Childrens Orthopaedics

Question 1

give 4 congenital foot conditions?

Answer 1

clubfoot
rocker bottom foot
neurofibromatosis
skeletal dysplasia

Question 2

give 4 neuromuscular disorders of feet

Answer 2

cerebral palsy
tip toe walking
Duchenne muscular dystrophy
high arch (cavus)

Question 3

what are the 4 features of clubfoot?

Answer 3

CAVUS
Cavus
Adductus
Varus
Equinus

Question 4

what is clubfoot and what causes it?

Answer 4

birth defect causing abnormal foot posture

can be idiopathic or associated with other more serious conditions

Question 5

what is postural talipes?

Answer 5

normal curved posture of newborns

looks like clubfoot but can be forced into normal position

Question 6

how is clubfoot treated?

Answer 6

ponseti method of casting

Question 7

what is rocker bottom feet?

Answer 7

congenital vertical talus due to irreducible dislocation of talus on navicular

Question 8

what are the features of rocker bottom feet?

Answer 8

round plantar features

equinus hindfoot

Question 9

common feature of clubfoot and rocker bottom feet?

Answer 9

fixed ankle equinus

Question 10

what is neurofibromatosis?

Answer 10

congenital disorder affecting extremities, spine and skin

Question 11

what causes neurofibromatosis?

Answer 11

autosomal dominant inheritance of NFI gene Ch17

Question 12

how is neurofibromatosis diagnosed?

Answer 12

2 out of the following 7 present
>6 café au lait spots
2 or more neurofibromas/plexiform neurofibromas
freckling axilla/inguinal region
optic glioma
2 or more lisch nodules
cortical thinning/pseudoarthrosis
first degree relative affected

Question 13

what is skeletal dysplasia?

Answer 13

congenital disorders involving bone and cartilage

Question 14

what are the features of skeletal dysplasia?

Answer 14

shortening of involved bone
short stature (usually <2 SD)
- can be proportionate or disproportionate

Question 15

what is the most common form of skeletal dysplasia?

Answer 15

achondroplasia
normal trunk/short limbs
frontal bossing
genu varum
normal intelligence
motor delay

Question 16

what causes achondroplasia?

Answer 16

fibroblast growth factor receptor 3 FGFR3

either autosomal dominant or spontaneous mutation

Question 17

what is cerebral palsy?

Answer 17

non-progressive neuromuscular disorder causing injury to immature brain (<2 years)

• prematurity
• perinatal (infection, injury, meningitis)

Question 18

what are the features of cerebral palsy?

Answer 18

UMN disease (muscle weakness/spasticity)
early = abnormal muscle forces > dynamic deformity
late = contractures, deformity, dislocation
head unaffected?

Question 19

what is clasp knife spasticity?

Answer 19

where abnormally increased resistance to stretching of a muscle gives way abruptly, usually near the end of the range of joint movement
seen in cerebral palsy

Question 20

how is cerebral palsy functionally diagnosed?

Answer 20

walking

non-walking

Question 21

how can cerebral palsy be treated?

Answer 21

benzodiazepines baclofen
selective dorsal rhizotomy
botulinum toxin

Question 22

what is Duchenne muscular dystrophe?

Answer 22

commonest muscular dystrophy

X linked recessive disorder causing progressive muscle weakness

Question 23

what causes duchenne muscular dystrophe?

Answer 23

absence of dystrophin protein

replacement of muscle with fibrofatty tissue

Question 24

how does Duchenne muscular dystrophy present?

Answer 24

2-5 yrs old
muscle weakness (prox > distal)
clumsy walking
positive gowers sign
scoliosis

Question 25

how is Duchenne muscular dystrophe diagnosed?

Answer 25

creatinine phosphokinase
muscle biopsy (absence of dystrophin)

Question 26

what is gowers sign?

Answer 26

cant stand up from knees alone

use hands to walk up the legs to stand upright

Question 27

what is cavus feet?

Answer 27

pes cavus (high arched foot)
elevated longitudinal arch and varus hindfoot

Question 28

what causes cavus feet?

Answer 28

idiopathic/familial
2/3 due to neurological disorder (polio, cerebral palsy, myelomeningocoele, SCI)
charcot marie tooth

Question 29

how is cavus feet assessed?

Answer 29

X rays

Coleman block test

Question 30

how is cavus feet managed?

Answer 30

conservative
surgery
- soft tissue
- bony (osteotomy)