orthopeadics Flashcards
what type of joints are intervertebral discs
secondary cartilaginous
what surrounds the nucleus pulposus
anulus fibrosus
why do people get shorter with old age
loss of water content
what suggests facet joint pain
pain worse on extension
what levels is degeneration and acute disc prolapse most common in
L4/5 L5/S1
where does the cauda equina lend
l1
what does nerve root compression cause
radiculopathy
what is radiculopathy
pain down the dermatome
pathology of spinal stenosis
compressed by osteophytes and hypertrophied ligaments in oa
pathology of spinal stenosis
compressed by osteophytes and hypertrophied ligaments in oa
easier to walk up hill is a sign of what and why
spinal stenosis as theyre opening up the spine
signs of cauda equina syndrome
usually prolapsed disc, bladder and bowel dysfunction, saddle anaesthesia, loss of anal tone
where to perform a lumbar puncture
posterior iliac crest - L4, PSIS S2
what is genu varum also known as
bow legs
what is typical of genu varum
the legs curve outward at the knees while feet and ankles touch
when is genu varum normal
3-4 year olds
examples of pathologies causing genu verum
skeletal dysplasia, rickets, tumour, blounts disease and trauma
what is genu valgum also known as
knock knees
presentation of ganu valgum
when the child stands straight and the knees touch but the ankles are apart
what is intoeing
when the child walks with toes pointing inwards
when is intoeing accentuated
in running
what is femoral neck anteversion
femoral neck usually points anteriorly, can be at 30-40 degrees at birth
what can femroal neck anteversion predispose
patellofemoral problems
what is internal tibial torsion
on knees foot is rotated too far medially
what is metatarussu adductus
metatarsals go too medially
what can fixed flat feet indicated
calf tightness, tarsal coalition
who is curly toes common in
younger children
when is curly toes resolved by
6
who gets anterior knee pain
females more than men
how to resolve anterior knee pain
physio
red flags for prolapsed intervertebral disc
non mechanical pain, systemic upset, major and new and neurological deficet, saddle anaethesia, bladder and bowel upset
what is a myotome
a group of muscles innervated by a single nerve root
myotome L1/2
hip flexion
myotome L3/4
knee extension
myotome L5
foot dorsiflexion and EHL
myotome S1/2
ankle plantarflexion
prolapsed intervertebral disc investigations
MRI 1st main line
what is sciatica
buttock and/or leg pain in a specific dermatomal distribution accomanied by neurological disturbance
how can a disc prolaose present
may be asymptoamitc, leg pain, neurological disturbance, episodic back pain
management of disc prolapse
70% will settle in 3 months - not an emergency unless cauda equina
what is the management of backache
short bed rest, anti inflammatory, mobilise thereafter, physicaly therapy, return to normal activity, physio and reassurance
red flags of back pain
history of cancer, < 20 and > 60 1st back pain, non mechanical and saddle paraesthesia
what are back pain emergencies
cauda equina, fracture with deteriorating neurology
assessment of back pain
immobilise, X rau and neuro motor and sensory
what is a common theme of congenital scoliosis
imbalance in the number of growth plates
causes of secondary scoliosis
nueromuscular, tumours, spina bifida
management of scoliosis
corrective casts, bracing, exercises and electrical stimulation
what is kyphsis
an exagerated forward rounding of the back
what is spondyloysis
defect in the pars interarticularis of the vertebra
what is spondyloisthesis
forward slippage on one vertebra on anaother
investigations of lower back pain
typically none, ESR/visosity/calciumalkphos, rarely X ray, MRI
causes of lower back pain
90% mechanical/non specific, 0.7% tumour/mets, 0.3% ankylosing spondylitis, 0.01% infection
presentation of facet arthropathy
stiff in morning, loosen up routine, resless, difficulty sittig, driving and standing, worse with extension, better with activity, often radiates to buttocks and legs
how does acute osteomyelitis mainly occur
post traumatic / open - inoculation
how does osteomyelitis occur in children or immunosuppressed
haematogenous
investigations of chronic osteomyelitis
X rays and MRI
what do bone abscesses do
chronically cause inflammation of the joint
what does septic arthritis effect
child development of a joint
how can septic arthritis occur
from inoculation, metaphyseal spread and direct haemotogenous
principles of treatment of cellulitis
know the bug, operate if dead tissue or forguen body, target antibiotics, right team
what shoudl infected arthroplasty affect
ni more than 1% of primary joints
tests for infected arthroplasty
CRP, joint aspiration, bone scan, Xrau
management of infected arthroplasty
let pus outm prophylaxis
marfans syndrome caused by
mutaton of the fibrillin gene
what is ehlers danlos
abnormal elastin and collagen formation
what does ehlers danlos present with
