Congenital and Developmental conditions

Question 1

What is the dominant feature in the unstable hip

What is lost in DDH

Answer 1

capsular laxity

the tight fit between the femoral head and acetabulum is lost

Question 2

What sex is more commonly affected by DDH

Answer 2

girls

Question 3

What are the two manoeuvres carried out to test for DDH

Answer 3

Ortolani and Barlow’s manouvres

Question 4

What makes an Ortolani’s sign positive

Answer 4

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

Question 5

What is a positive Barlow’s sign

Answer 5

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

Question 6

What are signs of DDH later in life

Answer 6

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

Question 7

When are most late cases of DDH spotted

Answer 7

when the child starts to walk

Question 8

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

Answer 8

Trendelenburg gait due to inefficiency of the abductor muscles

Question 9

How is DDH managed

Answer 9

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

Question 10

How long can a child wear a a Pavlik harness for

Answer 10

until the age of 6 months

Question 11

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

Answer 11

closed reduction

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

Question 12

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

Answer 12

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

Question 13

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

Answer 13

open reduction - femoral osteotomy

Question 14

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

Answer 14

avascular necrosis of the femoral head

Question 15

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

Answer 15

Relatively common

adolescent girls

Question 16

How does the knee lock in patella dislocation

Answer 16

in flexion

Question 17

How is recurrent patellar dislocation treated

Answer 17

transplantation of the patellar tendon more medially

Question 18

What is genu valgum

Answer 18

knock knees

Question 19

Up until what age is knock knee “normal”

Answer 19

around the age of 6

Question 20

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

Answer 20

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

Question 21

How do staples help genu valgum

Answer 21

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

Question 22

What is Tibia vara and what does it result in

Answer 22

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

Question 23

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

Answer 23

Osteotomy of the upper end of the tibia

Question 24

What is pseudoarthrosis of the tibia

Answer 24

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

Question 25

What happens in discoid meniscus

Answer 25

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

Question 26

What does a patient with discoid meniscus complain of

Answer 26

knee joint pain | snapping and swelling

Question 27

What is useful in confirming the diagnosis of a discoid meniscus

Answer 27

MRI

Question 28

What is meant by equinus

Answer 28

the hindfoot is plantar flexed at the ankle

Question 29

What is meant by calcaneus

Answer 29

the hindfoot is dorsiflexed at the ankle

Question 30

What is meant by varus

Answer 30

the hindfoot is adducted or inverted when looked at from behind

Question 31

What is meant by valgus

Answer 31

the hindfoot is abducted or everted when looked at from behind

Question 32

What is meant by cavus

Answer 32

the longitudinal arch is higher than normal

Question 33

What is meant by planus

Answer 33

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

Question 34

Using anatomical vocab describe the appearance of a flat foot

Answer 34

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

Question 35

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

Answer 35

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

Question 36

What is congenital vertical talus or convex pes valgus

Answer 36

dorsolateral dislocation of the navicular on the talus | The hindfoot is in a fixed equinovalgus position and the midfoot is dorsiflexed

Question 37

What appearance foes congenital vertical talus or convex pes valgus have

Answer 37

persian slipper

Question 38

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

Answer 38

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

Question 39

What is characteristic of metatarsus adductus or metatarsus virus

Answer 39

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

Question 40

What is the treatment for metatarsus adductus or metatarsus virus

Answer 40

stretching exercises splints/ braces serial casting

Question 41

What is the more common name for congenital talipes equinovarus

Answer 41

club foot

Question 42

What characterises club foot

Answer 42

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

Question 43

What are the deformities of club foot

Answer 43

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

Question 44

When should treatment of clubfoot be started

Answer 44

ASAP

Question 45

What is the gold standard treatment for club foot

Answer 45

Manipulation and serial casting

Question 46

What is syndactyly

Answer 46

fusion of digits

Question 47

Why does syndactyly occur

Answer 47

failure of separation of the digits in utero

Question 48

When is surgical separation carried out

Answer 48

12 months

Question 49

When do we separate toes

Answer 49

never - does not cause functional limitations

Question 50

What happens in Madelung's deformity

Answer 50

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

Question 51

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

Answer 51

Girls | Turner's syndrome, achondroplasia and Ollier's disease

Question 52

What does surgery involve in Madelung's deformity

Answer 52

Corrective osteotomies

Question 53

What is cerebral palsy

Answer 53

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

Question 54

What is the aetiology of CP

Answer 54

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

Question 55

What does persistent spasticity lead to in CP

Answer 55

short muscles contractures bony deformity joint subluxation and dislocation

Question 56

What is spasticity

Answer 56

an upper motor neurone type defect | characterised by increased muscle tone and reflexes

Question 57

What is Athetosis in CP

Answer 57

the limbs move at random, with jerking and uncoordinated movements

Question 58

What is the Topographic classification based on

Answer 58

the degree of limb involvement

Question 59

What are the 3 classifications in Topographic classification

Answer 59

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

Question 60

What are the main aims in surgery for CP

Answer 60

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

Question 61

Where are congenital malformation of the spine most common

Answer 61

lower thoracic, lumbar, and sacral regions

Question 62

What is the commonest congenital malformation of the spin

Answer 62

spina bifida

Question 63

What is spinal dysraphism

Answer 63

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

Question 64

What are the important clinical consequences of spina bifida with myelomeningocele

Answer 64

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

Question 65

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

Answer 65

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

Question 66

What is a scoliosis

Answer 66

lateral curvature of the spine

Question 67

What is congenital torticollis

Answer 67

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