Children's orthopedics Flashcards
What three classes of congenital diseases do we need to know?
Skeletal
Muscular dystrophies
Connective tissue disorders
What are the two congenital skeletal diseases we need to know?
Osteogenesis imperfecta (Brittle Bone Disease) Skeletal dysplasia
What is osteogenesis imperfecta?
Autosomal dominant defect in type 1 collagen leading to brittle bones.
How does osteogenesis present?
Multiple fractures (low energy), short stature, deformities, blue sclera, loss of hearing, can be fatal.
How do you treat osteogenesis imperfecta?
Treat fractures with splint, traction and stabilization.
What is skeletal dysplasia?
Short stature. Do NOT use ‘Dwarfism’!!!
Abnormal development of bone and connective tissue that can be proportional is disproportional.
What is the most common form of skeletal dysplasia?
Achondroplasia- Short limbs and large nose and forehead.
How do you treat skeletal dysplasia?
Treat deformities and can give growth hormone therapy.
What are the two muscular dystrophies we need to know?
Duchenne Muscular Dystrophy
Becker’s Muscular Dystrophy
Describe the genetics of muscular dystrophies.
Rare
X-linked
Recessive
What causes Duchenne Muscular Dystrophy?
Ca2+ transporter deformation resulting in muscle weakening.
How does Duchenne Muscular Dystrophy present?
Difficulty standing at young age
Can’t walk by 10
Cardiac and resp failure in 20s
How do you diagnose Duchenne Muscular Dystrophy?
Raised serum creatinine phosphokinase and muscle biopsy.
How can you treat Duchenne Muscular Dystrophy?
Physio, splint and correction can prolong mobility
What is Becker’s Muscular Dystrophy?
Similar to DMD except milder and has a teenage onset.
What are the three connective tissue disorders we need to know?
Generalised Joint Laxity (Double Jointedness)
Marfan’s Syndrome
Ehlers-Danlos Syndrome
What is generalised joint laxity?
Double jointedness
Autosomal dominant condition found in ~5% of people.
What are the problems with generalised joint laxity?
More prone to soft tissue injury and dislocations.
What is Marfan’s syndrome?
Autosomal dominant condition resulting in a tall person with disproportionately long limbs.
What complications are associated with Marfan’s syndrome?
Lax ligaments High palate Sclerosi and pectus excavatum Eye problems Aortic aneurysm and valve problems
What is Ehlers-Danlos syndrome?
An autosomal dominant disease resulting in abnormal elastin and collagen.
What are some of the complications of Ehlers_Danlos syndrome?
Joint hypermobility
Easy bruising
What are the only two recessive congenital diseases we need to know?
Duchenne Muscular Dystrophy
Becker’s Muscular Dystrophy
What are the three neuromuscular diseases we need to know?
Cerebral Palsy
Spina Bifida
Polio
What is polio?
Viral infection of the anterior horn affecting LMNs.
What are the symptoms of polio?
Flu like symptoms in initial infection.
Paralysis of muscle group 2-3 days later
Some LMN recover with weakness and some don’t
What problems does polio cause?
Joint deformities and growth defects.
How are the complications of polio treated?
Splint, risers on shoe, tendon transfer, joint fusion and lengthening/shortening.
What is spina bifida?
Herniation of part of the spinal column due to the two parts of the posterior vertebral arch failing to fuse.
What are the two subdivisions of spina bifida?
Spina bifida occulta- Mild form.
Spina bifida cystica- Severe form
Describe the problems associated with spina bifida occulta.
No problems but can get arched foot, clawed toes and dimple over the area.
Describe the two forms of spina bifida cystica.
Meningocele- Meninges alone herniate
Myelomeningocele- SC or CE herniate too
What are the problems associated with meningocele spina bifida cystica?
No problems
What are the problems associated with myelomeningocele spina bifida cystica?
Motor and sensory deficits
How do you treat spina bifida?
Close hole, correct scoliosis, release contractures and reduce/contain hip
What causes Cerebral Palsy?
Genetic problems, brain malformation, infection, prematurity, hypoxia or meningitis.
At what age does cerebral palsy occur?
2-3 YO
How does cerebral palsy present?
Expression and severity depend on part of brain affected.
What is the most common form of cerebral palsy?
Spastic CP (80%)- Affects motor cortex.
What problems can cerebral palsy cause?
Joint contractures, scoliosis, hip dislocation.
How do you treat the problems cerebral palsy causes?
Physio, splinting, botox, baclofen, surgical release of joints, correction of scoliosis.
At how many weeks do limb buds start to form?
4-6
What are the two types of developmental disorder we need to know?
Limb Malformation
Obstetric brachial Plexus Palsy
Give some examples of what can go wrong in limb malformation.
Extra bone
Missing bone
Short bone
Fused bone/skin/soft tissue
Give 4 examples of limb malformation.
Syndactyly
Polydactyly
Fibular hemimelia
Congenital fusion
What is syndactyly?
2+ digits fuse either fully or partially. Can be surgically separated.
What is polydactyly?
An extra digit. Can be amputated.
What is fibular hemimelia?