hypermobility, vascular fragility, easy bruising, joint instability and scoliosis
what is duchene muscular dystrophy caused by
a defect in dystrophin gene involved in calcium transport
DMD presenation
progressive mmuscle weakness till can no longer walk by age 20 - carfiac and resp failure common in early 20s, gowers dign
what is gowers sign
usung hands to ush on legs to stand
what is the diagnosis of DCD
raised CK, abnormalities on muscle biopsy
management of muscular dystrphy
physiotherapy and splintage to prolong mobility
what is spinal bifida
congenital disorder where the two halves of the posterior vertebral arch fail to fuse
presentation of bifida occulta
spina tethering of spinal cord -> high arched foot and toe clawing
what is bifida cystica assocaited with
hydrocephalus
what is hydrocephalus
excess CSF at brain increasing intracranial pressure
mingocele has neuro deficit true or false
false
what occurs below the lesion in myelomengocele
motor/sensory deficit
management of spina bifida
usually closed at birth
what is syndactyly
two digits fused together
what is polydactyl
extra digit formed
what is fibular hemimelia
partial or complete absence of the fibula
what does fibular hemimelia lead to
shortened lib, bowing of the tibia and ankle deformity
management of mild fibular hemimelia
limb lengthening with circular frame
management of severe fibular hemimelia
ankle amputation
risk factors of brachial plexus palsy
large babies, twin deliveries, shoulder dystocia
risk factors of brachial plexus palsy
large babies, twin deliveries, shoulder dystocia
what is erbs palsy
injury t upper C5 and C6 nerve roots
what does erbs palsy lead to
loss of motor innervation of the deltoid, supraspinatus, infraspinatus biceps and brachalis
management of erbs palsy
physiotherapy to prevent contractures, retirn of biceps function by 6 months
what is klumpkes palsy
lower brachial plexus injury (C8 & T1)
what does klumpkes palsy cause
paralysis of intrinsic hand muscles due to forceful adduction
recovery of klumpke
less than 50%
knees at birth
varus knees
knees at 14 months
neutrally aligned
knees at 3 years
knock knees
knees at 7-9 years
6 degree valgus
normal range of knees
6 degree
varum
bow legged
valgum
lateral
what is genu varum due to
medial proximal tibial physis (blounts), growth plate restriction at medial side in adolescence, skeletal dysplasia, tumour, rickets, trauma
what is genu valgum due to
rickets, tumours, trauma and neurofibromatosis
management of genu vasum and valgus
osteotoy or growth plate manipulation surgery, olate at side of knee cap growing abnormally
what is intoeing
feet pointing toards the midline when walking and standing
causes of in toeing
femoral neck anteversion, internal tibial torsion, forefoot adduction
when does internal tibial torsion resolve
6 years
when does forefoot adduction resolev
8 years
when is flat feet normal
at bruth
flexible flat feet
flattened medial arch forms with dorsiflexion of the great toe
what is flexible flat foot due to
ligamentous laxity, familial or idiopathic, in adlts tibialis posterior tendon dysfunction
fixed fflat foot
flattened medial arch regardless of load or great toe dorsifelxion
cause of fixed flat foot
underlying bony abnormality
what may fixed foot require
surgey
when do curly toes resolve
by 6 years
how to treat persistant cases of curly toes
flexor tenotomy
what is developmental dysplasia of the hip
the dislocation or subluxation of the femoral head during the perinatal period which affects the subsequent development of the hip
who gets developmental displasia of the hip
usually females
what hip does developmental dysplasia tend to effect
left hip
what is a risk factor of developmental dysplasia of the hip
breech birth
signs of developmental dysplasia of the hip
asymmetric, decreased leg length, ortolanu test, barlow test
what is the ortolani test
reducing a dislocated hip with abducion and anterior displacement
what is barlow test
dislocatable hip with flecuon and posterior displacement
investigations of developmental dysplasia of the hip
US, X rays after 4-6 months
management of developmental dysplasia of the hip
panlik harness for over 18 months,, -> surgery
if left untreated what can developmental displasia of the hip lead to
arthritis,mobility affected, shallow acetabulum
what is transient synovitis of the hip
self limiting inflammation of the synovium of the hip
when does transient synovitis of the hip occur
after URTI
who gets transient synocitis of the hip
men more than females - 2-10 years
what is the most common cause of childhood hip pain
transient synovitis of the hip
presentation of transient synovitis of the hip
reluctance to weight bear on affected side, restriction motion, maybe low grade fever, less pain than septic arthritis
investigations of transient synovitis of the hip
US, normal CRP,
management of transient synovitis of the hip
NSAIDs and rest
what is perthes disease
