Children’s Orthopaedics - Complex needs - CP, Talipes,Scoliosis Flashcards
Which functions may be involved in complex exceptional needs?
Learning and mental functions Communication Motor skills Self care Hearing Vision
Child has CEN if 4 involved or 4 involved and on ventilation
or impairments for over 6 months
What is cerebral palsy?
A permanent and non-progressive motor disorder due to brain damage before birth or during the first 2 years of life
What are the main causes in prenatal CP?
Placental insufficiency Toxaemia Smoking Alcohol Drugs Infection Rubella CMV Herpes
What are the main causes in perinatal CP?
Prematurity Anoxic injury Infection Kernicterus Haemolytic disease of the newborn
What are the main causes of postnatal CP?
CMV
Rubella
Head trauma
Where does Spastic CP affect?
Pyramidal system
Motor cortex
Where does athetoid system affect?
Extrapyramidal system
Basal ganglia
Where does Ataxia CP affect?
Cerebellum and brainstem
What is GMFCS?
Gross Motor Function Classification System
LEVEL I - Walks without Limitations
LEVEL II - Walks with Limitations
LEVEL III - Walks Using a Hand-Held Mobility Device
LEVEL IV - Self-Mobility with Limitations
LEVEL V - Transported in a Manual Wheelchair
What are the main issues in CP?
Spasticity Lack of voluntary limb control Weakness Poor co-ordination Impaired senses (Hearing, Vision, Taste, Touch etc)
What are dynamic contractures? (CP)
Increased muscle tone and hyper-reflexia
No fixed deformity of joints
Deformity can be overcome
What are fixed muscle contractures?
Persistent spasticity and contracture
Shortened muscle tendon units
Deformity cannot be overcome
How might joint subluxation/dislocation occur in CP?
Secondary bone changes
Joint degeneration
How is the gait lab used?
Document joint movement
Force distribution through feet
Timing of cycle
How do we estimate risk of hip dislocation in CP?
GMCFS
How can we manage posture in CP?
Physiotherapy
Seating
What are some treatment options for generalised spasticity?
Baclofen oral
Diazepam
What are some treatment options for localised spasticity?
Botulinum toxin
Baclofen intra-thecal pump
How is deformity treated in CP?
Soft tissue release for adductors and hamstrings
Varus derotation osteotomy or pelvic osteotomy for bony realignment
What are some pros for surgical options in CP?
Reduced risk dislocation
Reduced risk pain
Better seating
What are some drawbacks of surgical CP treatment?
Not all would have gone on to dislocate
It is a very big surgery
What is another name for club feet?
Congenital talipes equinovarus
How can clubfoot be diagnosed?
60% identified by USS
What are some treatment options for clubfeet?
Strapping Serial casting Dennis Browne Boots Surgery Postero-medial release Ilizarov frame
How can we remember anatomy of clubfoot?
CAVE acronym
Cavus
Adductus (midfoot)
Varus (hindfoot)
Equinus (hindfoot)
How is equinus corrected surgically?
Percutaneous tenotomy of achilles tendon
What is non-structural scoliosis?
Due to extrinsic cause like a leg length discrepancy, a hip problem etc.
Resolves when causal factor is addressed
What is structural scoliosis?
Abnormal rotation of the vertebrae
Intrinsic spinal problem
It has a propensity to progress
How do we highlight scoliosis on examination
Structural scoliosis worse on torso flexion
Abnormal neurology or pain should be noted
What is MRI used for in scoliosis?
Cord abnormalities
Vertebral anomalies in formation/segmentation
Tumours
What are some consequences of severe curves in scoliosis?
Cardiorespiratory compromise
Pain from rib/pelvic abutment
Seating issues
Surgical challenge
What are the non-surgical options for managing scoliosis?
Bracing
Needs to be worn 23/24 hours to work
Usually used to delay surgery while spine is growing
What are some possible surgical complications in scoliosis?
Nerve root damage Cord traction injury Vascular injury Degenerative changes later Problems of growth like growing rods, changing rods, crankshaft phenomenon
What is crankshaft phenomenon?
Progressive rotational and angular spinal deformity that can occur after posterior spinal surgery
What are some “manufacturing defects” causing infant abnormalities?
Spina Bifida Proximal femoral focal deficiency TAR Syndrome Thalidomide Congenital scoliosis
What are some “packaging defects” causing infant abnormalities?
Metatarsus Adductus
Infantile postural scoliosis
Plagiocephaly
Congenital Torticolis
