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BMSc SB > Orthopaedics Unit 3 > Flashcards

Orthopaedics Unit 3 Flashcards

1
Q

what are the average age for child to sit independently, stand and walk

A

sit - 9 months

stand - 12 months

walk - 20 months

[however is a lot of variation, not always a problem if child does not reach the milestone at this point]

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2
Q

what is the medical term for knock knees

A

genu valgum

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3
Q

what is the medical term for bow legs

A

genu varum

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4
Q

what is the normal alignment of the knee

A

in valgus

when child stands to attention, normally a gap of 4cm between the FEET

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5
Q

how does the gap change between the feet in varus and valgus

A

varus - gap decreases

valgus - gap increases

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6
Q

what is important to note in relation to genu varum and genu valgum in children

A

almost all children by the age of 7 with this condition will have normal knee alignment t

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7
Q

what is in-toeing and how can you spot it

A

children stand with their feet pointing inwards “pigeon-toed”

often exaggerated when they run and causes clumsiness

shoes tend to wear down at the heels

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8
Q

what are causes of in-toeing

A

femoral neck angle variation

tibial torsion

abnormal forefeet

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9
Q

how does femoral neck angle variation develop

A

During later stages of the normal development of foetus, the leg rotates on the pelvis so that the acetabulum points almost backwards and the femoral head on the neck is orientated forwards

sometimes this process is not completed by birth and the femoral neck is more anteriorly orientated (i.e. anteverted)

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10
Q

what can children who are born with femoral neck angle variation do more than other children

A

internally rotate their femur a lot and externally rotate it only a little
- causes the in-toeing posture

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11
Q

when is femoral neck angle variation often corrected by

A

10 y/o

surgery rarely needed

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12
Q

what is tibial torsion

A

bone is warped along vertical axis

is normal variation and can be ignored

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13
Q

what is abnormal forefeet

A

hooked (adducted) forefoot

vast majority correct spontaneously

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14
Q

what is important to remember about flat foot

A

it is normal variation which rarely causes functional abnormalities

all children’s feet are flat at birth, normal arch may not form until child is 7

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15
Q

what are the 2 types of flat foot

A

rigid

  • rare
  • implies bony abnormality
  • sometimes seen in RA

mobile

  • vast majority
  • no issue
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16
Q

what is curly toes

A

minor overlapping, commonly of the 5th toe

most correct spontaneously and should be left alone

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17
Q

when would surgery on curly toes be required

A

if the overlapping toes becomes fixed or if people are getting discomfort from shoes

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18
Q

when is pain around the knee most common in girls

A

as they develop secondary sexual characteristics.

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19
Q

what is Osgood Schlatter’s disease

A

inflammation of the attachment of the patellar tendon to the growing tibial epiphysis, caused by excess traction by the quads

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20
Q

Sx of Osgood Schlatter’s disease

A

tenderness, discomfort worse after exercise

swelling

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21
Q

what are features of the Osgood Schlatter’s disease

A

thought to be overuse injury, seen most common in active children

episodic
Tx w/ rest

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22
Q

when will children cease to have Osgood Schlatter’s disease

A

in middle adolescence when the epiphysis fuses

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23
Q

what is features of adolescent knee pain

A

most common in girls

not the same as dislocation of patella

most girls grow out of the condition

if Sx persist, arthroscopy may be necessary

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24
Q

what is chondromalacia patellae

A

erosion of an area of patella cartilage

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25
Q

what is the rate of Congenital Dislocation of the Hip (CDH) [or congenital hip dysplasia CHD]

A

occurs in 1 or 2 births per thousand

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26
Q

epidemiology of CHD

A

girls > boys

significant number of children, condition is bilateral

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27
Q

what is the screening program for CHD

A

screened at birth, 3 months, 6 months and 12 months

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28
Q

what are the two screening tests for CHD and what are they doing

A

Barlow maneuver

  • adduct the hip, apply light pressure
  • if hip dislocates = +ve test

Ortolani test

  • try to relocate the hip
  • if you hear a click or a clunk = +ve test
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29
Q

what are the Sx of CHD if it is not discovered till later life

A

shortening of the limb

asymmetrical skin creases

limited abduction

limp

30
Q

what should be the next stages if a “click” is heard in CHD

A

re-examined by specialist at 3 months

radiograph

31
Q

Mx of CHD

A

Tx from birth
- Pavlik harness

Tx if discovered late but before weight bearing

  • period of gentle traction followed by open or closed manipulation
  • then splinted in plaster for 3 months

Tx if discovered late and is weight bearing
- major surgery to deepen the undeveloped acetabulum and re-angulate the femoral neck to stabilise the hip

32
Q

why is it important to Tx CHD from birth

A

If the femoral head is relocated and maintained in the acetabulum using splintage then the vast majority will settle with no further development issue

33
Q

what is the issue with the Tx of CHD if discovered late and child is weight bearing

A

results are at best moderate,

Secondary OA is highly likely.

