Children's Orthopaedics Flashcards
What is the steps involved in Cerebral palsy progression?
- Brain injury
- Increased tone
- Abnormal posture
- Contracture
- Bony deformity
What is the migration index?
- gives % of hip ball out of socket, then gives the % risk factor for dislocation
What is the GMFCS score?
- Cerebral palsy
- Score 1-5 at risk children
In the gait cycle what percentage is swing and what percentage is stance?
- stance = 60%
- swing = 40%
What is ambulation?
- Walking
What is dependant on for normal walking?
-An appropriate and adequate force acting via a rigid lever of appropriate length on a stable joint
What are the prorities of normal gait?
- Stability in stance
- Clearance in swing
- Pre-position of foot in terminal swing
- Adequate step length
- Conservation of energy
What are the main orthopaedic complications with CP?
- Hip dislocation
- Scoliosis
- Gait
Causes of CP CNS insult?
- In utero (2nd or 3rd trimester)
- Prematurity birth
- Very few obstetrics
Muscle dystrophy in males?
- Duchenne muscle dystrophy
In club foot what region of the foot is in contact with the ground?
- Dorsum of the foot
CAVE nmenonic for deformity of club foot?
o Cavus
o Adduct
o Varus
o Equinus
Rockerbottom vs clubfoot?
- Club foot towards midline
- Rockerbottom laterally
Leg pain red flags
- Asymmetry
- Good localisation
- Short history
- Persisting limp
- Not thriving
- Pain worsening
Treatment of clubfoot?
- Boots and bar (bracing)
Knee pain means what examination should be done?
- Hip examination
- referred pain
HSMN stands for?
- Hereditary sensory and motor neuropathy
What may be seen in HSMN in the foot?
- High arched foot
- foot weakness
Why are babies USS of their hips?
- To assess for developmental dysplasia
What are specific hip tests in babies?
o Barlow’s
o Ortolani
What are you checking for when inspecting a babie’s hips?
o Asymmetry
o Loss of knee height
o Crease asymmetry
o Less abduction in flexion
How is Barlow’s test preformed?
-Adduction with downward pressure
Risk factors for developmental dysplasia?
o Females o Breech (foot first) o Family history o Oligohydramnios (low level of amniotic fluid) o Moulded baby o First born o Weight >4kg
How is Ortolani’s exam performed?
-Clunk towards the midline
Treatment of early DDH?
- Pavlik Harness
- 23-24hrs per day for 12 weeks
- Hips are abducted and flexed
Treatment of late DDH?
- Age > 3months
- Surgery
o CR spica
o OR spica - Will not get a normal hip
What is Antalgic gait
- painful limp
Symptoms of SCFE – Slipped Capital Femoral Epiphysis
o Short
o Externally rotated
o Loss of internal rotation
o Loss of deep flexion
Tip toe walking may be normal variation up to what age?
- 3 years
Tip toes walking may be a sign of?
- Cerebral Palsy
What is SCFE/SUFE?
- Ball of the hip (epiphysis) starts to flip off the growth plate (physis)
Transient synovitis may occur after what?
- viral infection
What position may a child lie in with transient synovitis?
- lie with the hip flexed and externally rotated
What must you rule out in a possible case of transient synovitis?
- Septic arthritis
What does septic arthritis lead to?
- destruction of the joint
What may be the presenting features of septic arthritis in paediatrics?
- severe pain
- lie with hip flexed and externally rotated
- severe pain
- struggle to walk
- high fever
What is the treatment of septic arthritis?
- surgical drainage
- antibiotics
What criteria is used in septic arthritis?
- Kocher’s criteria
DDH vs SCFE/SUFE
- DDH - born with, not painful
- SCFE/SUFE - acquired, painful, teenage years
What is Perthes disease?
- Avascular necrosis of the hip
What forms at the apical ectodermal ridge?
- Hand development
What gene may be affected that leads to hand deformities?
- Sonic Hedgehog gene
What hip is most commonly affected in DDH?
- the left hip
Define cavus
- foot has a very high arch
- seen in CP
Define equinus
- Lacks the flexibility to bring the toes closer to the leg
What is another term for osteogenesis imperfecta
- Brittle bones disease
What gene is affected in osteogenesis imperfecta
- defect of the maturation and organisation of type 1 collagen
What are some symptoms of osteogenesis imperfecta
- Multiple fragility fractures
- short stature
- blue sclerae
- loss of hearing
What gene is affected in Marfan’s syndrome?
- Fibrillin gene
What are the symptoms of Marfan’s syndrome?
- tall stature
- out of proportion long limbs
- laxity
What is abnormally formed in Ehlers-Danlos syndrome?
- abnormal elastin and collagen formation
What gene is defected in Duchenne muscular dystrophy?
- Dystrophin gene (calcium transport)
Explain varus gait?
- angulation of the distal segments of a bone or joint towards the midline
Explain valgus gait?
- angulation of the distal segments of a bone or joint away for the midline
What is the treatment for talipes equinovarus (clubfoot)
-Ponseti technique splints
