Orthopaedics Flashcards
102 What is congenital dysplasia of the hip joint?
Condition present at birth where ‘ball and socket’ joint of hip doesn’t form properly as the acetabulum is too shallow. Leading to instability and possible dislocation. Can affect one or both hip joints
102 Causes of Congenital dysplasia of the hip joint?
Unknown causes but known to be associated with genetic and environmental factors.
Risk factors: female, first born, family history, breech delivery, oligohydramnios
102 Types of congenital dysplasia of the hip joint?
- Hip instability.
- Hip subluxation (partial dislocation)
- Hip dislocation (complete dislocation)
102 Sx of congenital dysplasia of the hip joint?
- Buttock creases
- Asymmetric leg in which one leg may appear shorter than the other
- Limited range of motion in hip on affected side
102 Dx of congenital dysplasia of the hip joint?
- Physical examination, Ortolani and Barlow manoeuvre
- US, MRI, Xray
102 What is the Ortolani test?
Flex hip to 90 degrees, knee to maximum flexion and abduct femur to feel for click
102 What is the Barlow maneuver?
Flex hip to 90 degrees, knee to maximum flexion and adduct femur to feel for click
102 Tx of congenital dysplasia of the hip joint?
Non Surgical: Pavlik harness
Surgical: closed reduction, if ineffective open reduction followed by spica casting
NSAIDs for pain
102 Complications of congenital dysplasia of the hip joint?
Hip instability, osteoarthritis, potential weakness, difference in length, mobility issues on affected side
130 What is coxa vara? What is coxa valga?
Coxa Vara and Valga are conditions that refer to the angle between the head and the shaft of the femur at the hip joint
Coxa Vara the angle is decreased (less than 120 degrees) leading to bowlegged appearance
Coxa Valaga the angle increased (more than 135 degrees) leading to a knock kneed appearance
103 Causes and Risk factors of Coxa Vara and Coxa Valga?
Coxa Vara: congenital, acquired due to injury, certain diseases like rickets, complication from surgery
Coxa Valga: associated with certain diseases such as hip dysplasia or cerebral palsy. Results from previous surgery
103 Sx of Coxa Vara and Coxa Valga?
Coxa Vara: bow leggedness
Coxa Valga: knock kneed appearance
Both associated with abnormal gait, difficulty walking, leg length discrepancy, decreased ROM
103 Dx of Coxa Vara and Coxa Valga?
Physical exam, observe child gait, measure leg lengths, assess hip mobility
Xray MRI
103 Tx of Coxa Vara and Coxa Valga?
- Non Surgical tx: braces or orthotics
- Surgical: Varus or Valgus derotational osteotomy (for vara and valga respectively)
103 Complications of Coxa Vara and Coxa Valga?
Long term abnormal hip joint, early onset osteoarthritis and mobility issues
103 Epyphisiolysis adolescentia def?
Aka Slipped Capital Femoral Epiphysis occurs in adolescents where the metaphysis (neck part of the bone) slips anteriorly and externally due to a facture in the growth plate (physis) causing slippage of the metaphysis.
Can also say the head of the femur slips off the neck of the bone in a backwards direction but this is wrong as the head stays in the acetabulum due to the teres femoris ligament (ligament of head of femur or round ligament of femur)
103 Epyphisiolysis adolescentia causes?
Unknown causes but believed to be a combination of hormonal changes during puberty and mechanical stress.
Risk factors: obesity, rapid growth, family history, more common in boys
103 Epyphisiolysis adolescentia Sx?
Pain in hip, groin, knee or thigh, which can be sudden or gradual
Abnormal gait, Limited ROM, turning of foot outwards when walking
103 Epyphisiolysis adolescentia Dx?
Physical exam for pain and reduced mobility
Xray
MRI
103 Epyphisiolysis adolescentia Tx?
- Non surgical: activity modification, weight loss and use of crutches to relieve weight from hip
- Surgical: single screw fixation and osteotomy in severe cases
- NSAIDs for pain
103 Epyphisiolysis adolescentia Complications?
Osteoarthritis, long term hip deformity, mobility issues, Avascular Necrosis
Scoliosis def
Lateral distortion of the spine accompanied by vertebral rotation in the transverse plane
Types of scoliosis
Congenital: defects of formation, segmentation or mixed. Characterised by longitudinal and rotational imbalance
Acquired: during growth 85% are idiopathic
Based on age can be further categorised as infantile, juvenile or adolescent idiopathic
Does scoliosis present more in boys or girls?
Girls
Sx of scoliosis
Lateral curvature of spine therefore lateral body posture
One shoulder higher than other
Local muscular aches and ligament pain
Grades of scoliosis
Grade 1: curve angle less than 10 degree
Grade 2: 10-25 degree
Grade 3; 24-50 degree
Grade 4: over 50 degree curve angle
Dx of scoliosis
Ferguson method: lines connecting centres of peripheral vertebrae to the centre of apex angle this indicates severity
Cobb: find the apex vertebra and then from the top and bottom of the most tilted ones from here you draw lines out and the intersecting angle is measured.
Tx of scoliosis
Grade 1 and 2 conseverative tx with physiotherapy and correctional plaster corsets
Grade 3 and 4 surgical tx usually at age 12-13 when growth process of spin is almost complete
Kyphosis Def
Dorsal convexity in the sagittal plane typically in the thoracic spine. Cobb angle is >45 degrees.
Types of Kyphosis
Postural: due to posture, most common and in all ages more commen in Female
Structural: osteoporosis, tumors, tb, ankylosisng spondylitis
Congenital: vertebral malformation in utero fusion
Scheuermann’s Kyphosis: type of osteochondrosis, anterior wedging of vertebrae
Sx of Kyphosis
Anterior thoracic pain, dyspnea, convex spine curvature, dysphagia
Dx of Kyphosis
X ray sagittal plane, >45 degree cobb angle
Tx of Kyphosis
Treat underlying cause first such as rickets
Conservative: sleep on hard bed or plaster tray
Milwaukee brace, pain management, physiotherapy
Surgery reserverd for significant pulmonary\neurological impairment cases
Lordosis Def
Exaggerated inward curvature of lumbar or cervical spine. Can be partial or complete. Complete is the entire spine.
Causes of Lordosis
High spine flexibility, improper lifting, muscle strength imbalance, obesity, osteoporosis
Dx of Lordosis
Physical exam for degree of curvature and muscle tightness, Xray, CT, MRI
Tx of Lordosis
Boston brace, physical therapy to strengthen and balance back muscles, pain management
