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Orthopaedic Medicine > ortho conditions in childhood > Flashcards

ortho conditions in childhood Flashcards

1
Q

average child usually sits by what age

A

9 months

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2
Q

average child usually stands by

A

1 year

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3
Q

average child usually walks by

A

20 months

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4
Q

by what age are most cases of genu varum and valgum normally corrected

A

age 7

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5
Q

causes of in-toeing

A

femoral neck anteversion
tibial torsion
abnormal forefeet

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6
Q

femoral neck ante version means the femur can be ? rotated a lot

A

internally rotated a lot

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7
Q

is tibial torsion a normal variation

A

yes and should be ignored

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8
Q

surgery to correct abnormal forefeet should not be considered until after age ?

A

7

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9
Q

is flat foot normal variation

A

yes

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10
Q

most types of flat foot are ?

A

mobile

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11
Q

are all childrens feet flat at birth

A

yes

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12
Q

what does rigid flat foot usually imply

A

underlying bony abnormality

occasionally its a sign of serious disease such as RA

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13
Q

what is osgood schlatter’s disease

A

inflammation of the attachment of the patellar tendon to the growing tibial epiphysis

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14
Q

what causes the inflammation in osgood schlatter’s disease

A

excess traction by the quadriceps

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15
Q

what is rarely seen in adolescent knee pain

A

chondromalacia patellae - eroded area of patellar cartilage

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16
Q

eroded area of patellar cartilage

A

chondromalacia patellae

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17
Q

how common is CDH

A

one or two live births per thousand

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18
Q

is the hip usually completely dislocated at birth in CDH?

A

rarely

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19
Q

CDH more common in girls or boys?

A

girls

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20
Q

what kind of tendency is there in CDH

A

familial and racial

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21
Q

when should children be screened for CDH?

A

at birth
3 m
6m
12 m

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22
Q

clinical signs of CDH

A

limb shortening
asymmetrical creases
limited adduction
limp

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23
Q

what is the next step of action if the CDH test produces a click

A

re examination at 3 m in a specialist clinic - radiograph usually justified

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24
Q

next step of action if CDH is discovered late but before weight bearing

A

gentle traction followed by open or closed manipulation

followed by splintage for

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25
Q

next step of action in CDH if discovered late and walking has commenced

A

major surgery to deepen the undeveloped acetabulum and re-angulate the femoral neck
secondary arthritis is highly likely

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26
Q

when is the mild, postural form of club foot seen

A

after breech

usually easily corrected at birth by manipulation

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27
Q

what is the fixed form of club foot associated with

A

developmental abnormalities of nerves and muscles of the leg

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28
Q

initial tx for club foot

A

in both forms: gentle stretching in 2 phases
1. correction of hind foot equinus
2. corrects the mid and forefoot varus
for 6 weeks

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29
Q

Until when do children with club foot need to be followed up

A

until their feet stop growing (around age 14)

30
Q

why is follow up for club foot important?

A

late relapse requiring surgery is not uncommon

31
Q

the affected foot in clubfoot is usually significantly larger than the normal foot - true or false?

A

false - usually SMALLER

32
Q

is spina bifida occulta usually of significance?

A

usually not!

33
Q

some people who are affected by spina bifida occult develop what?
a very small number may get what?

A

some people get mechanical backache

a very small number get tethering of the spinal cord to the higher lumbar vertebrae during growth (“diastamatomyelia”)

34
Q

what is diastamatomyelia?

A

tethering of the spinal cord to the higher lumbar vertebrae during growth

35
Q

what is spina bifida cystica?

A

baby is born with the neural plate tissues open with little or no skin or bony cover

36
Q

what do many children with spina bifida cystica also have?

A

hydrocephalus

37
Q

hydrocephalus leads to mental retardation - t or f

A

true

38
Q

whats it called when nerve tissue is covered by a cyst

A

meningocele

meningomyocele if nerve tissue is incorporated into cyst wall

39
Q

can spina bifida cystica be life threatening?

A

yes, many children die at or soon after birth

40
Q

long term complications of spina bifida cystica

A

paralysis
growth deformities through muscle imbalance
incontinence
many are mentally retarded

41
Q

many children with spina bifida cystic need early surgery to their ?

A

feet - to maintain a functional shape

42
Q

if a child with spina bifida cystica develops joint contraction what can this result in?

A

fixed flexion of knees and dislocation of hips

43
Q

children with spina bifida cystica should be encouraged to do minimal movement - t or f

A

false - they should keep mobile until adolescence so that they may grow to a reasonable size

44
Q

in CP does spinal tissue develop normally?

A

yes, so they have uninhibited spinal reflexes

45
Q

in terms of movement what do people with CP lack? what does this result in?

A

they lack co-ordination and purpose of movement normally controlled by the brain, resulting in a spastic type of paralysis

46
Q

what causes joint deformity in CP

A

some muscles contract strongly (spastic) and some are weak and flaccid&raquo_space; imbalance&raquo_space; abnormal muscle and bone growth&raquo_space; joint deformity

47
Q

name of CP where 2 legs are affected

A

paraparesis

48
Q

a common sign of minor degree of spasticity seen in adolescence

A

toe walking

49
Q

splintage should be used frequently in CP - true or false?

A

false - it should be used with caution as too much can lead to increased muscle spasm and deformity

50
Q

what is scoliosis

A

curvature of the spine with a rotary abnormality of the vertebrae

51
Q

when do most cases of idiopathic scoliosis occur

A

adolescence

52
Q

Is scoliosis more common in girls or boys?

A

far more common in girls

53
Q

With scoliosis what does the child usually complain of?

A

twisting of the ribs which causes a hump on one side of the shoulder

54
Q

do braces have a role in scoliosis

A

no

55
Q

causes of a limp from birth

A

CDH

infection of the hip

56
Q

cause of a limp between age 4 and 10

A

Perthe’s

57
Q

cause of a limp from 10 to 15

A

SUFE

58
Q

what is Perthe’s?

A

an osteochondritis of the femoral head epiphysis

59
Q

what percentage of cases of Perthe’s are bilateral

A

20%

60
Q

presentation of Perthe’s

A

painful limp followed by a slow recovery

61
Q

what does U/S reveal in Perthe’s

A

excess fluid in the hip joint

62
Q

what is Perthe’s thought to be caused by?

A

avascular necrosis of the growing femoral head

63
Q

strategy of treatment in Perthe’s

A

to maintain the head of the femur concentrically within the acetabulum until the disease runs its course

64
Q

if involving up to half the femoral head, does Perthe’s need tx?

A

no - prognosis is good

65
Q

is prognosis for Perthe’s better in younger or older children?

A

younger

66
Q

what can be done in Perthe’s to alleviate pain and limp?

A

traction

67
Q

Who is SUFE seen in?

A

boys age 12 who are sexually immature for their age

girls a little older who have recently undergone an adolescent growth spurt

68
Q

what nerve causes SUFE to sometimes cause knee pain?

A

obturator

69
Q

is the limp always painful in SUFE?

A

no

70
Q

what must radiographs in suspected SUFE include?

A

lateral view

71
Q

management of SUFE

A

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
72
Q

when are pins from SUFE surgery best to be removed?

A

after epiphyseal fusion at around 18 y/o

Orthopaedic Medicine (5 decks)

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