34
Q

what is the medical name for club foot

A

Talipes Equino Varus

35
Q

what are the 2 types of club foot

A 
postural form (mild)
- seen after breech birth

fixed form
- associated with development abnormalities of nerves and muscles of the leg

both CAN BE bilateral (not always)

36
Q

Mx of mild talipes equino varus

A

initial Tx for both forms

  • gentle stretching in two phases
  • 1st phase = corrects hindfoot equinus
  • 2nd phase = corrects mid and forefoot varus

= 6 weeks of stretching and strapping in a corrected or over-corrected position

37
Q

Mx of fixed talipes equino varus

A

6 weeks of stretching

Reassessed - if correction is incomplete or cannot be maintained

Surgery

38
Q

what is the follow up period for talipes equino varus

A

until feet stop growing
- around age 14

[affected foot often significantly smaller than normal foot which causes difficulties in shoe fitting]

39
Q

what are the 2 types of spina bifida

A

spina bifida occulta

spina bifida cystica

40
Q

what is spina bifida occulta

A

minor bony abnormality which affects 2% of the population
- usually of no significance

develop mechanical backache

41
Q

what is a possible consequence of spina bifida occulta

A

diastamatomyelia

- tethering of the spinal cord to the higher lumbar vertebrae

42
Q

what is spina bifida cystica

A

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

43
Q

what is a meningocele

A

nerve tissue covered by a cyst

44
Q

what is meningomyelocele

A

nerve tissue may be incorporated in the cyst wall

45
Q

what are the consequences of spina bifida cystica

A

hydrocephalus
> can lead to mental retardation

paralysis

growth deformities [due to muscle imbalance]

incontinence

joint contraction resulting in a fixed flexed position of their knees and dislocation of their hips

46
Q

Mx of spina bifida cystica

A

most babies die at, or soon after, birth

some survive to undergo surgery

  • early surgery to feet to maintain functional shape
  • try to keep the children mobile
47
Q

what causes cerebral palsy

A

damage to the brain at birth

48
Q

what are the pathological features of cerebral palsy

A

spinal tissue develops normally
> have uninhibited spinal reflexes
> lack co-ordination and purpose of movement, normally controlled by the brain
> causes SPASTIC PARALYSIS

abnormal muscle and bone growth
> due to some spastic muscle [muscles contracting strongly in uncoordinated way]
> and due to some muscles being weak and flaccid

secondary deformities of joints

49
Q

what are the patterns of cerebral palsy

A

Hemiparesis
- 1 arm and 1 leg on the SAME side

Paraparesis
- 2 legs are affected

Quadraparesis
- all limbs affected

50
Q

what are other Sx of cerebral palsy

A

some are mentally retarded

some are blind and/or deaf

some are neither

51
Q

what is the management of patients with only minor degrees of spasticity

A

spasticity may only affect 1 muscle group

  • common sign is toe-walking in teens
  • often calf muscle spasticity

Tx = tendo-achilles lengthening before growth ceases

52
Q

Mx of cerebral palsy

A

similar to spina bifida

maintain mobility

physiotherapy

surgery to lengthen tight muscles or to denervate them to maintain posture and function

53
Q

what is scoliosis

A

Curvature of the spine with a rotatory abnormality of the vertebrae

54
Q

what causes the curve of the spine in scoliosis

A

abnormal lordosis of the spine, which leads to buckling and twisting of the vertebral column as a result of the action of muscles and gravity.

55
Q

what is the aetiology of scoliosis

A

most are idiopathic

  • seen in adolescence
  • girls more than boys
  • principal effects are cosmetic but cause great distress

can be caused by congenital abnormalities of the vertebrae or by neuromuscular imbalance

56
Q

clinical presentation of scoliosis

A

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

skirts hang crooked

may be painful

57
Q

Mx of scoliosis

A

not all curves get worse

if curve is progressive or causing distress Tx should be offered early
- surgical correction of the ROTATORY element of the deformity

58
Q

what is the most likely cause of a limp at birth, between 4-10 and between 10-15

A

birth

  • CDH
  • infection of the hip

between 4 and 10
- Perthe’s disease

between 10 and 15
- SUFE

59
Q

what is Perthe’s disease

A

blood supply to the femoral head epiphysis becomes inadequate

causes AVN of the femoral head

60
Q

aetiology of perthe’s disease

A

more common in boys than girls

20% of cases are bilateral

61
Q

clinical presentation of perthe’s disease

A

child has painful limp which is followed by a slow recovery

62
Q

radiological appearance of perthe’s disease

A

femoral head may be normal on 1st presentation
- month later it may show changes

USS reveals fluid around hip joint

63
Q

Mx of Perthe’s disease

A

maintain the head within the acetabulum until the natural process of the disease runs its course

minor cases [up to half of femoral head involved]

  • need no Tx
  • good prognosis

severe cases

  • splintage to achieve containment
  • Careful follow-up with periods of traction to alleviate symptoms of pain and limp
64
Q

what are children who have had Perthe’s disease at an older age prone to

A

secondary OA

65
Q

what is SUFE

A

slippage of the epiphysis of the femoral head on the femoral neck so that the head is abnormally tilted.

66
Q

aetiology of SUFE

A

seen mostly in boys around 12 y/o who are sexually immature for their age

and in girl who are little older and have recently undergone an adolescent growth spurt

67
Q

clinical presentation of SUFE

A

child has a limp

may be pain radiating to the knee [due to the obturator nerve supplying both the hip and knee joint]

ANY CHILD WITH KNEE PAIN HAS TO HAVE THEIR HIP EXAMINED

loss of internal rotation of the hip is the predominant clinical sign

68
Q

what imagining must be obtained for SUFE and why

A

a lateral view or minor degrees of slippage may be missed

69
Q

if a child has hip pain, what is the working diagnosis

A

All young adolescents with a painful hip must be regarded as having SUFE until it is clinically and radiologically excluded

70
Q

Mx for SUFE

A

Tx is always surgery

Minor slippage
- hip should be pinned in its new deformed position

Major slippage

  • gentle attempt to replace the head on the neck by manipulation
  • does carry risk of AVN

Always observe the other hip for slippage using imaging
- pinned if any slippage

71
Q

when are the pins from surgery removed in SUFE

A

removed after fusion of the epiphysis at around eighteen years of age.

BMSc SB (18 decks)

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