Congenital and Developmental conditions Flashcards
What is the dominant feature in the unstable hip
What is lost in DDH
capsular laxity
the tight fit between the femoral head and acetabulum is lost
What sex is more commonly affected by DDH
girls
What are the two manoeuvres carried out to test for DDH
Ortolani and Barlow’s manouvres
What makes an Ortolani’s sign positive
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
What is a positive Barlow’s sign
the femoral head is palpated as it exist the acetabulum partially or completely
What are signs of DDH later in life
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
When are most late cases of DDH spotted
when the child starts to walk
What is the characteristic gait that a child with DDH walks with
Trendelenburg gait due to inefficiency of the abductor muscles
How is DDH managed
Splinting the limb in abduction usually allows reduction and stabilisation of this hip using the Pavlik harness
How long can a child wear a a Pavlik harness for
until the age of 6 months
What is the treatment for a child aged between 6 months and 2 years for DDH
closed reduction
proximal femoral head is gently manipulated into he acetabulum by applying traction with flexion and abduction
What are some obstacles to reduction in DDH for 6 months -2 years
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
What is usually the treatment for a child over the age of 2 years with DDH
open reduction - femoral osteotomy
What is a recognised complication of DDH treatment in a child over the age of 2
avascular necrosis of the femoral head
How common is recurrent dislocation of the patella and who does it affect
Relatively common
adolescent girls
How does the knee lock in patella dislocation
in flexion
How is recurrent patellar dislocation treated
transplantation of the patellar tendon more medially
What is genu valgum
knock knees
Up until what age is knock knee “normal”
around the age of 6
What should be done if genu valgum is still present at age 11/12
correction by inserting staples across the inner side of the femoral or both the femoral and tibial epiphyses
How do staples help genu valgum
They slow down growth on that side and the knee gradually straightens out
What is Tibia vara and what does it result in
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
What is the treatment for tibia vara (Blount’s disease)
Osteotomy of the upper end of the tibia
What is pseudoarthrosis of the tibia
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
What happens in discoid meniscus
The lateral meniscus of the knee fails to develop normally remaining as a complete disc
What does a patient with discoid meniscus complain of
knee joint pain
snapping and swelling
What is useful in confirming the diagnosis of a discoid meniscus
MRI
What is meant by equinus
the hindfoot is plantar flexed at the ankle
What is meant by calcaneus
the hindfoot is dorsiflexed at the ankle
What is meant by varus
the hindfoot is adducted or inverted when looked at from behind
What is meant by valgus
the hindfoot is abducted or everted when looked at from behind
What is meant by cavus
the longitudinal arch is higher than normal
What is meant by planus
The arch is flattened (and the foot is usually valgus)
Using anatomical vocab describe the appearance of a flat foot
The hindfoot is valgus and the sole faces laterally (pronation)
Describe the appearance of a foot in a child with calcaneo valgus
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
What is congenital vertical talus or convex pes valgus
dorsolateral dislocation of the navicular on the talus
The hindfoot is in a fixed equinovalgus position and the midfoot is dorsiflexed
What appearance foes congenital vertical talus or convex pes valgus have
persian slipper
What is the treatment for congenital vertical talus or convex pes valgus
Manipulation and serial casting
the corrective forces applied must be opposite to those for talipes equinovarus correction
if this fails, surgery is required
What is characteristic of metatarsus adductus or metatarsus virus
medial deviation of the forefoot on the hindfoot resulting in the forefoot pointing inwards
What is the treatment for metatarsus adductus or metatarsus virus
stretching exercises
splints/ braces
serial casting
What is the more common name for congenital talipes equinovarus
club foot
What characterises club foot
complex malalignment of the bones and joints of the foot and ankle
What are the deformities of club foot
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
When should treatment of clubfoot be started
ASAP
What is the gold standard treatment for club foot
Manipulation and serial casting
What is syndactyly
fusion of digits
Why does syndactyly occur
failure of separation of the digits in utero
When is surgical separation carried out
12 months
When do we separate toes
never - does not cause functional limitations
What happens in Madelung’s deformity
the polar ulnar aspect of the distal radial physics fails to develop normally so that the radius becomes bowed with an oblique distal end
Who does Madelung’s deformity occur in and what might it be associated with
Girls
Turner’s syndrome, achondroplasia and Ollier’s disease
What does surgery involve in Madelung’s deformity
Corrective osteotomies
What is cerebral palsy
Disorder of movement and posture resulting from injury to the immature brain
What is the aetiology of CP
intrauterine developmental defects
birth trauma
asphysxia
diseases or injuries in early life
What does persistent spasticity lead to in CP
short muscles
contractures
bony deformity
joint subluxation and dislocation
What is spasticity
an upper motor neurone type defect
characterised by increased muscle tone and reflexes
What is Athetosis in CP
the limbs move at random, with jerking and uncoordinated movements
What is the Topographic classification based on
the degree of limb involvement
What are the 3 classifications in Topographic classification
Hemiplegia - upper and lower limbs on the same side
Diplegia - involvement of both lower limbs
Quadriplegia - all four limbs are involved
What are the main aims in surgery for CP
to correct any established deformity and to restore muscle balance and diminish spasticity
Where are congenital malformation of the spine most common
lower thoracic, lumbar, and sacral regions
What is the commonest congenital malformation of the spin
spina bifida
What is spinal dysraphism
a condition in which the neural arches fail to form or close posteriorly
What are the important clinical consequences of spina bifida with myelomeningocele
the vertebrae are often malformed, causing serious spinal deformity such as scoliosis and kyphosis
Describe where the cord lies in spina bifida with myelomeningocele and what does this result in
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
What is a scoliosis
lateral curvature of the spine
What is congenital torticollis
A condition in which the child develops a fixed, fusiform swelling in one sternomastoid muscle
