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Lecture Notes- Orthopaedics and Fractures > Congenital and Developmental conditions > Flashcards

Congenital and Developmental conditions Flashcards

1
Q

What is the dominant feature in the unstable hip

What is lost in DDH

A

capsular laxity

the tight fit between the femoral head and acetabulum is lost

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2
Q

What sex is more commonly affected by DDH

A

girls

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3
Q

What are the two manoeuvres carried out to test for DDH

A

Ortolani and Barlow’s manouvres

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4
Q

What makes an Ortolani’s sign positive

A

slight limitation of abduction
as the hip is abducted, the head slips over the edge of the acetabulum into the joint with a clunk
This occurs when the hip and knee are flexed and the baby supine

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5
Q

What is a positive Barlow’s sign

A

the femoral head is palpated as it exist the acetabulum partially or completely

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6
Q

What are signs of DDH later in life

A

short leg and abduction of the hip is limited

femoral head is felt to move in and out of the joint in abduction When are most late cases of DDH spotted

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7
Q

When are most late cases of DDH spotted

A

when the child starts to walk

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8
Q

What is the characteristic gait that a child with DDH walks with

A

Trendelenburg gait due to inefficiency of the abductor muscles

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9
Q

How is DDH managed

A

Splinting the limb in abduction usually allows reduction and stabilisation of this hip using the Pavlik harness

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10
Q

How long can a child wear a a Pavlik harness for

A

until the age of 6 months

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11
Q

What is the treatment for a child aged between 6 months and 2 years for DDH

A

closed reduction

proximal femoral head is gently manipulated into he acetabulum by applying traction with flexion and abduction

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12
Q

What are some obstacles to reduction in DDH for 6 months -2 years

A

The gleaned labrum and superior capsule may be folded inwards to form a concentric flap - this is the limbus
The psoas tendon may constrict the inferior capsule like an hour glass
the inferior capsule may be infolded and adherent to the floor of the true acetabulum
The ligament theres may be hypertrophied

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13
Q

What is usually the treatment for a child over the age of 2 years with DDH

A

open reduction - femoral osteotomy

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14
Q

What is a recognised complication of DDH treatment in a child over the age of 2

A

avascular necrosis of the femoral head

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15
Q

How common is recurrent dislocation of the patella and who does it affect

A

Relatively common

adolescent girls

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16
Q

How does the knee lock in patella dislocation

A

in flexion

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17
Q

How is recurrent patellar dislocation treated

A

transplantation of the patellar tendon more medially

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18
Q

What is genu valgum

A

knock knees

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19
Q

Up until what age is knock knee “normal”

A

around the age of 6

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20
Q

What should be done if genu valgum is still present at age 11/12

A

correction by inserting staples across the inner side of the femoral or both the femoral and tibial epiphyses

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21
Q

How do staples help genu valgum

A

They slow down growth on that side and the knee gradually straightens out

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22
Q

What is Tibia vara and what does it result in

A

Rare condition in which there is a developmental defect of the medial part of the upper tibial epiphysis resulting in a progressive bow-leg deformity

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23
Q

What is the treatment for tibia vara (Blount’s disease)

A

Osteotomy of the upper end of the tibia

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24
Q

What is pseudoarthrosis of the tibia

A

A condition present at birth or developing in early childhood in which blowing of the tibia occurs.
It is often associated with a cystic defect in the lower third and eventually results in a fracture which persistently fails to unite

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25
Q

What happens in discoid meniscus

A

The lateral meniscus of the knee fails to develop normally remaining as a complete disc

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26
Q

What does a patient with discoid meniscus complain of

A

knee joint pain

snapping and swelling

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27
Q

What is useful in confirming the diagnosis of a discoid meniscus

A

MRI

28
Q

What is meant by equinus

A

the hindfoot is plantar flexed at the ankle

29
Q

What is meant by calcaneus

A

the hindfoot is dorsiflexed at the ankle

30
Q

What is meant by varus

A

the hindfoot is adducted or inverted when looked at from behind

31
Q

What is meant by valgus

A

the hindfoot is abducted or everted when looked at from behind

32
Q

What is meant by cavus

A

the longitudinal arch is higher than normal

33
Q

What is meant by planus

A

The arch is flattened (and the foot is usually valgus)

