orthopaedic paediatrics Flashcards
when would you do spinal fusion on a child ?
cobb angle >45 degrees
11-13 years old
what is fused during spinal fusion surgery?
T2 fused to pelvis
what does normal motion depend on
-an appropriate adequate force acting via a rigid lever of appropriate length on a stable joint
what are some features of a normal gait?
- stability in stance
- clearance in swing
- pre position of foot in terminal swing
- adequate step length
what 3 types of scoliosis are there?
infantile <3
juvenile 3-10
adolescent 11-18
how do long bones grow?
from the physes- increase in length
how do long bones grow?
from the physes- increase in length
what zones does the physes consist of?
- hypertrophic zone
- proliferative zone
- reserver zone
what is required for bone growth?
- good diet
- sunshine
- vitamins
- growth plates
- hormones
how to assess growth?
- growth chart
- menalaus chart
- moseley chart
- look at lower limb
what is normal variation is babies knees?
start - varus
end up- valgus
then have normal knees
what suggests infection/being unwell in the bone?
Harris lines
what is a type 1 fracture?
goes through growth plate
diastrophic meaning
bent/curve
what does a higher GMFC mean?
-higher risk of dislocation
what can tiptoe walking suggest?
- autism
- congenital tightness of muscle
- problem with CNS or PNS system
what is this?
clubfeet/ CTEV
what is CTEV?
Congenital deformity of foot causing feet to turn in (varus) due to in utero abnormal alignment of joint between talus, calcaneus and navicular
who is clubfoot/ congenital talipes equinovarus more common in?
- babies in breech position
- oligohydramnio (low amniotic fluid content)
- boys 2x more affected than girls
what is the treatment for early clubfoot?
Ponsetti technique (early splinatge)
- held in cast with 5 or 6 weekly changes
- 80% require tenotomy of achilles to maintain correction
- once correction achieved , child placed in brace consisting of boots attached to bar which worn 23 hours a day for 3 months and used during sleep until age 3-4
what is SUFE (slipped upper femoral epiphysis)?
A condition where the femoral head epiphysis slips inferiorly in relation to femoral neck
what causes slipped upper femoral epithysis (SUFE)?
The cause is not fully understood
-growth plate (physis) not strong enough to support body weight
who is more likely to experience slipped upper femoral epithysis (SUFE)?
- Linked to hypothyroidism or renal disease
- More common in boys
- More common if overweight
- 10-16 yo
how does SUFE present?
1/3 cases are bilateral
- Pain and limp
- limited movement
- externally rotated foot
- pain in knee, hip or groin (due to obturator nerve supplying both hip and knee)
- loss of internal rotation of hip
what investigations would be done for SUFE?
X-ray
MRI
what view must be obtained on XRay for a patient wiht SUFE and why?
-lateral view to detect mild degrees of slip
what treatment should be done for SUFE?
Urgent surgery to pin femoral head to prevent further slippage
-percutaneous pinning of hip
+/- pinning of other side
+/- open reduction of very severe slip
what does a larger slip mean for the prognosis of a patient with SUFE?
worse prognosis
how should a patient with acute SUFE be treated?
gentle manipulation
what are the risks of gentle manipulation in SUFE?
AVN (avascular necrosis)
what may need to be done for chronic SUFE?
osteotomy
what is Perthe’s disease?
A rare childhood condition that occurs when there’s avascular necrosis/ compression osteochondritis of hip
