Developmental Disorders

Question 1

What is the most common congenital fusion? What can this cause later in life?

Answer 1

Tarsal coalition- may cause painful flat feet

Question 2

What is the treatment for tarsal coalition?

Answer 2

Surgical division

Question 3

How can congenital developmental disorders occur?

Answer 3

Can be genetic (autosomal dominant) or an insult to the developing limb bud at 4-6 weeks gestation

Question 4

What is syndactyly?

Answer 4

Failure of separation of 2 digits

Question 5

Most cases of syndactyly require surgical separation at what age?

Answer 5

3/4

Question 6

What is polydactyly? How should this be treated?

Answer 6

An extra digit, should be surgically removed

Question 7

What is fibular hemimelia?

Answer 7

The partial or complete absence of the fibula

Question 8

As well as the fibula, what else may be missing in fibular hemimelia?

Answer 8

The lateral 2 metatarsals

Question 9

What deformities is fibular hemimelia associated with?

Answer 9

Shortening of the leg, bowing of the tibia, deformities of the ankle

Question 10

How are mild cases of fibular hemimelia treated?

Answer 10

Limb lengthening (circular frame external fixator)

Question 11

How are severe cases of fibular hemimelia treated?

Answer 11

Amputation and use of a below knee prosthetic

Question 12

What is radial club hand?

Answer 12

Absence of the radial bone and sometimes also the thumb

Question 13

What is proximal focal femoral deficiency? How is this treated?

Answer 13

Bowed and shortened femur, can be lengthened but some require amputation

Question 14

What are some factors which make obstetric brachial palsies more common?

Answer 14

Large baby, diabetic mum, twin deliveries, shoulder dystocia

Question 15

What is shoulder dystocia?

Answer 15

The baby’s shoulder catches on the pubic bone

Question 16

Where does Erb’s palsy affect?

Answer 16

Upper brachial plexus, C5/6

Question 17

Erb’s palsy results in the weakness and loss of motor innervation of which muscles?

Answer 17

Deltoid, supraspinatus, infraspinatus, biceps and brachialis

Question 18

How will the upper limb look in Erb’s palsy?

Answer 18

Internal rotation (waiter’s tip posture)

Question 19

Why is the upper limb medially rotated in Erb’s palsy?

Answer 19

Because the subscapularis is not affected

Question 20

What treatment is required in Erb’s palsy to prevent contractors early on?

Answer 20

Physiotherapy

Question 21

What implies a good prognosis in cases of Erb’s palsy?

Answer 21

If biceps function has resumed by 6 months

Question 22

If there is no recovery from Erb’s palsy, this can cause contractures. How can these be treated?

Answer 22

Release contractures and tendon transfers

Question 23

Which is rarer, Erb’s palsy or Klumpke’s palsy?

Answer 23

Klumpke’s

Question 24

Where does Klumpke’s palsy affect? How?

Answer 24

Lower brachial plexus, C8/T1 from forceful adduction

Question 25

What is the result of Klumpke’s palsy?

Answer 25

Paralysis of the intrinsic hand muscles and possible paralysis of the wrist and finger flexors

Question 26

Klumpke’s palsy can result in Horner’s syndrome. How?

Answer 26

Due to interruption of the 1st sympathetic ganglion at T1

Question 27

What is the recovery rate for Klumpke’s palsy? What is the treatment?

Answer 27

50% recovery, no specific treatment

Question 28

What is the classical position of a hand with Klumpke’s palsy?

Answer 28

The fingers are flexed

Question 29

What type of brachial plexus palsy has the worst prognosis?

Answer 29

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