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MSK > O: Paediatric Orthopaedics > Flashcards

O: Paediatric Orthopaedics Flashcards

1
Q

what are the 4 congenital disorders?

A

osteogenesis imperfecta, skeletal dysplasia, marfan’s syndrome, ehlers-danlos syndrome

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2
Q

what is osteogenesis imperfecta?

A

defect of maturation and organisation of T1 collagen

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3
Q

aetiology of osteogenesis imperfecta?

A

mutation to T1 collagen genes- COL1A1/ COL1A2

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4
Q

which types of osteogenesis imperfecta are the most severe?

A

T3 & T4

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5
Q

s/s of osteogenesis imperfecta?

A

multiple fragility fractures in childhood, short stature with multiple other deformities, blue sclerae, loss of hearing, scoliosis

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6
Q

what are some x-ray findings of osteogenesis imperfecta?

A

calloused bone healing and thin cortices

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7
Q

mx of osteogenesis imperfecta?

A

treat fractures, bisphosphonates. no cure

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8
Q

what should you be aware of when treating osteogenesis imperfecta?

A

non accidental injury and osteopenia as both may result in multiple fracture presentations

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9
Q

what is skeletal dysplasia?

A

dwarfism

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10
Q

types of skeletal dysplasia?

A

proportionate, disproportionate (limbs shorter than spine),

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11
Q

which is the most common type of skeletal dysplasia?

A

Achondroplasia: short limbs, prominent forehead, widened nose

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12
Q

what is Marfan’s syndrome?

A

autosomal dominant mutation of fibrillin gene

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13
Q

s/s of Marfan’s?

A

tall stature, disproportionate long limbs, ligamentous laxity, high arched palate, pacts excavatum

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14
Q

main complications of Marfan’s?

A

aortic aneurysm, cardiac myopathy

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15
Q

what is ehlers- dances syndrome?

A

heterogenous condition often autosomal dominant of abnormal elastin and collagen formation

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16
Q

s/s of Ehlers-danlos?

A

profound jt jypermobility,vascular fragility, ease of bruising, jt instability, scoliosis

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17
Q

what is cerebral palsy?

A

umbrella term for disorders that are apparent at birth that are characterised by non-progressive motor deficits

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18
Q

epi of cerebral palsy?

A

onset before 2-3yo

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19
Q

aetiology of cerebral palsy?

A

1/10 due to problems during labour- prematurity, hypoxia, intrauterine infections, cerebral insults, neonatal meningitis

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20
Q

s/s of cerebral palsy?

A

learning difficulties, failure to achieve developmental milestones, motor issues develop later- typically spastic displegia

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21
Q

what 2 other conditions are often associated with cerebral palsy?

A

autism and ADHD

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22
Q

what is scoliosis?

A

sideways curvature of spine

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23
Q

epi of scoliosis?

