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MB2 Rheumatology and Orthopaedics > Paediatric and congenital orthopaedics > Flashcards

Paediatric and congenital orthopaedics Flashcards

1
Q

what is osteogenesis imperfecta and autosomal dominant/recessive is more common

A

defect in maturation and organisation of type I collagen

autosomal dominant

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2
Q

how would bones appear in osteogenesis imperfecta

A

thin cortices

osteopenia

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3
Q

features of achondroplasia, proportionate/disproportionate, inheritance

A

disproportionate short limbs, prominent forehead and wide nose, joint laxity
autosomal dominant but usually sporadic

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4
Q

complicating features of skeletal dysplasias

A 
learning difficulty 
spine deformity 
atlantoaxial subluxation 
cord compression 
joint hypermobility 
tumour 
organ dysfunction
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5
Q

patients with general joint laxity are more prone to?

A

dislocations and sprains - especially joint and patella

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6
Q

what is marfans syndrome

A

autosomal dominant/sporadic mutation of fibrillin gene leading to tall stature with disproportionately long arms and joint laxity

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7
Q

features of marfans syndrome

A

scoliosis, long arms, tall stature, joint laxity, high arch palate, aortic/mitral regurgitation, pectus excavatum, aortic aneurism/dissection

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8
Q

what is ehlers-danlos syndrome and common features?

A

heterogenous condition with autosomal dominance affecting collagen and elastin
easy bruising, vascular fragility, joint hypermobility and instability, scoliosis

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9
Q

what is duchenne muscular dysytrophy

A

x linked recessive dystrophin mutation in calcium transport causing progressive muscle weakness

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10
Q

what is CP

A

neuromuscular disorder with onset <2-3 due to immature brain before, during or after birth

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11
Q

causes of CP

A 
genes 
brain malformation 
issues during labour 
meningitis 
intrauterine infection 
intra-cranial haemorrhage 
hypoxia during birth
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12
Q

most common type of CP

A

spastic

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13
Q

what does ataxic CP affect

A

cerebellum

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14
Q

features of athetoid CP

A

writhing, changes in tone and difficulty with speech

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15
Q

MSK manifestations of CP

A

hip dislocation, joint contacture, scoliosis

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16
Q

what is spina bifida

A

congenital defect where two halves of the vertebral arch fail to fuse
mildest is spina bifida occulta and most severe is spina bifida cystica

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17
Q

who is obstetric brachial plexus palsy more common in

A

larger babies, twins, shoulder dystocia

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18
Q

what nerve roots does erb’s palsy affect

A

C5-C6 upper nerve roots

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19
Q

what nerve roots are affected in klumpke’s palsy

A

C8-T1

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20
Q

at what age should a child be able to sit alone/crawl

A

6-9 months

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21
Q

at what age should a child be able to stand

A

8-12 months

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22
Q

at what age should a child be able to walk

A

14-17 months

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23
Q

at what age should a child be able to jump

A

24 months

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24
Q

at what age should a child be able to manage stairs independently

A

3 years

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25
Q

at what age should a child be able to move head

A

8 weeks

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26
Q

at what age should a child be able to speak a few words

A

9-12 months

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27
Q

at what age should a child be able to use a spoon or fingers eating

A

14 months

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28
Q

at what age should a child be able to stack 4 blocks

A

18 months

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29
Q

at what age should a child be able to understand 200 words and learn 10 new words/day

A

18-20 words

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30
Q

at what age should a child be able to be potty trained

A

2-3 years

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31
Q

describe child lower limb development

A

at birth children have varus legs that become neutrally alligned, then 10-15 degrees valgus at 3 years before 6 degrees valgus at 7-9 years old

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32
Q

what is femoral neck anteversion

A

femoral neck is slightly pointed anterior so gives appearance of intoeing and knock knee

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33
Q

describe formation of arch of foot

A

all feet flat at birth anf as we walk muscles develop to cause arch to form

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34
Q

true/false - flat feet is a problem

A

false - not always, it can be normal variation

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35
Q

what is jacks test

A

dorsiflexion of great toe causes arch of foot to form, positive sign of flexible flat footedness

36
Q

causes of flexible flat footedness

A

ligament laxity, idiopathic, familial, tibialis posterior tendon dysfunction

37
Q

what is a cause of rigid flat footedness

A

tarsal coalition

38
Q

true/false - the first toe is most affected by overlapping of toes

A

false - fifth is

39
Q

what is DDH, what hip is it more common in and who is more likely to get it

A

dilocation/subluxation of the femoral head affecting further development of the hip
more common in the left hip and women

40
Q

risk factors for DDH

A

FHx
Breech position
first born
other congenital disorders and downs syndrome

41
Q

untreated pathology of DDH?

A

acetabulum formed is shallow so false acetabulum may form proximal to original
severe OA may occur due to lesser SA

42
Q

what is barlow’s test

A

dislocatable hip with flexion and posterior displacement

43
Q

what is ortolani test

A

reduced dislocated hip with abduction and anterior displacement

44
Q

true/false - DDH can be detected in a 3 month old by radiograph

A

false - USS should be used for up to 4-6 months as the head of femur is not ossified

45
Q

what is transient synovitis of the hip

A

self limiting inflammation of hip joint following viral URTI (or other)
most common paeds hip pain and usually boys age 2-10

46
Q

what is perthes disease, who gets it

A

idiopathic osteochondritis of fem head, transient lost blood supply so altered growth and possible collapse and OA
boys aged 4-9, short and active

47
Q

what is SUFE, whos more likely to get it

A

slipped upper femoral epiphysis, overweight prepubescent boys, hypothyroidism and renal disease

48
Q

a child has knee pain, what joint do you examine?

