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AY BMSc Orthopaedics > Orthopaedics (Unit 3: Orthopaedic Conditions in Childhood) > Flashcards

Orthopaedics (Unit 3: Orthopaedic Conditions in Childhood) Flashcards

1
Q

By what age does the average child sit independently?

A

9 months

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2
Q

By what age does the avergae child stand?

A

1 year

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3
Q

By what age does the average child normally walk?

A

20 months

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4
Q

What is the normal gap between the feet when a child stands to attention?

A

4cm

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5
Q

By what age should children with genu valgum & varus have developed normal allignment?

A

7 years

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6
Q

When is in-toeing exaggerated?

A

When children run

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7
Q

What are the 3 causes of in-toeing?

A

Femoral neck angle variation
Tibial torsion
Abnormal forefeet

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8
Q

Clinically how can children with an anteverted femoral head move their femur?

A

Can internally rotate their femur alot and externally rotate only a little

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9
Q

By what age should femoral neck angle variation correct itself by?

A

10 years

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10
Q

What is the treatment for tibial torsion?

A

It is normal variation and should be ignored

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11
Q

By what age should surgery on abnormal forefeet definitely not be considered before?

A

7 years

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12
Q

What are the 2 kinds of flat foot?

A

Rigid & mobile

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13
Q

What type are the majority of flat feet?

A

Mobile

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14
Q

What is a rigid flat foot?

A

Rare at any age
Underlying bony abnormality
Occasionally a sign of a serious disease such as RA

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15
Q

When might it be appropriate to operate on curly toes?

A

If causing severe discomfort in shoes

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16
Q

What is Osgood Schlatter’s disease?

A

Inflammation of the attachment of the patellar tendon to the growing tibial ephiphysis caused by excess traction by the quadriceps

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17
Q

Who is Osgood Schlatter’s more common in?

A

Very active children who are often involved in organised sport

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18
Q

What are the symptoms of Osgood Schlatter’s?

A

Tenderness & discomfort which is worse after exercise (episodic)

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19
Q

When do symptoms of Osgood Schlatter’s cease?

A

Middle adolescence when the epiphysis fuses

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20
Q

What is chondromalacia patellae?

A

When an area of patella cartillage is eroded (causes adolescent knee pain)

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21
Q

What might predispose a child to CDH?

A

Female

Familial & racial tendency

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22
Q

When are children screened for CDH?

A

Birth, 3, 6, & 12 months

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23
Q

What technique is used to diagnose CDH?

A

Barlow’s (dislocate) & Ortolani’s (relocate) manouevre

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24
Q

If missed in screening how might CDH present?

A

Shortening of the limb
Asymmetrical skin creases
Limited abduction
Limp

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25
Q

If a “click” is found on B & O what is the next step?

A

Re-examined in a specialist clinic at 3 months old (radiograph)

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26
Q

If a “clunk” is found on B & O what is the next step?

A

Should be treated from birth

Splintage required

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27
Q

What is the management of CDH if it is discovered late but not walking?

A

Period of gentle traction followed by open or closed manipulation then splintage for 3 months

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28
Q

What is the management of CDH if discovered late and walking has commenced?

A

Major surgery required to deepen undeveloped acetabulum and re-angulate femoral neck
Results are at best moderate and secondary arthritis is likely

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29
Q

What is talipes equino varus?

A

Deformity of the foot which makes it look like a golf club

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30
Q

What are the 2 forms of talipes equino varus?

A

Postural (mild)

Fixed

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31
Q

When is the postural mild form of talipes equino varus seen?

A

After a breech birth (probably related to baby’s position in the womb)

32
Q

What is the fixed form of talipes equino varus associated with?

A

Developmental abnormalities of nerves and muscles of the leg

33
Q

Describe the initial treatment of talipes equino varus

A

Gentle strestching in two phases
1 - corrects hindfoot equinus
2 - corrects mid & forefoot varus

34
Q

How long is treatment in mild forms of talipes equino varus?

A

6 weeks of stretching and srapping in a corrected ro over-corrected position

35
Q

How long is treatment in severe cases of talipes equino varus?

A

6 weeks then reassessed

If incomplete surgery required

36
Q

What age do feet on avergae stop growing?

A

14 years old

37
Q

What is spina bifida occulta?

A

Minor bony abnormality usually of no significance

38
Q

What orthopaedic problems might be caused by spina bifida occulta?

A

Mechanical backache

Diastamatomyelia

39
Q

What is diastamatomyelia?

A

Tethering of the spinal cord to the higher lumber vertebrae during growth

40
Q

What is spina bifida cystica?

