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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
Q

what is Heuter-Volkmann’s Law

A

inc pressure across epiphyseal plate

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26
Q

3 main groups of scoliosis causes?

A

congenital, neuromuscular, myopathic (Deuchene Muscular Dystrophy)

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27
Q

ix for scoliosis

A

x-ray and forward bend test

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28
Q

mx for scoliosis

A

bracing, surgery

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29
Q

criteria for surgical intervention in scoliosis?

A

> 45º, thoracic/ lumbar spine, high chance of curve progression, cosmetically unacceptable, cerebral palsy/ spina bifida, breathing difficulties

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30
Q

risk factors for curve progression in scoliosis

A

pre-menarche, growth spurt, angle >30º, right thoracic curve in girls

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31
Q

what are 3 other spinal defects in kids?

A

kyphosis: outward curve of spine
spondylosis: stress fracture of isthmus of vertebral arch
spondylolisthesis: displacement of vertebra due to spondylosis

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32
Q

what is developmental dysplasia (DDH)

A

ball and socket jt of hip doesn’t form properly

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33
Q

what does DDH result in?

A

dislocation and sublimation of hip

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34
Q

epi of DDH?

A

8:1 F:M, 1st born, left hip

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35
Q

types of DDH?

A

early <3 months

late onset >3months

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36
Q

aetiology of DDH?

A

fhx, pregnancy- breech position, moulded baby, >4kg, twins, Down’s Syndrome

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37
Q

what is the usually pathophysiology of DDH?

A

socket is too shallow for femoral head

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38
Q

s/s of DDH?

A

fairly asymptomatic- mothers concerns, clicking hip

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39
Q

what may be some typical late onset DDH presentations?

A

limping, difficulty running, external rotation of foot

40
Q

early investigation for DDH?

A

ALAC exam: asymmetry, loss of knee height, less abduction in flexion, crease asymmetry, USS <6weeks

41
Q

T/F: x-ray is investigation of choice for early DDH presentation

A

F: investigation of choice for late presentation DDH

42
Q

what is the test where clicking of hip is a +ve finding for DDH?

A

Barlow/Ortolani test

43
Q

T/F: Ortolani is adduction and downward pressure of hip

A

F: Ortolani is abduction and upward lift, Barlow is adduction and downward pressure

44
Q

tx for early diagnosed DDH?

A

Pavlik Harness

45
Q

tx for late (>18months) diagnosed DDH?

A

surgery

46
Q

what is slipped upper femoral epiphysis?

A

fracture of the epiphyseal plate causing femoral head to slip out of socket

47
Q

epi of SUFE?

A

8-18yo, afro-caribbean, overweight pre-pubertal boys, 1/10,000

48
Q

possible aetiology of SUFE?

A

rapid pubertal growth, hypothyroidism

49
Q

s/s of SUFE?

A

knee pain, groin/ hip pain, limp, loss of internal rotation of hip

50
Q

tx for SUFE?

A

surgery to hold femoral head in place

51
Q

what is transient synovitis?

A

inflammation of hip joint

52
Q

epi of transient synovitis?

A

pre-pubescent children, no1 cause of hip pain in kids, boys

53
Q

aetiology of transient synovitis of hip?

A

viral infection from elsewhere commonly URTI

54
Q

s/s of transient synovitis of hip?

A

fever, limp, hip pain, antalgic gait (can’t weight bare)

55
Q

how to tx transient synovitis?

A

NSAIDs and bed rest

56
Q

what must you exclude before treating transient synovitis?

A

septic arthritis

57
Q

what is Perthes disease?

A

avascular necrosis of femoral head

58
Q

epi of Perthes?

A

1/9000, males, 4-9yo, active boys of short stature, unilateral

59
Q

pathophysiology of Perthes?

A

femoral head transiently loses blood supply > necrosis > abnormal growth > susceptible to fracture > remodelling

60
Q

s/s of Perthes?

A

pain in groin, thigh, knee,
stiffness in hip jt
waxes and wains
loss of internal rotation

61
Q

ix for Perthes?

A

x-ray, MRI, +ve trandellenburg test

62
Q

tx for Perthes?

A

60% self resolve, reduce impactful activity, physio and plastering may be useful

63
Q

what is a complication of Perthes?

A

coxa vara (angle between femoral head and socket is <120º)

64
Q

T/F: Genu Varum is knock kneed

A

F: Genu Varum is bow legs, Genu Valgum is knock kneed

65
Q

when is genu varum worrying?

A

if unilateral or >16º

66
Q

what is Blount’s Disease?

A

growth arrest of tibial epiphysis of unknown aetiology

67
Q

at what age is bracing/ splinting considered in genu valgum?

A

at age 8

68
Q

what is Osgood-Schlatter’s Disease?

A

inflammation of tibial tubercle apophysis

69
Q

aetiology of osgood-schlatter’s?

A

body wt inc and more sport played, F>M

70
Q

s/s of osgood-schlatter’s?

A

localised patellar tenderness, anterior knee pain, hurts to do stairs/squat

71
Q

tx for osgood?

A

physio and rest

72
Q

what is anterior knee pain aetiology?

A

usually patellofemoral dysfunction due to muscle imbalance, ligamentous laxity, subtle skeletal predisposition

73
Q

what is the major risk associated with osteochondritis dissecans?

A

a loosened body in knee leading to premature arthritis

74
Q

what are 5 feet deformities?

A

tip toe walking, clubfeet, rocker bottom feet, flat feet, curly toes

75
Q

T/F: clubfeet is midline deviation of feet

A

T: and rocker bottom are eversion of feet

76
Q

what are some causes of clubfeet?

A

Larson’s syndrome, abnormal alignment of talus, calcaneus, navicular bones

77
Q

what are the 2 types of flat feet

A

rigid (bony connection), flexible

78
Q

main tx for clubfeet?

A

ponseti method (gentle stretching and casting)

79
Q

reverse ponseti is used for…

A

rocker bottom feet

80
Q

what are curly toes?

A

overlapping of toes

81
Q

for foot pathologies always check…

A

SPINE!

82
Q

for knee pain always check…

A

HIPS!

83
Q

a high arched foot is characteristic of which condition?

A

hereditary sensory motor neuropathy (HSMN)

84
Q

T/F: girls are more prone to fractures

A

F: boys are

85
Q

what are the 2 peaks of child injuries?

A

6/7yo and puberty

86
Q

types of child fractures?

A

greenstick, torus fractures, plastic deformation, salter-harris breaks

87
Q

greenstick fractures are…

A

incomplete fractures

88
Q

FOOSH cause which child fracture?

A

torus fracture

89
Q

bent bone is…

A

plastic deformation fracture

90
Q

what is a salter-harris fracture?

A

fracture involving the epiphyseal plate (growth plate)

91
Q

4 signs of fracture?

A

pain, swelling, deformity, bruise

92
Q

Ix for fractures?

A

exam (look, feel, move, always check neuromuscular status)

x-ray, CT/MRI, arthrogram

93
Q

how to tx a fracture?

A

reduce (open or closed or bracing), retain (splinter, plaster)

94
Q

in which fracture should you apply counter traction in the form of a Thomas Splint?

A

femur fractures in older kids

95
Q

when are ex-fixes good?

A

contaminated wounds, vascular injury, burns, soft tissue with bone injuries

96
Q

when in a hx should you suspect NAI?

A

hx that doesn’t match nature of injury, vague recounts, accusation that child hurt itself, delay in seeking help, poor child presentation

97
Q

s/s consistent with NAI?

A

<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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