idiopathic osteochondritis of the femoral head leading to loss of blood supply and avascular necrosis of femoral head
who gets perthes disease
males more than females - 4-9 years olf
stage 1 of perthes disease
necrosis/sclerosis
stage 2 of perthes disease
fragmentation
stage 3 of perthes disease
re ossification
stage 4 of perthes disease
remodelling
presentation of perthes disease
pain and limp, loss of internal rotation,loss of abduction, positive of trendelenburg test
what are the investigations of perthes disease
hip radiographs, regular x ray observation
management of perthes disease
containment, keep hip in socket and rest
who does SUFE effect
overweight pre pubertal adolenscent boys
why does SUFE oocur
the growth plate is not strong enough to support body weight and slips due to strain
who gets SUFE
males more than females
predisposing factors to SUFE
hypothyroidism and renal disease
presentation of SUFE
pain in hip, pain in knee, loss of unternal roatation of the hip
investigation of SUFE
hip radiographs
management of SUFE
urgent surgery to pin femoral head to prevent further slipping - if severe hip replacement and osteomoty
what is epophysitis
inflammation of growing tibercle where a tendon attaches due to repetitive strain
management of paellar tendonitis
rest +/- physiotherapy
what can anterior knee pain be due to
muscle imbalance, ligamentous laxity or subtle skeletal predisposition
what is patellar instability caused by
trauma witha tear in the medial patellofemoral ligament
what can dislocation of the patella cause
osteochondral fractures and torn MPFL
management of dislocation of patella
reduction on extension
management of patellar instability
stabilizes as growing older, physiotherapy
what is osteochondritis dissecans
ostiochondritis where a fragment of hyaline cartilage and bone fragments break the surface of a joint
where is osteochondritis dissecans most common
medial femoral condyle
what can osteochondritis dissecans result in
loose bodies that predispose to osteoathritis
presentation of osteochondritis dissecans
poorly localised pain, effusion, locking
investigations of osteochondritis dissecans
MRI
what is tilpes equinovarus also known as
club foot
what is club foot due to
a congenital defomrity due to in utero alignment of the joints between talus, calcaneus and navicular
who gets club foot
men more than women
development of club foot
abnormal alignment -> contractures of sort tissues ->deformity
risk factores of club foot
breech birth and oligohydramnios (low amniotic fluid content)
presentation of club foot
ankle equinus, supination of the forefoot, varus alignment of the forefoot
management of club foot
early splintage (ponseti technique and tenotomy of the achilles tendon, bracing until 3 years olf as prevention, late deformity - extensive surgery
what is tarsal coalition
abnormal bridge betwen the calcaneus and navicular or the talus ond calcaneus
what does tarsal coalition lead to
pain ful fixed flat foot
management of tarsal coalition
splintage if resistant pain -> surgery
young person with spine probelms
red flag
differentials of young person with spine problems
infection (discitis), tumours (osteoid osteoma)
what is kyphosis
abnormal rounding of the upper back - cenyre of gravity is amyerior to spine
management of kyphosis
bracing for kids
what is scoliosis
lateral curvature of the spine
what can scoliosis be caused by
congenital, idiopathic, secondary to mueromuscular disease
congenital scoliosis
defect of formation / segmentation
idiopathic scoliosis occurs when
growth spurrt before puberty
neuromuscular disease leading to scoliosis
tumour, skeletal dysplasia or infection
investigations of scoliosis
painful scoliosis -> urgen MRI
managemant of mild and non progressive scoliosis
no surgery
management of severe scoliosis with breathing difficulties
maybe surgery
what is spondylotehsis
slippage of one vertebra over another
where does spondylolisthesis usually occur
L4/5, L5/S1
what is spondylolisthesis due to
a developmental ldefect or posterior stress fractire which fails to heal
presentation of spondyloisthesis
adolenscence with low back pain, possible radiculopathy if severe slippage, paradoxial flat back due to muscle spasm, waddling gait
grading system for spondylolisthesis
meyerding
management of mild spondylolisthesis
rest and physio
management of severe spondylolisthesis
stabilistaion and possibly reduction
what spondylosis
defect in the pars interarticularis of vertebrae
when are distal radial fractures common
during metaphyseal growth spurt with FOOSH
radial fractires tend to occur in who
12-14 year old men
radial fractures tend to occur when in females
10-12 years
management of stable distal radial fractures
cast
managment of unstable distal radial fractures
fixation and cast
proximal ulna fracture and raidal head dislocation
manteggia fracture
distal 1/3 rd radius fracture and radioulnar joint injury
galeazzi fracture
