Module 11 - musculoskeletal

Question 1

3 causes of intoeing

Answer 1

persistent femoral anteversion - child prefers W sitting
internal tibial torsion
metatarsus adductus

Question 2

Causes of a limp in a child

Answer 2

post infection arthritis (septic arthritis)
osteoarthritis
slipped upper femoral epiphysis
transient synovitis
muscular dystrophy (in boys)
fracture
neurological - cerebral palsy

Question 3

Common cause of limp in child age 0-2?

Answer 3

Consider developmental hip dysplasia - look for a shallow acetabulum

Question 4

Risk factors for hip dysplasia

Answer 4

breech
first born
family history
female
oligohydramnios (low amniotic fluid)
twin

Baby carriers that put baby into ABduction are protective

Question 5

Investigations/examinations for hip dysplasia

Answer 5

Barlows - ADDuction with posterior force (dislocates)
Ortolani’s - ABduction with anterior force (relocates)
US - look for the alpha angle (>60 degrees normal) and also the shallowness (coverage >50% normal) of the acetabulum
Baby will have limited ABduction
Also look for skin fold symmetry - indicates shortening of legs

Question 6

Treatment for DDH?

Answer 6

Pavlik harness for the first 6mths
Closed reduction and hip spica up (plastic cast from waist to leg) to 18mths
Open reduction and acetabular osteotomy after 3yrs
Osteotomy - last resort

Question 7

Common causes of limp in adolescent 10-15yrs of age?

Answer 7

Slipped upper femoral epiphysis

Stress fracture

Tumours - sarcomas