34
Q

Using anatomical vocab describe the appearance of a flat foot

A

The hindfoot is valgus and the sole faces laterally (pronation)

35
Q

Describe the appearance of a foot in a child with calcaneo valgus

A

Foot is markedly dorsiflexed at the ankle joint and everted at the subtler joint
dorsum of the foot is often thought to be in contact with the anterior shin

36
Q

What is congenital vertical talus or convex pes valgus

A

dorsolateral dislocation of the navicular on the talus

The hindfoot is in a fixed equinovalgus position and the midfoot is dorsiflexed

37
Q

What appearance foes congenital vertical talus or convex pes valgus have

A

persian slipper

38
Q

What is the treatment for congenital vertical talus or convex pes valgus

A

Manipulation and serial casting
the corrective forces applied must be opposite to those for talipes equinovarus correction
if this fails, surgery is required

39
Q

What is characteristic of metatarsus adductus or metatarsus virus

A

medial deviation of the forefoot on the hindfoot resulting in the forefoot pointing inwards

40
Q

What is the treatment for metatarsus adductus or metatarsus virus

A

stretching exercises
splints/ braces
serial casting

41
Q

What is the more common name for congenital talipes equinovarus

A

club foot

42
Q

What characterises club foot

A

complex malalignment of the bones and joints of the foot and ankle

43
Q

What are the deformities of club foot

A

equinus and inversion of the hindfoot

cavus and adduction of the forefoot on the midfoot so that the sole of the foot points medially or even upwards

44
Q

When should treatment of clubfoot be started

A

ASAP

45
Q

What is the gold standard treatment for club foot

A

Manipulation and serial casting

46
Q

What is syndactyly

A

fusion of digits

47
Q

Why does syndactyly occur

A

failure of separation of the digits in utero

48
Q

When is surgical separation carried out

A

12 months

49
Q

When do we separate toes

A

never - does not cause functional limitations

50
Q

What happens in Madelung’s deformity

A

the polar ulnar aspect of the distal radial physics fails to develop normally so that the radius becomes bowed with an oblique distal end

51
Q

Who does Madelung’s deformity occur in and what might it be associated with

A

Girls

Turner’s syndrome, achondroplasia and Ollier’s disease

52
Q

What does surgery involve in Madelung’s deformity

A

Corrective osteotomies

53
Q

What is cerebral palsy

A

Disorder of movement and posture resulting from injury to the immature brain

54
Q

What is the aetiology of CP

A

intrauterine developmental defects
birth trauma
asphysxia
diseases or injuries in early life

55
Q

What does persistent spasticity lead to in CP

A

short muscles
contractures
bony deformity
joint subluxation and dislocation

56
Q

What is spasticity

A

an upper motor neurone type defect

characterised by increased muscle tone and reflexes

57
Q

What is Athetosis in CP

A

the limbs move at random, with jerking and uncoordinated movements

58
Q

What is the Topographic classification based on

A

the degree of limb involvement

59
Q

What are the 3 classifications in Topographic classification

A

Hemiplegia - upper and lower limbs on the same side
Diplegia - involvement of both lower limbs
Quadriplegia - all four limbs are involved

60
Q

What are the main aims in surgery for CP

A

to correct any established deformity and to restore muscle balance and diminish spasticity

61
Q

Where are congenital malformation of the spine most common

A

lower thoracic, lumbar, and sacral regions

62
Q

What is the commonest congenital malformation of the spin

A

spina bifida

63
Q

What is spinal dysraphism

A

a condition in which the neural arches fail to form or close posteriorly

64
Q

What are the important clinical consequences of spina bifida with myelomeningocele

A

the vertebrae are often malformed, causing serious spinal deformity such as scoliosis and kyphosis

65
Q

Describe where the cord lies in spina bifida with myelomeningocele and what does this result in

A

It is opened out on the surface and is functionally abnormal resulting in lower limb and possibly trunk paralysis with paralysis of the bladder and anal sphincter

66
Q

What is a scoliosis

A

lateral curvature of the spine

67
Q

What is congenital torticollis

A

A condition in which the child develops a fixed, fusiform swelling in one sternomastoid muscle

Lecture Notes- Orthopaedics and Fractures (23 decks)

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