A

3% of adolescents, F>M

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24
Q

aetiology of scoliosis

A

widely unknown, hereditary

  • Heuter-Volkmann’s Law
  • triangular spine (growth spurt)
  • trunk rotation while walking
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25
what is Heuter-Volkmann's Law
inc pressure across epiphyseal plate
26
3 main groups of scoliosis causes?
congenital, neuromuscular, myopathic (Deuchene Muscular Dystrophy)
27
ix for scoliosis
x-ray and forward bend test
28
mx for scoliosis
bracing, surgery
29
criteria for surgical intervention in scoliosis?
>45º, thoracic/ lumbar spine, high chance of curve progression, cosmetically unacceptable, cerebral palsy/ spina bifida, breathing difficulties
30
risk factors for curve progression in scoliosis
pre-menarche, growth spurt, angle >30º, right thoracic curve in girls
31
what are 3 other spinal defects in kids?
kyphosis: outward curve of spine spondylosis: stress fracture of isthmus of vertebral arch spondylolisthesis: displacement of vertebra due to spondylosis
32
what is developmental dysplasia (DDH)
ball and socket jt of hip doesn't form properly
33
what does DDH result in?
dislocation and sublimation of hip
34
epi of DDH?
8:1 F:M, 1st born, left hip
35
types of DDH?
early <3 months | late onset >3months
36
aetiology of DDH?
fhx, pregnancy- breech position, moulded baby, >4kg, twins, Down's Syndrome
37
what is the usually pathophysiology of DDH?
socket is too shallow for femoral head
38
s/s of DDH?
fairly asymptomatic- mothers concerns, clicking hip
39
what may be some typical late onset DDH presentations?
limping, difficulty running, external rotation of foot
40
early investigation for DDH?
ALAC exam: asymmetry, loss of knee height, less abduction in flexion, crease asymmetry, USS <6weeks
41
T/F: x-ray is investigation of choice for early DDH presentation
F: investigation of choice for late presentation DDH
42
what is the test where clicking of hip is a +ve finding for DDH?
Barlow/Ortolani test
43
T/F: Ortolani is adduction and downward pressure of hip
F: Ortolani is abduction and upward lift, Barlow is adduction and downward pressure
44
tx for early diagnosed DDH?
Pavlik Harness
45
tx for late (>18months) diagnosed DDH?
surgery
46
what is slipped upper femoral epiphysis?
fracture of the epiphyseal plate causing femoral head to slip out of socket
47
epi of SUFE?
8-18yo, afro-caribbean, overweight pre-pubertal boys, 1/10,000
48
possible aetiology of SUFE?
rapid pubertal growth, hypothyroidism
49
s/s of SUFE?
knee pain, groin/ hip pain, limp, loss of internal rotation of hip
50
tx for SUFE?
surgery to hold femoral head in place
51
what is transient synovitis?
inflammation of hip joint
52
epi of transient synovitis?
pre-pubescent children, no1 cause of hip pain in kids, boys
53
aetiology of transient synovitis of hip?
viral infection from elsewhere commonly URTI
54
s/s of transient synovitis of hip?
fever, limp, hip pain, antalgic gait (can't weight bare)
55
how to tx transient synovitis?
NSAIDs and bed rest
56
what must you exclude before treating transient synovitis?
septic arthritis
57
what is Perthes disease?
avascular necrosis of femoral head
58
epi of Perthes?
1/9000, males, 4-9yo, active boys of short stature, unilateral
59
pathophysiology of Perthes?
femoral head transiently loses blood supply > necrosis > abnormal growth > susceptible to fracture > remodelling
60
s/s of Perthes?
pain in groin, thigh, knee, stiffness in hip jt waxes and wains loss of internal rotation
61
ix for Perthes?
x-ray, MRI, +ve trandellenburg test
62
tx for Perthes?
60% self resolve, reduce impactful activity, physio and plastering may be useful
63
what is a complication of Perthes?
coxa vara (angle between femoral head and socket is <120º)
64
T/F: Genu Varum is knock kneed
F: Genu Varum is bow legs, Genu Valgum is knock kneed
65
when is genu varum worrying?
if unilateral or >16º
66
what is Blount's Disease?
growth arrest of tibial epiphysis of unknown aetiology
67
at what age is bracing/ splinting considered in genu valgum?
at age 8
68
what is Osgood-Schlatter's Disease?
inflammation of tibial tubercle apophysis
69
aetiology of osgood-schlatter's?
body wt inc and more sport played, F>M
70
s/s of osgood-schlatter's?
localised patellar tenderness, anterior knee pain, hurts to do stairs/squat
71
tx for osgood?
physio and rest
72
what is anterior knee pain aetiology?
usually patellofemoral dysfunction due to muscle imbalance, ligamentous laxity, subtle skeletal predisposition
73
what is the major risk associated with osteochondritis dissecans?
a loosened body in knee leading to premature arthritis
74
what are 5 feet deformities?
tip toe walking, clubfeet, rocker bottom feet, flat feet, curly toes
75
T/F: clubfeet is midline deviation of feet
T: and rocker bottom are eversion of feet
76
what are some causes of clubfeet?
Larson's syndrome, abnormal alignment of talus, calcaneus, navicular bones
77
what are the 2 types of flat feet
rigid (bony connection), flexible
78
main tx for clubfeet?
ponseti method (gentle stretching and casting)
79
reverse ponseti is used for...
rocker bottom feet
80
what are curly toes?
overlapping of toes
81
for foot pathologies always check...
SPINE!
82
for knee pain always check...
HIPS!
83
a high arched foot is characteristic of which condition?
hereditary sensory motor neuropathy (HSMN)
84
T/F: girls are more prone to fractures
F: boys are
85
what are the 2 peaks of child injuries?
6/7yo and puberty
86
types of child fractures?
greenstick, torus fractures, plastic deformation, salter-harris breaks
87
greenstick fractures are...
incomplete fractures
88
FOOSH cause which child fracture?
torus fracture
89
bent bone is...
plastic deformation fracture
90
what is a salter-harris fracture?
fracture involving the epiphyseal plate (growth plate)
91
4 signs of fracture?
pain, swelling, deformity, bruise
92
Ix for fractures?
exam (look, feel, move, always check neuromuscular status) | x-ray, CT/MRI, arthrogram
93
how to tx a fracture?
reduce (open or closed or bracing), retain (splinter, plaster)
94
in which fracture should you apply counter traction in the form of a Thomas Splint?
femur fractures in older kids
95
when are ex-fixes good?
contaminated wounds, vascular injury, burns, soft tissue with bone injuries
96
when in a hx should you suspect NAI?
hx that doesn't match nature of injury, vague recounts, accusation that child hurt itself, delay in seeking help, poor child presentation
97
s/s consistent with NAI?
<2 yo having a fracture, injuries in various stages of healing, more injuries than other children same age, inc intracranial pressure, intra-abdominal injuries

MSK (26 decks)

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