hip, spine, foot (paeds) Flashcards
what is in-toeing, what is it also known as
feet pointing towards the midline
aka pigeon toeing
what causes in-toeing
(in order of frequency)
metatarsal adductus
internal tibial torsion
femoral neck anteversion
a combo of the above
what is genu valgum
knock-knees
when does genu valgum peak?
3 1/2yrs
when would you suspect genu valgum is abnormal
unilateral/asymmetric
painful
severe
if intermalleolar distance >8cm by 11yrs
what are the pathological causes of genu valgum
tumours
rickets
neurofibromatosis
what is genu varum
bowed legs
at what age is genu varum normal
<2yrs
when would you suspect genu varum is abnormal
unilateral/asymmetrical
severe
short stature
painful
what are the pathological causes of genu varum
skeletal dysplasia
rickets
tumor
Blout’s disease
what is Blout’s disease
growth arrest of medial tibial of physics, aetiology unknown
what is the buzzword for Blout’s disease
beak-like protrusion
what is spondylolisthesis
slippage of one vertebra over another
at what spinal level does spondylolisthesis usually occur
L4/5
L5/S1
what are the causes of spondylolisthesis
developmental defect
recurrent stress fracture of posterior elements which fail to heal
what are the symptoms of spondylolisthesis? when do they present
present in adolescence
lower back pain
nerve pinching is slippage is severe
flat back = due t muscle spasm
waddling gait
what is the treatment of spondylolisthesis
minor = rest + physio
more severe = stabilisation +/- reduction
what is scoliosis
lateral curvature of the spine
what are the causes of scoliosis
idiopathic (most common) secondary to neuromuscular disease tumour skeletal dysplasia infection
investigations of scoliosis
X-ray
MRI but only if painful
treatment of scoliosis
mild/ non-progressive = nothing
large curve/progressive = surgery
what is Hallux valgus
a bunion
when/where does Hallux valgus occur
late in adolescence
on the foot
what is tarsal coalition
abnormal bridge (bony, fibrous, or cartilaginous) between the calcareous and navicular or between the talus and calcaneus leading to a fixed, flat foot deformity
what is talipes equinovarus
club foor
what are the risk factors of talipes equinovarus
make FM breech presentation low amniotic fluid content skeletal dysplasia
symptoms of talipes equinovarus
50% are bilateral
ankle equines (plantar flexion)
supination of foot
varus alignment of forefoot
treatment of talipes equinovarus
early splintage = Ponseti technique
late presentation = surgery
what is development dysplasia of the hip (DDH)
dislocation or subluxation of the femoral head during the perinatal period
what hip is more commonly affected in development dysplasia of the hip (DDH)
Left
what are the risk factors of development dysplasia of the hip (DDH)
female FH first born breech presentation down's syndrome lack of uterine fluid other congenital disorders
symptoms of development dysplasia of the hip (DDH)
shortening, asymmetric groin/thigh creases uneven leg lengths clicl/clunk in manoeuvres positive ortolani manoeuvre posotove Barlow manoeuvre
what is the Barlow manoeuvre
hip dislocated with flexion and posterior displacement
B for putting it Back/ posterior
what is the ortolani manoeuvre
dislocated hip can be reduced with abduction and anterior displacement
what are the investigations of development dysplasia of the hip (DDH)
<6 months = ultrasound
>6months = X-ray
what is the treatment of development dysplasia of the hip (DDH)
pavilik harness for 23hrs daily for 6 weeks = maintains correct position serial Ultrasound to document improvement
persistent dislocation >18motnhs = open or closed reduction + spica cast
if reducible = reduce then monitor
what is transient synovitis of the hip
self-limiting inflammation of the hip joint
what usually precedes transient synovitis of the hip
URT infection
who does transient synovitis of the hip most commonly affect
girls, 2-10yrs
what are the symptoms of transient synovitis of the hip
limp
reluctance to bear weight
restricted range of motion
low grade fever but NOT systemically unwell
what are the investigations of transient synovitis of the hip, what are their purpose
X-ray = exclude earths
CRP = exclude septic arthritis
aspirate hip
MRI = exclude osteomyelitis
what is the treatment of transient synovitis of the hip
shot course of NSAIDs + rest
what is perthes disease, what does it lead to
idiopathic osteochondritis of the femoral head which leads to avascular necrosis of the hip
who most commonly gets perthes disease
active boys with short stature
at what age does perthes disease occur
occurs between 4-9
what are the symptoms of perthes disease
pain gradual onset of painless limp unilateral loss of internal rotation loss of abduction postive trendelenburg test = gluteal weakness
what is the treatment of perthes disease
regular X-ray observation
avoid physical activity
what is slipped upper femoral epiphysis (SUFE)
Occurs when the proximal femoral head epiphysis slips inferiorly in relation the femoral neck
who is at risk of slipped upper femoral epiphysis (SUFE)
pre-pubertal, adolescent boys obese hypothyroidism renal disease growth spurt may preclude onset
what are the symptoms of slipped upper femoral epiphysis (SUFE)
1/3 bilateral
pain in knee and/or groin
loss of internal rotation of the hip
limp due to externally rotated foot
what are the investigations of slipped upper femoral epiphysis (SUFE), what would these show
lateral X-ray = ice cream fallen off it’s cone
what is the treatment of slipped upper femoral epiphysis (SUFE)
urgent surgery to pin femoral head in order to prevent further slips
