ortho conditions in childhood Flashcards
average child usually sits by what age
9 months
average child usually stands by
1 year
average child usually walks by
20 months
by what age are most cases of genu varum and valgum normally corrected
age 7
causes of in-toeing
femoral neck anteversion
tibial torsion
abnormal forefeet
femoral neck ante version means the femur can be ? rotated a lot
internally rotated a lot
is tibial torsion a normal variation
yes and should be ignored
surgery to correct abnormal forefeet should not be considered until after age ?
7
is flat foot normal variation
yes
most types of flat foot are ?
mobile
are all childrens feet flat at birth
yes
what does rigid flat foot usually imply
underlying bony abnormality
occasionally its a sign of serious disease such as RA
what is osgood schlatter’s disease
inflammation of the attachment of the patellar tendon to the growing tibial epiphysis
what causes the inflammation in osgood schlatter’s disease
excess traction by the quadriceps
what is rarely seen in adolescent knee pain
chondromalacia patellae - eroded area of patellar cartilage
eroded area of patellar cartilage
chondromalacia patellae
how common is CDH
one or two live births per thousand
is the hip usually completely dislocated at birth in CDH?
rarely
CDH more common in girls or boys?
girls
what kind of tendency is there in CDH
familial and racial
when should children be screened for CDH?
at birth
3 m
6m
12 m
clinical signs of CDH
limb shortening
asymmetrical creases
limited adduction
limp
what is the next step of action if the CDH test produces a click
re examination at 3 m in a specialist clinic - radiograph usually justified
next step of action if CDH is discovered late but before weight bearing
gentle traction followed by open or closed manipulation
followed by splintage for
next step of action in CDH if discovered late and walking has commenced
major surgery to deepen the undeveloped acetabulum and re-angulate the femoral neck
secondary arthritis is highly likely
when is the mild, postural form of club foot seen
after breech
usually easily corrected at birth by manipulation
what is the fixed form of club foot associated with
developmental abnormalities of nerves and muscles of the leg
initial tx for club foot
in both forms: gentle stretching in 2 phases
1. correction of hind foot equinus
2. corrects the mid and forefoot varus
for 6 weeks
Until when do children with club foot need to be followed up
until their feet stop growing (around age 14)
why is follow up for club foot important?
late relapse requiring surgery is not uncommon
the affected foot in clubfoot is usually significantly larger than the normal foot - true or false?
false - usually SMALLER
is spina bifida occulta usually of significance?
usually not!
some people who are affected by spina bifida occult develop what?
a very small number may get what?
some people get mechanical backache
a very small number get tethering of the spinal cord to the higher lumbar vertebrae during growth (“diastamatomyelia”)
what is diastamatomyelia?
tethering of the spinal cord to the higher lumbar vertebrae during growth
what is spina bifida cystica?
baby is born with the neural plate tissues open with little or no skin or bony cover
what do many children with spina bifida cystica also have?
hydrocephalus
hydrocephalus leads to mental retardation - t or f
true
whats it called when nerve tissue is covered by a cyst
meningocele
meningomyocele if nerve tissue is incorporated into cyst wall
can spina bifida cystica be life threatening?
yes, many children die at or soon after birth
long term complications of spina bifida cystica
paralysis
growth deformities through muscle imbalance
incontinence
many are mentally retarded
many children with spina bifida cystic need early surgery to their ?
feet - to maintain a functional shape
if a child with spina bifida cystica develops joint contraction what can this result in?
fixed flexion of knees and dislocation of hips
children with spina bifida cystica should be encouraged to do minimal movement - t or f
false - they should keep mobile until adolescence so that they may grow to a reasonable size
in CP does spinal tissue develop normally?
yes, so they have uninhibited spinal reflexes
in terms of movement what do people with CP lack? what does this result in?
they lack co-ordination and purpose of movement normally controlled by the brain, resulting in a spastic type of paralysis
what causes joint deformity in CP
some muscles contract strongly (spastic) and some are weak and flaccid»_space; imbalance»_space; abnormal muscle and bone growth»_space; joint deformity
name of CP where 2 legs are affected
paraparesis
a common sign of minor degree of spasticity seen in adolescence
toe walking
splintage should be used frequently in CP - true or false?
false - it should be used with caution as too much can lead to increased muscle spasm and deformity
what is scoliosis
curvature of the spine with a rotary abnormality of the vertebrae
when do most cases of idiopathic scoliosis occur
adolescence
Is scoliosis more common in girls or boys?
far more common in girls
With scoliosis what does the child usually complain of?
twisting of the ribs which causes a hump on one side of the shoulder
do braces have a role in scoliosis
no
causes of a limp from birth
CDH
infection of the hip
cause of a limp between age 4 and 10
Perthe’s
cause of a limp from 10 to 15
SUFE
what is Perthe’s?
an osteochondritis of the femoral head epiphysis
what percentage of cases of Perthe’s are bilateral
20%
presentation of Perthe’s
painful limp followed by a slow recovery
what does U/S reveal in Perthe’s
excess fluid in the hip joint
what is Perthe’s thought to be caused by?
avascular necrosis of the growing femoral head
strategy of treatment in Perthe’s
to maintain the head of the femur concentrically within the acetabulum until the disease runs its course
if involving up to half the femoral head, does Perthe’s need tx?
no - prognosis is good
is prognosis for Perthe’s better in younger or older children?
younger
what can be done in Perthe’s to alleviate pain and limp?
traction
Who is SUFE seen in?
boys age 12 who are sexually immature for their age
girls a little older who have recently undergone an adolescent growth spurt
what nerve causes SUFE to sometimes cause knee pain?
obturator
is the limp always painful in SUFE?
no
what must radiographs in suspected SUFE include?
lateral view
management of SUFE
surgical
- if minor slippage, pin in new deformed position
- if major slippage, may attempt to replace the head although this comes with high risk of AVN
- observe other hip!! pin if an sign of slippage
when are pins from SUFE surgery best to be removed?
after epiphyseal fusion at around 18 y/o
