msk cortex - paediatric orthopaedics Flashcards
What type of collagen disorder is osteogenesis imperfect a
Type 1
How does osteogenesis imperfecta present
Blue sclera
Fragility fractures
Short stature with multiple deformities
Loss of hearing
*aka brittle bone disease
Is autosomal dominant
What is the most recognised type of skeletal dysplasia
Achondroplasia - disproportionately short limbs with a prominent forehead and widened nose
What type of collage results in joint hypermobility
Type 1 - mainly affects bone tendon and ligaments
Eye problems associated with Marfan’s
Lens dislocation and retinal detachment
Heart problems associated with Marfans
Aortic aneurysm
Cardiac valve abnormalities
What type of inheritance pattern are muscular dystrophies
Usually x-linked recessive (only affects boys)
What is Gower’s sign?
+ duchenne muscular dystrophy
Prognosis of patients with duchenne muscular dystrophy
Poor :(
By age 20 there is progressive cardiac and respiratory failure —> death in the early 20s usually
Diagnosis of duchenne muscular dystrophy
Raised serum creatinine phosphokinase and abnormalities on muscle biopsy
Management of duchenne muscular dystrophy
Physiotherapy
Splintage
Deformity correction
Severe scoliosis can be corrected by spinal surgery
What is the most common type of Cerebral palsy
Spastic - 80%
Non-pharmacological treatment of cerebral palsy
Physiotherapy
Splintage
Management of Cerebral palsy
Baclofenac - given in the subarachnoid space
Botox - reduce spasticity
Surgery - hip excision or replacement to treat a painful hip dislocation
What is spina bifida
Two halves of the posterior vertebral arch fail to fuse
There are two types - oculta and cytsica
Oculta = pes cavus
Cystica = herniating of vertebral canal - type of myelomeningoceal
What is Erb’s palsy
Type of obstetric brachial plexus palsy
With injury to the upper C5-C6 nerve roots resulting in loss of motor innervation of deltoid , supraspinatus , infraspinatus , biceps and brachialis muscles
*waiter’s tip posture
Erb’s palsy
Due to internal rotation of the humerus
Treatment of Erb’s palsy
Physiotherapy —> good prognosis
Surgical release of contracture and tendons also may be required if there is no recovery
What is Klumpke’s palsy ?
Another brachial plexus palsy - and is due to injury or lower brachial plexus roots (C8-T1)
Leads to paralysis of intrinsic hand muscles
Parents worried about child of 3 years knees - concerns of knock knee . What to do ?
Reassure
Vast majority develop normal alignment by age 7-9years
What is considered pathological varus of valgus ?
+/- 6 degrees from normal range from mean value for age
Causes of genu valgum and Varum
Rickets
Trauma
Bone tumours
Causes of in-toeing
Femoral neck anteversion
Internal tibial torsion
Forefoot adduction
T/F all feet are flat when born
True
Treatment of flexible ped planus
In children is a normal variant
Adults - may be related to tibialis anterior tendon dysfunction
What is the rigid type of flat footedness
When dorsiflexion of great toe doesn’t affect arch - remains flat
Usually due to tarsal coalition
May require surgery
After Ortolani and Barlow on suspicion of DDH - which investigation is next ?
Ultrasound
(X-rays cannot be used for early diagnosis of DDH as femoral head epiphysis is unossified until 4-6months - after this then X-rays are the preferred modality of choice)
Management of DDH if persistent dislocation after 18months old
Open reduction
Most common cause of hip pain in childhood
Transient synovitis of the hip
How does transient synovitis of the hip present ?
Limp
Reluctance to weight bear
Range of motion may also be restricted
Treatment of transient synovitis
Short course of NSAIDs + rest
Generally resolves in a few weeks , but if persists then consider another cause of hip pain
Who gets Perthes disease
Very active boys that are short
What is Perthe’s
The femoral heads transiently loses its blood supply resulting in necrosis with subsequent abnormal growth
The femoral head may collapse on fracture —> subsequent remodelling occurs however the head shape and congruence depends on age —> can lead to early onset arthritis
How does perthes present
Hip pain and limp
Pain is usually unilateral
Loss of internal rotation is the first clinical sign , then loss of abduction and later a + Trendelendburg from gluteal weakness
Treatment of Perthes’
X-ray surveillance is all that is needed in 50%
However some may need osteotomy
How does SUFE present ?
Hip pain (bilateral usually)
Limp
Pain may radiate to groin
Can also present with only knee pain ! (Obturator nerve)
Treatment of SUFE
Urgent surgery to pin femoral head from further slipping out
In some severe cases may need hip replacement in early adulthood
What is important to remember when someone is presenting with solely knee or hip pain ?
Could be referred pain from either (obturator nerve)
Ie knee pain but problem is with the hip
Treatment of Osgood Schlatters
Rest and physio
Treatment of patellar tendonitis
Self - limiting
Rest + physio is all that is needed
What is clubfoot
Congenital deformity of foot due to abnormal alignment of joints between talus, calcaneus, and navicular
50% cases are bilateral
How does clubfoot present ?
Ankle equinus / plantarflexion
Supination of forefoot
Varus alignment of the forefoot
Who gets clubfoot
Boys are doubly likely to get this
Also breech presentation and family history
Treatment of clubfoot
Early diagnosis = Splintage ‘ponsetti’
Late diagnosis —> not so great as difficult to correct as they develop fixed flexion deformity = surgery
What is the Ponseti technique ?
In treatment of early diagnosed clubfoot
Foot held in plaster cast with 5-6 weekly changes
80% of children with clubfoot require tenotomy to maintain a full correction
Treatment of hallucx valgus
Surgical correction
What is spondylolisthesis
Slippage of one vertebra over another and usually occurs at L4/L5 or L5/S1
How does spondylolithesis present
Low pack pain
Radiculopathy (severe)
‘Flat back’
Waddling gait (acutely)
Treatment of slipped vertebra
Minor slip = observation + rest + physio
Major = stabilisation and possibly reduction
