Paed - pathology Flashcards
talipes =
foot twisted
talipes equinus =
foot twisted in plantar flexion
talipes calcaneus =
foot twisted in dorsiflexion
foot twisted towards midline =
talipes varus
foot twisted away from midline
talipes valgus
physiological talipes aka
it is fully __
positional talipes
correctable
equinovarus =
clubfoot
Rx of equinovarus
ponseti cast (divide Achilles tendon) for 3 months boots and bar > boot at night for yrs
calcaneovalgus =
if uncorrectable may be due to
rockerbottom foot
congenital vertical talus
irreducible hip at birth is ___ not ___
teratogenic (not DDH)
irreducible hip at birth can be due to __/__
arthrogryposis (fixed contractures of joints ass with neuro deficit)
spina bifida
meningocele contains
CSF
form of spina bifida that is found in 10% of normal pop and of no clinical relevance
occulta
myelomeningocele contains
CSF and nerve roots
if myelomeningocele in spina bifida is above L1/2 =
in a wheelchair
if myelomeningocele in spina bifida is T12 and above =
numb from waist down , no hip movement
if myelomeningocele in spina bifida is L1 =
numb below waist and limited hip movement
if myelomeningocele in spina bifida is L2-3
numb from lower hip and weak hip muscles
if myelomeningocele in spina bifida is L4
numb below knee and weak leg muscles
if myelomeningocele in spina bifida is L5-S1
numb in buttock and feet
abnormal feet position
if myelomeningocele in spina bifida is S2-4
can walk without aids, need shoe inserts
numb buttocks
skin sensation may be affected
painful limb aka
minimise __ phase
antalgic gait
stance
lurch to one side to get foot clearance as abductors don’t lift pelvis =
trendelenberg gait
causes of trendelenberg gait
weak abductors (polio, muscular dystrophies, Hip Sx, motor neuron) defective fulcrum (congenital/pathological dislocation of hip) defective lever (Perthes, coxa vara)
assess a tight Achilles with ___ test =
Silverskold test
flex knee and relax gastroc = can get more dorsiflexion in this position
neurological gait (spasticity) can be caused by
spina bifida, cerebral palsy, spinal cord/CNS pathology
muscular dystrophy
loss of motor development, maintenance of primitive reflexes, selective motor control loss, weakness, balance mechanism injury and abnormal tone are all primary features of ___
may => ++_
Cerebral palsy
deformity, contractures and dislocations
prenatal causes of Cerebral palsy
prem + low birth wt due to congenital brain malformation
intrauterine infection - TXMS, CMV
perinatal causes of cerebra palsy
birth trauma/asphyxia
kernicterus - choreoathetosis
postnatal causes of cerebral palsy
meningitis
NAI
cerebral haemorrhage
CP with a flexed knee and upper limb + tip toe walk =
hemiplegia/unilateral
CP with predom lower limb, femoral anteversion => intoe. Often hip and knee flexion contracture =
diplegia
5 different neurological classes of CP
spastic athetoid dystonic rigid mixed
scale used to assess severity of CP
GMFCS levels 1-5
orthopaedic problems seen in non-walking cerebral palsy ptnts
hip dislocation
pelvic obliquity
spinal deformity
perineal hygiene issues
if in Thomas test lumbar lordosis is not obliterated =
hip flexion contracture
orthopaedic problems seen in CP
psoas and adductors (contractures) hamstrings gastrocsoleus hip dislocation pelvic obliquity spinal deformity
management of CP =
Sx for contractures
benzodiazepines and baclofen
selective dorsal rhizotomy
botox IM
Hip problem common in pre/peri walker (0-18m)
Congenital dislocation of the hip
hip problem common in 2-5yo
transient synovitis
hip problem common in 5-10yo
Perthes
hip problem common in 11-15yo
SUFE
DDH aka
risks =
developmental dysplasia of the hip
breech birth
FH
more likely in F and 1st born
instability tests for DDH =
unreliable after ___ old
Barlow
Ortolani
Gariatri
6wks
instability test for DDH where you can dislocate/sublux the hip by flexion adduction
Barlow
instability test for DDH where if you try to relocate dislocated hip by abduction you can feel a clunk at ring finger on the trochanter
Ortolani
instability test for DDH where if you lie them on their back with hip 90 degrees flexed there is asymmetry
Gariatri
imaging for DDH
indication =
time to do it =
> 3-6m = xray
<3m = US - lateral (spoon and teacup)
if FH/breech
in first4-6wk preferably
treatment of DDH diagnosed early
relocate, splint in Pavlik harness (95% success) and monitor acetabular development
Rx for DDH
>3m
>9m
>2yo
3 = closed reduction 9 = open reduction 2 = femoral / pelvic osteotomy, preop gallows traction > plaster spica for 3 months - never get a normal hip
idiopathic AVN of capital epiphysis of femur
Perthes
Perthes:
age:
M:F usually __+__
present with __/__
4-8yo
M4:1F - small active
limp/pain
Rx Perthes :
contain femur in acetabulum
rest brace and Sx to maintain hip abduction
SUFE aka age M:F black:white 25-60% are \_\_\_ 10-15% complain of only \_\_\_
slipped upper femoral epiphysis 10-16yo M2:1F black 2 : 1 white bilateral knee/distal thigh pain
Ix for SUFE
xray - AP (trethowans sign - line from femoral neck doesnt go through epiphysis) and lateral (imperative)
whole leg sticks out
less than __ duration makes SUFE acute (any longer = chronic)
<3months
3 characteristics used to classify SUFE
acute/chronic
magnitude of slip - mild, mod, severe
stability of slip - wt bear w/wo aids?
adolescent with hip/groin, thigh or knee pain = __ until disproven = immediate ___
SUFE
xray
