Ortho unit 3 Flashcards
(43 cards)
Child milestones
sits- 9 months
stands- 12 months
walks- 20 months
knock knees
genu valgum
bow legs
genu varum
normal alignment of knees
valgus- when child stands to attention there is normally a gap of 4cm or so between the feet
what age should normal knee alignment be achieved by
7 yrs
in toeing
children stand with feet pointing inwards- often exaggerated when they run. Often referred to oath because of clumsiness. Shoes tend to wear down at the heel
causes of in toeing
femoral neck angle variation- anteverted femoral neck - children born like this can internally rotate their femur a lot and externally rotate it only a little- reflected by posture- in toed gait. Should correct itself by age of 10 although some are left with residual deformity
Tibial torsion - normal variation and should be ignored
Abnormal forefeet- hooked forefoot- commonly seen. Dubious whether surgery to correct this is ever justified, defs shouldn’t be considered before 7yrs. vast majority correct spontaneously - no evidence that special shoes make any difference
Flat foot
Normal variation- rarely causes any functional abnormalities apart from uneven shoe were.
2 kinds of flat foot
Mobile- vast majority- flat feet at birth, normal arch may not form until the child is 7
rigid flat foot- rare- implies underlying bony abnormality of the foot
curly toes
minor overlapping of toes, particularly of the 5th toe. Most correct spontaneously, occasionally crossed 5th toe can cause discomfort in shoes- if fixed requires surgical correction
Osgood schlatters disease
inflammation of attachment of patellar tendon to growing tibial epiphysis- caused by excess traction by the quads. Cause unknown but more common in very active children
Osgood schlatters disease symptoms
tenderness and discomfort, worse after exercise, may also be swelling. Episodic and may be treated by rest. Rarely necessary to reinforce with plaster. Child will have symptoms until middle adolescence when epiphysis fuses
Adolescent knee pain
more common in girls. Rarely chondromalacia patellae is seen on arthroscopy. Most girls grow out of the condition
Congenital dislocation of the hip (CDH)
1-2/1000 live births. Better name would be congenital hip dysplasia (reflecting underlying abnormality of femoral head, acetabulum or both) as hip usually abnormal but rarely completely dislocated. Bilateral in a significant no. of children
clinical presentation of CDH
all children screened at birth and checked again at 3,6 and 12 months. Diagnosed at birth using a technique where examiner tries to dislocate or relocate the hop- may produce a click (suspicious) or a clunk as the hip dislocates or relocates
clinical signs of CDH if goes unnoticed at birth
becomes apparent either before weight bearing (sitting) or after weight bearing (standing). Clinical signs- shortening of limb, asymmetrical skin creases, limited abduction and limp
management of CDH
children who produced a click sound should be reexamined by specialist at 3 months- radiograph usually justified. All clunks should be treated from birth.
If femoral head is relocated and maintained in the acetabulum using splint age- then the vast majority will settle and give no further trouble as the hip starts to develop normally
If discovered late- traded by period of gentle traction followed by open or closed manipulation. Then splinted in plaster for three months
If walking has commenced- major surgery required to deepen the undeveloped acetabulum and re angulate the femoral neck to stabilise the hip- secondary arthritis likely
clubfoot
talipes equino varus
talipes equino varus
deformity- makes foot look like a golf club. If treated early, mild cases can be fully corrected and major cases much improved
talipes equino varus
relatively common- mild postural form and fixed form.
Mild- after breech birth- probs related to babies position in womb
Fixed- developmental abnormalities of nerves and muscles of the leg. Both cases can be bilateral
management of talipes equino varus
Mild form- easily corrected at birth by manipulation
Severer forms- require surgery
Both forms- initial treatment- gentle stretching in 2 phases- first corrects hind foot equinus and second phase corrects mid and forefoot varus. Mild cases- - 6 weeks of strapping and stretching. Severe- may require surgery after this 6 weeks
Children need to be followed up until feet stop growing- relapse not uncommon
spina bifida occulta
minor bony abnormality- affects around 2% of the population - usually of no significant- some people develop mechanical backache and v small number may get tethering of spinal cordite higher lumbar vertebrae during growth- diastamatomyelis
spina bifida cystic
neural plate tissues open with little or no skin or bony cover- nerve tissue may be covered by a cyst (meningocele) or nerve tissue may be incorporated into a cyst (meningomyelocele). Many have hydrocephalus which leads to mental retardation and increase in size of head
spina bifida cystic treatment
many die at or soon after birth. some survive and undergo op to close lesion on their back - these children have issues-paralysis, growth deformities, incontinence, many are mentally retarded. Many need early feet surgery to maintain functional shape, others develop joint contraction resulting in a fixed flexed position of their knees and dislocation of their hips. Every effort should be made to keep the children mobile until adolescence so that they may grow to a reasonable size. Many children manage to walk aided by splints and hand-held aids until then. As they reach adolescence many go into a wheelchair as they find this easier for themselves socially.
