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everything > msk cortex - paediatric orthopaedics > Flashcards

msk cortex - paediatric orthopaedics Flashcards

1
Q

What type of collagen disorder is osteogenesis imperfect a

A

Type 1

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2
Q

How does osteogenesis imperfecta present

A

Blue sclera
Fragility fractures
Short stature with multiple deformities
Loss of hearing

*aka brittle bone disease

Is autosomal dominant

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3
Q

What is the most recognised type of skeletal dysplasia

A

Achondroplasia - disproportionately short limbs with a prominent forehead and widened nose

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4
Q

What type of collage results in joint hypermobility

A

Type 1 - mainly affects bone tendon and ligaments

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5
Q

Eye problems associated with Marfan’s

A

Lens dislocation and retinal detachment

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6
Q

Heart problems associated with Marfans

A

Aortic aneurysm
Cardiac valve abnormalities

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7
Q

What type of inheritance pattern are muscular dystrophies

A

Usually x-linked recessive (only affects boys)

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8
Q

What is Gower’s sign?

A

+ duchenne muscular dystrophy

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9
Q

Prognosis of patients with duchenne muscular dystrophy

A

Poor :(

By age 20 there is progressive cardiac and respiratory failure —> death in the early 20s usually

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10
Q

Diagnosis of duchenne muscular dystrophy

A

Raised serum creatinine phosphokinase and abnormalities on muscle biopsy

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11
Q

Management of duchenne muscular dystrophy

A

Physiotherapy
Splintage
Deformity correction
Severe scoliosis can be corrected by spinal surgery

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12
Q

What is the most common type of Cerebral palsy

A

Spastic - 80%

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13
Q

Non-pharmacological treatment of cerebral palsy

A

Physiotherapy
Splintage

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14
Q

Management of Cerebral palsy

A

Baclofenac - given in the subarachnoid space
Botox - reduce spasticity

Surgery - hip excision or replacement to treat a painful hip dislocation

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15
Q

What is spina bifida

A

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

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16
Q

What is Erb’s palsy

A

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

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17
Q

*waiter’s tip posture

A

Erb’s palsy

Due to internal rotation of the humerus

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18
Q

Treatment of Erb’s palsy

A

Physiotherapy —> good prognosis

Surgical release of contracture and tendons also may be required if there is no recovery

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19
Q

What is Klumpke’s palsy ?

A

Another brachial plexus palsy - and is due to injury or lower brachial plexus roots (C8-T1)

Leads to paralysis of intrinsic hand muscles

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20
Q

Parents worried about child of 3 years knees - concerns of knock knee . What to do ?

A

Reassure

Vast majority develop normal alignment by age 7-9years

21
Q

What is considered pathological varus of valgus ?

A

+/- 6 degrees from normal range from mean value for age

22
Q

Causes of genu valgum and Varum

A

Rickets
Trauma
Bone tumours

23
Q

Causes of in-toeing

A

Femoral neck anteversion

Internal tibial torsion

Forefoot adduction

24
Q

T/F all feet are flat when born

A

True

25
Q

Treatment of flexible ped planus

A

In children is a normal variant

Adults - may be related to tibialis anterior tendon dysfunction

26
Q

What is the rigid type of flat footedness

A

When dorsiflexion of great toe doesn’t affect arch - remains flat

Usually due to tarsal coalition

May require surgery

27
Q

After Ortolani and Barlow on suspicion of DDH - which investigation is next ?

A

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)

28
Q

Management of DDH if persistent dislocation after 18months old

A

Open reduction

29
Q

Most common cause of hip pain in childhood

A

Transient synovitis of the hip

30
Q

How does transient synovitis of the hip present ?

A

Limp
Reluctance to weight bear
Range of motion may also be restricted

31
Q

Treatment of transient synovitis

A

Short course of NSAIDs + rest

Generally resolves in a few weeks , but if persists then consider another cause of hip pain

32
Q

Who gets Perthes disease

A

Very active boys that are short

33
Q

What is Perthe’s

A

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

34
Q

How does perthes present

A

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

35
Q

Treatment of Perthes’

A

X-ray surveillance is all that is needed in 50%

However some may need osteotomy

36
Q

How does SUFE present ?

A

Hip pain (bilateral usually)
Limp
Pain may radiate to groin

Can also present with only knee pain ! (Obturator nerve)

37
Q

Treatment of SUFE

A

Urgent surgery to pin femoral head from further slipping out

In some severe cases may need hip replacement in early adulthood

38
Q

What is important to remember when someone is presenting with solely knee or hip pain ?

A

Could be referred pain from either (obturator nerve)

Ie knee pain but problem is with the hip

39
Q

Treatment of Osgood Schlatters

A

Rest and physio

40
Q

Treatment of patellar tendonitis

A

Self - limiting

Rest + physio is all that is needed

41
Q

What is clubfoot

A

Congenital deformity of foot due to abnormal alignment of joints between talus, calcaneus, and navicular

50% cases are bilateral

42
Q

How does clubfoot present ?

A

Ankle equinus / plantarflexion
Supination of forefoot
Varus alignment of the forefoot

43
Q

Who gets clubfoot

A

Boys are doubly likely to get this

Also breech presentation and family history

44
Q

Treatment of clubfoot

A

Early diagnosis = Splintage ‘ponsetti’

Late diagnosis —> not so great as difficult to correct as they develop fixed flexion deformity = surgery

45
Q

What is the Ponseti technique ?

A

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

46
Q

Treatment of hallucx valgus

A

Surgical correction

47
Q

What is spondylolisthesis

A

Slippage of one vertebra over another and usually occurs at L4/L5 or L5/S1

48
Q

How does spondylolithesis present

A

Low pack pain
Radiculopathy (severe)
‘Flat back’
Waddling gait (acutely)

49
Q

Treatment of slipped vertebra

A

Minor slip = observation + rest + physio

Major = stabilisation and possibly reduction

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