Partial or complete loss of fibula. SHortened leg, bowed tibia and ankle deformity.
How do you treat fibular hemimelia?
Mild- Lengthen leg
Severe- Amputate
What is congenital fusion?
Most common between tarsal bones- can lead to sore flat feet.
What is obstetric brachial plexus palsy?
Damage to the brachial plexus during birth.
What are the two forms of obstetric brachial plexus palsy?
Erb’s palsy
Klumpke’s palsy
Describe Erb’s palsy
Damage to C5+6. Internally rotated arm. Treat with physio and potential to operate.
Describe Klumpke’s palsy
C8+T1 damage. Paralysis of intrinsic hand muscles, fingers and wrist. Fingers flexed.
No treatment and <50% resolve.
What are the 5 MSK developmental landmarks in children?
6-9m: Sits alone and crawls 8-12m: Stands 14-17m: Walks 24m: Jumps 3y: Climbs stairs unaided
What are the 7 neurological developmental landmarks in children?
1-6m: Loss of primitive reflexes. 2m: Head control 9-12m: Speaking a few words 14m: Eats w/ spoon 18m: Stacks blocks 18-20m: Understands 200 words 2-3y: Potty trained
Describe the normal changes in knee alignment as a child develops
Varus at birth
Neutral at 14m
10-15 degree valgus at 3y
6 degree valgus at 7-9y
What is genu varum?
Bow legged
What can cause genu varum?
Blount's disease- Excessive medial growth Rickets Tumour Trauma Skeletal dysplasia
What is genu valgum?
Knock knee
What can cause genu valgum?
Rickets Tumour Trauma Neurofibromatosis Idiopathic
What is in-toeing?
Feet point to midline.
Exaggerated on running/ look clumsy
What can cause intoeing?
Internal tibial torsion- Normal
Forefoot adduction- Potentially need surgery
What are the two types of flat feet?
Mobile- Arch appears on great toe flexion. Do nothing
FIxed- May require surgery
What are the four knee pathologies we need to know?
Extensor mechanism problems
Patellar instability
Osteochondritis dissecans
Meniscal tears
Name some knee extensor mechanism problems
Pain from growing in teens
Patellar tendonitis- Self limiting
Apophysitis- Inflammation of growing tubercle
Name to apophysitis associated with the knee
Osgood-Schlatter- Inflammation of tibial tubercle
Sinding-Larsen-Johansson disease- Inflammation of patellar.
What is patellar instability?
Dislocation or subluxation. Can be due to tear in medial patellofemoral ligament and anatomical variation.
What is osteochondritis dissecans?
When knee dislocates part of hyaline cartilage can break off joint surface. Medial femoral condyle most common.
Poorly localised pain. effusion and locking
Predisposes to OA.
What are meniscal tears?
Tears in the minisci.
Peripheral/bucket handle most common.
What are the four pathologies of the hip we need to know?
Developmental dysplasia of the hip
Transient synovitis of hip
Perthes Disease
Slipped Upper Femoral Epiphysis
What is developmental dysplasia of the hip?
Dislocated/subluxed hip during perinatal period which affects development.
Examine all hips at birth and diagnose early.
How do you treat developmental dysplasia of the hip?
Pavlik harness for 6w full time then 6w at night.
What is transient synovitis of the hip?
A synovitis in the hip most commonly after a respiratory infection. Most common cause of pediatric hip pain.
What is Perthes disease?
Idiopathic osteochondritis of femoral head due to transient loss of blood supply.
Pain and limp. Can lead to OA.
What is a Slipped Upper Femoral Epiphysis?
Femoral head epiphysis slips inferiorly to neck.
Common in overweight kids.
Groin and kneed pain. Loss of internal rotation.
What does SUFE stand for?
Slipped Upper Femoral Epiphysis. Ice cream cone on XR.
What are the two foot pathologies we need to know?
Talipes Equinovarus (clubfoot) Tarsal Coalition
What is talipes equinovarus?
Clubfoot. Abnormal alignment of talus, calcaneus and navicular joints.
Splint.
What is Tarsal Coalition?
Abnormal bony/cartilage/fibrous bridge between calcaneus and talus. Leads to flat foot.
Splint and can under go surgery.
What are the two back pathologies we need to know about?
Scoliosis
Spondylolisthesis
What is scoliosis?
Lateral curve in spine.
What can cause scoliosis?
Idiopathic Neuromuscular disease Tumour Skeletal dysplasia Infection
How do you treat mild scoliosis?
No treatment
How do you treat severe scoliosis?
Surgery. Severe can result in breathing problems.
What is spondylolisthesis?
Slippage of one vertebrae over another.
Usually at L4/5 or L5/S1 level
What can cause spondylolisthesis?
Developmental defect or recurrent stress fracture.
Linked to increased body weight and activity.
How do spondylolisthesis present?
Lower back pain
Nerve impingement
Flat back due to spasm
Waddling gait
How do you treat spondylolisthesis?
Mild- Rest and physio
Severe- Stabilization and reduction
What is a gibbus?
Angular deformity of the spine in the sagittal plane.
