?

A

<3 months = US

3-6 months = x-ray (calcified epiphysis)

35
Q

What is the treatment of DDH with early diagnosis?

A

Pavlov harness

36
Q

What is the treatment of DDH with late diagnosis?

A

Closed or open reduction followed by hip spica

37
Q

What is Perthes?

A

Idiopathic avascular necrosis in children, where the blood supply to the epiphysis becomes inadequate. As a result the bone softens and breaks down

38
Q

Who is more likely to get Perthes, boys or girls?

A

Boys (4:1)

39
Q

What is SUFE?

A

Slipped Upper Femoral Epiphysis - A fracture through the growth plate, which results in slippage of the overlying end of the femur (epiphysis).

40
Q

True or False: An adolescent with hip/groin thigh or knee pain has a SUFE until proven otherwise

A

True

41
Q

Which type of x-ray is imperative in SUFE?

A

Lateral view

42
Q

What are you thinking of in 1) Newborn 2) pre-school and 3) adolescent with hip problems?

A

1) DDH
2) Perthes
3) SUFE

RW Musculoskeletal (9 decks)

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