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MSK > Children’s Orthopaedics - Complex needs - CP, Talipes,Scoliosis > Flashcards

Children’s Orthopaedics - Complex needs - CP, Talipes,Scoliosis Flashcards

1
Q

Which functions may be involved in complex exceptional needs?

A 
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

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2
Q

What is cerebral palsy?

A

A permanent and non-progressive motor disorder due to brain damage before birth or during the first 2 years of life

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3
Q

What are the main causes in prenatal CP?

A 
Placental insufficiency
Toxaemia
Smoking
Alcohol
Drugs
Infection
Rubella
CMV
Herpes
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4
Q

What are the main causes in perinatal CP?

A 
Prematurity
Anoxic injury
Infection
Kernicterus
Haemolytic disease of the newborn
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5
Q

What are the main causes of postnatal CP?

A

CMV
Rubella
Head trauma

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6
Q

Where does Spastic CP affect?

A

Pyramidal system

Motor cortex

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7
Q

Where does athetoid system affect?

A

Extrapyramidal system

Basal ganglia

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8
Q

Where does Ataxia CP affect?

A

Cerebellum and brainstem

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9
Q

What is GMFCS?

A

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

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10
Q

What are the main issues in CP?

A 
Spasticity
Lack of voluntary limb control
Weakness
Poor co-ordination
Impaired senses (Hearing, Vision, Taste, Touch etc)
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11
Q

What are dynamic contractures? (CP)

A

Increased muscle tone and hyper-reflexia
No fixed deformity of joints
Deformity can be overcome

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12
Q

What are fixed muscle contractures?

A

Persistent spasticity and contracture
Shortened muscle tendon units
Deformity cannot be overcome

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13
Q

How might joint subluxation/dislocation occur in CP?

A

Secondary bone changes

Joint degeneration

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14
Q

How is the gait lab used?

A

Document joint movement
Force distribution through feet
Timing of cycle

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15
Q

How do we estimate risk of hip dislocation in CP?

A

GMCFS

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16
Q

How can we manage posture in CP?

A

Physiotherapy

Seating

17
Q

What are some treatment options for generalised spasticity?

A

Baclofen oral

Diazepam

18
Q

What are some treatment options for localised spasticity?

A

Botulinum toxin

Baclofen intra-thecal pump

19
Q

How is deformity treated in CP?

A

Soft tissue release for adductors and hamstrings

Varus derotation osteotomy or pelvic osteotomy for bony realignment

20
Q

What are some pros for surgical options in CP?

A

Reduced risk dislocation
Reduced risk pain
Better seating

21
Q

What are some drawbacks of surgical CP treatment?

A

Not all would have gone on to dislocate

It is a very big surgery

22
Q

What is another name for club feet?

A

Congenital talipes equinovarus

23
Q

How can clubfoot be diagnosed?

A

60% identified by USS

24
Q

What are some treatment options for clubfeet?

A 
Strapping
Serial casting
Dennis Browne Boots
Surgery
Postero-medial release
Ilizarov frame
25
Q

How can we remember anatomy of clubfoot?

A

CAVE acronym

Cavus
Adductus (midfoot)
Varus (hindfoot)
Equinus (hindfoot)

26
Q

How is equinus corrected surgically?

A

Percutaneous tenotomy of achilles tendon

27
Q

What is non-structural scoliosis?

A

Due to extrinsic cause like a leg length discrepancy, a hip problem etc.
Resolves when causal factor is addressed

28
Q

What is structural scoliosis?

A

Abnormal rotation of the vertebrae
Intrinsic spinal problem
It has a propensity to progress

29
Q

How do we highlight scoliosis on examination

A

Structural scoliosis worse on torso flexion

Abnormal neurology or pain should be noted

30
Q

What is MRI used for in scoliosis?

A

Cord abnormalities
Vertebral anomalies in formation/segmentation
Tumours

31
Q

What are some consequences of severe curves in scoliosis?

A

Cardiorespiratory compromise
Pain from rib/pelvic abutment
Seating issues
Surgical challenge

32
Q

What are the non-surgical options for managing scoliosis?

A

Bracing
Needs to be worn 23/24 hours to work
Usually used to delay surgery while spine is growing

33
Q

What are some possible surgical complications in scoliosis?

A 
Nerve root damage
Cord traction injury
Vascular injury
Degenerative changes later
Problems of growth like growing rods, changing rods, crankshaft phenomenon
34
Q

What is crankshaft phenomenon?

A

Progressive rotational and angular spinal deformity that can occur after posterior spinal surgery

35
Q

What are some “manufacturing defects” causing infant abnormalities?

A 
Spina Bifida
Proximal femoral focal deficiency
TAR Syndrome
Thalidomide
Congenital scoliosis
36
Q

What are some “packaging defects” causing infant abnormalities?

A

Metatarsus Adductus
Infantile postural scoliosis
Plagiocephaly
Congenital Torticolis

MSK (26 decks)

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