A

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

41
Q

What is a meningocele?

A

When the open neural plate tissues are covered by a cyst

42
Q

What is a meningomyelocoele?

A

When the open neural plate tissue is incorporated in the cyst wall

43
Q

What is hydrocephalus?

A

Abnormal increase in the amount of fluid in the brain which leads to mental retardation and increase in head size

44
Q

What is the prognosis of spina bifida cystica?

A

Many die at or soon after birth

Those that survive with surgery have profound problems

45
Q

What problems do children who survive surgery for spina bifida cystica suffer from?

A

Paralysis, growth deformities, muscle imbalance, incontinence

46
Q

What orthopaedic problems need corrected in spina bifida cystica?

A

Feet

Joint contraction resulting in fixed flexed knees

47
Q

In the treatment of children with spina bifida cystica what non-surgical management is important?

A

Keep mobile until adolescence so they can grow to a reasonable size

48
Q

What is cerebral palsy?

A

Abnormality of the brain often cause by damage to the brain at birth that results in delayed or arrested development of the nervous and MSK systems

49
Q

What would be found on a neuro exam of a child with CP?

A

Uninhibited spinal reflexes

Lack of coordination and purpose of movement

50
Q

Why do patients with CP have a spastic type of paralysis?

A

Some muscles contract strongly in an uncoordinated way whilst others are very weak and flaccid

51
Q

What are the clinical presentations of CP?

A 
Hemiparesis 
Paraparesis 
Quadraparesis 
Mental retardation 
Blind and/or deaf
Some do not siffer mental or sensory impairment
52
Q

What is a common presentation of a person with CP who has only minor degrees of spasticity?

A

Toe-walking in adolescence

53
Q

What is the treatment for a CP adolescent with toe-walking?

A

Tendo-achilles lengthening

54
Q

How can orthopaedic problems in CP be managed?

A

Careful physiotherapy
Cautious use of splintage
Careful use of surgery to either lengthen tight muscle or to denervate them or (occasionally) to move them

55
Q

What is Scoliosis?

A

Curvature of the spine with a rotatory abnormality of the vertebrae

56
Q

What can cause scoliosis?

A

Congenital abnormalities of the vertebrae
Neuromuscular imbalance
Idiopathic (most cases)

57
Q

How does scolisosis present?

A

Twisting of the ribs which causes a hump on one side of the shoulder
Skirts hang crookedly

58
Q

What ar indications for surgery in scoliosis?

A

Curve is progressive

Causing distress

59
Q

What are 2 causes of a limp from birth?

A

CDH

Infection of the hip

60
Q

What is the likely cause of a limp between the ages of four and ten?

A

Perthe’s disease

61
Q

What is the likely cause of a limp from age ten to fifteen?

A

SUFE

62
Q

What is Perthe’s disease?

A

Osteochondritis (fragmentation of the bone and overlying cartilage) of the femoral head epiphysis

63
Q

How does Perthe’s disease present?

A

Painful limp followed by slow recovery

64
Q

What would investigations for Perthe’s reveal?

A

Femoral head may be normal radiographically at first presentation but change when repeated after a month
US - excess fluid in hip joint

65
Q

What is the pathological process of Perthe’s disease?

A

AVN of the growing femoral head

Will eventually re-vascularise and re-ossify but may be enlarged and deformed

66
Q

What is the strategy of management for Perthe’s disease?

A

Maintain head concentrically within the acetabulum until the natueral process of the disease runs it’s course

67
Q

What are older children who develop Perthe’s prone to?

A

Secondary arthritis

68
Q

What are the treatment options for severe Perthe’s disease/

A

Splintage may help
Osteotomy (enlarge acetabulum or redirect femoral head)
Careful follow-up with periods of traction

69
Q

What pateint demographic does SUFE present in?

A

Boy around 12 y/o who are sexually immature

Girls who are a little older and have recently undergone an adolescent growth spurt

70
Q

What is SUFE?

A

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

71
Q

How does SUFE present?

A

Limp

Pain radiating to knee

72
Q

Which nerve causes pain to radiate to the knee in SUFE?

A

Obturator

73
Q

What view must be included when imaging a suspected SUFE?

A

Lateral (so minor degrees of slippage aren’t missed0

74
Q

What is the surgical management of SUFE if the slippage in minor?

A

Pinned in its new deformed position

75
Q

What is the surgical management of SUFE if the slippage is major?

A

Gentle attempt to replace head on neck by manipulation (risk of AVN is high)

76
Q

When should pins for SUFE be removed?

A

After fusion of the epiphysis at around 18 y/o

AY BMSc Orthopaedics (5 decks)

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