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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
If a "click" is found on B & O what is the next step?
Re-examined in a specialist clinic at 3 months old (radiograph)
26
If a "clunk" is found on B & O what is the next step?
Should be treated from birth | Splintage required
27
What is the management of CDH if it is discovered late but not walking?
Period of gentle traction followed by open or closed manipulation then splintage for 3 months
28
What is the management of CDH if discovered late and walking has commenced?
Major surgery required to deepen undeveloped acetabulum and re-angulate femoral neck Results are at best moderate and secondary arthritis is likely
29
What is talipes equino varus?
Deformity of the foot which makes it look like a golf club
30
What are the 2 forms of talipes equino varus?
Postural (mild) | Fixed
31
When is the postural mild form of talipes equino varus seen?
After a breech birth (probably related to baby's position in the womb)
32
What is the fixed form of talipes equino varus associated with?
Developmental abnormalities of nerves and muscles of the leg
33
Describe the initial treatment of talipes equino varus
Gentle strestching in two phases 1 - corrects hindfoot equinus 2 - corrects mid & forefoot varus
34
How long is treatment in mild forms of talipes equino varus?
6 weeks of stretching and srapping in a corrected ro over-corrected position
35
How long is treatment in severe cases of talipes equino varus?
6 weeks then reassessed | If incomplete surgery required
36
What age do feet on avergae stop growing?
14 years old
37
What is spina bifida occulta?
Minor bony abnormality usually of no significance
38
What orthopaedic problems might be caused by spina bifida occulta?
Mechanical backache | Diastamatomyelia
39
What is diastamatomyelia?
Tethering of the spinal cord to the higher lumber vertebrae during growth
40
What is spina bifida cystica?
When a baby is born with the neural plate tissues open with little or no skin or bony cover
41
What is a meningocele?
When the open neural plate tissues are covered by a cyst
42
What is a meningomyelocoele?
When the open neural plate tissue is incorporated in the cyst wall
43
What is hydrocephalus?
Abnormal increase in the amount of fluid in the brain which leads to mental retardation and increase in head size
44
What is the prognosis of spina bifida cystica?
Many die at or soon after birth | Those that survive with surgery have profound problems
45
What problems do children who survive surgery for spina bifida cystica suffer from?
Paralysis, growth deformities, muscle imbalance, incontinence
46
What orthopaedic problems need corrected in spina bifida cystica?
Feet | Joint contraction resulting in fixed flexed knees
47
In the treatment of children with spina bifida cystica what non-surgical management is important?
Keep mobile until adolescence so they can grow to a reasonable size
48
What is cerebral palsy?
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
What would be found on a neuro exam of a child with CP?
Uninhibited spinal reflexes | Lack of coordination and purpose of movement
50
Why do patients with CP have a spastic type of paralysis?
Some muscles contract strongly in an uncoordinated way whilst others are very weak and flaccid
51
What are the clinical presentations of CP?
``` Hemiparesis Paraparesis Quadraparesis Mental retardation Blind and/or deaf Some do not siffer mental or sensory impairment ```
52
What is a common presentation of a person with CP who has only minor degrees of spasticity?
Toe-walking in adolescence
53
What is the treatment for a CP adolescent with toe-walking?
Tendo-achilles lengthening
54
How can orthopaedic problems in CP be managed?
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
What is Scoliosis?
Curvature of the spine with a rotatory abnormality of the vertebrae
56
What can cause scoliosis?
Congenital abnormalities of the vertebrae Neuromuscular imbalance Idiopathic (most cases)
57
How does scolisosis present?
Twisting of the ribs which causes a hump on one side of the shoulder Skirts hang crookedly
58
What ar indications for surgery in scoliosis?
Curve is progressive | Causing distress
59
What are 2 causes of a limp from birth?
CDH | Infection of the hip
60
What is the likely cause of a limp between the ages of four and ten?
Perthe's disease
61
What is the likely cause of a limp from age ten to fifteen?
SUFE
62
What is Perthe's disease?
Osteochondritis (fragmentation of the bone and overlying cartilage) of the femoral head epiphysis
63
How does Perthe's disease present?
Painful limp followed by slow recovery
64
What would investigations for Perthe's reveal?
Femoral head may be normal radiographically at first presentation but change when repeated after a month US - excess fluid in hip joint
65
What is the pathological process of Perthe's disease?
AVN of the growing femoral head | Will eventually re-vascularise and re-ossify but may be enlarged and deformed
66
What is the strategy of management for Perthe's disease?
Maintain head concentrically within the acetabulum until the natueral process of the disease runs it's course
67
What are older children who develop Perthe's prone to?
Secondary arthritis
68
What are the treatment options for severe Perthe's disease/
Splintage may help Osteotomy (enlarge acetabulum or redirect femoral head) Careful follow-up with periods of traction
69
What pateint demographic does SUFE present in?
Boy around 12 y/o who are sexually immature | Girls who are a little older and have recently undergone an adolescent growth spurt
70
What is SUFE?
Slippage of the epiphysis of the femoral head on the femoral neck so that the head is abnormally tilted
71
How does SUFE present?
Limp | Pain radiating to knee
72
Which nerve causes pain to radiate to the knee in SUFE?
Obturator
73
What view must be included when imaging a suspected SUFE?
Lateral (so minor degrees of slippage aren't missed0
74
What is the surgical management of SUFE if the slippage in minor?
Pinned in its new deformed position
75
What is the surgical management of SUFE if the slippage is major?
Gentle attempt to replace head on neck by manipulation (risk of AVN is high)
76
When should pins for SUFE be removed?
After fusion of the epiphysis at around 18 y/o

AY BMSc Orthopaedics (5 decks)

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