A

the hip, never forget it as it follows referred pain from obturator nerve

49
Q

what is apophysitis

A

inflamation of a growing tubercle where a tendon attaches

50
Q

what is osgood-schlatter disease

A

apophysitis of tibial tubercle

51
Q

what is sinding-larsen-johnasen disease

A

apophysitis of inferior pole of patella

52
Q

what is osteochondritis dissecans and where is it most common

A

hyaline cartilage breaks off joint surface, knee

53
Q

what is talipes equinovarus and what deformity does it cause

A

abnormal in uero alignment of joints between talus, calcaneus and navicular
ankle equinus, forefoot supination and varus alignment

54
Q

who is talipes equinovarus more common in

A

oligohydraminos and breech presentation, twice as common in males

55
Q

red flags for paediatric leg pain?

A 
asymmetry 
good localisation 
short hx 
persisitent limp
fail to thrive 
worsening pain 
tender and guarding
reduced ROM
56
Q

what is a salter harris I fracture and what prognosis does it carry

A

pure physeal seperation

best prognosis and least likely for growth arrest

57
Q

what is a salter harris II fracture and what prognosis does it carry

A

mostly physeal frcture
most common and small metaphyseal fracture attached to epiphysis and metaphysis
low likelihood growth disturbance

58
Q

what is a salter harris III/IV fracture and what prognosis does it carry

A

intra articular fracture with splitting of physis so greater risk growth arrest
reduce and stabilise to ensure congruent joint surface - this minimises post traumatic OA and growth arrest

59
Q

what is a salter harris V fracture and what prognosis does it carry

A

compression to physis with subsequent growth arrest

not disgnostic on xray and only once angular deformity has occurred

60
Q

features of NAI

A 
poverty, special needs, substance abuse 
bruising/injury of different age 
multiple trips to A&E 
inconsistent or changing injury 
discrepancy in hx with parents/carers
injury not consistent with child age 
dental injury, LL and trunk burn, torn frenulum, genital injury and cigarette burns 
rib fracture 
metaphyseal fracture in the young infant
61
Q

how is a distal radius buckle fracture managed

A

splint for 3-4 weeks as stable

62
Q

how is a distal radius greenstick fracture managed

A

manipulation if angulated and casting if there is deformity

63
Q

what salter harris fracture is common in fracture to distal radius and how is it managed

A

manipulate to correct angulation/deformity
casting
salter harris II - low risk growth arrest

64
Q

in a complete childrens distal radius fracture, how is it managed and what displacement/angulation is most common

A

dorsal displacement/angulation
if stable then cast
unstable - wires or plate fixation

65
Q

how would you manage a childrens monteggia and galeazzi fracture

A

plates and screws with rigid anatomical fixation

66
Q

how would you manage a fracture of both bones of forearm

A

if there is one plane of angulation then casting may be okay
displaced fractures are unstable so flexible IM nail is often used

67
Q

types of fracture to supracondyle of elbow

A

extension type most common due to fall on outstretched hand

flexor type can occur due to fall on point of elbow

68
Q

managing undisplaced supracondylar elbow fracture

A

splint as stable

69
Q

managing an angulated, rotated or displaced elbow fracture

A

closed reduction with wire pinning
manage quickly to avoid swelling
if severely displaced brachialis may be tethered and needs open reduction
if radial pulse absent emergency surgery to reduce/explore

70
Q

why cant people with off ended extension fracture of elbow supracondyle make an OK sign

A

distal fragment displaces posterior to stretch and put pressure on brachial artey and median nerve
loss of FPL and FDP

71
Q

how should nerve injury on supracondylar elbow fractures be managed

A

manage urgently in theatre
majority are neuropraxia but can be axonotmesis
neuralgic pain ongoing may be entrapment needing surgical release

72
Q

how may a childrens femoral shaft fracture ccur

A

flexed knee, indirect bending/rotation

73
Q

why can shortening in femoral fractures be tolerated

A

there is usually overgrowth

74
Q

true/false - in <2y 1/4 fem shaft fractures are NAI

A

false - 1/2 are

75
Q

how is femoral shaft fracture in <2 managed

A

gallows traction and hip spica cast

76
Q

how is femoral shaft fracture in 2-6 managed

A

thomas’ splint or hip spica cast

77
Q

how is femoral shaft fracture in 6-12 managed

A

flexible IM nail

78
Q

how is femoral shaft fracture in >12 managed

A

Adult IM nail

79
Q

if there is no obvious hx for femur shaft bone fracture what may it be

A

NAI

benign/malignant bone tumours

80
Q

true/false - the risk of compartment syndrome during a paeds tibial fracture is more than that of an adult

A

false - it is less

81
Q

how much angulation is tolerated in paeds tibial fracture

A

10 degrees, above that manupulation and casting needed

82
Q

true/false - shortening and rotation can be accepted in tibial fracture

A

false - never

83
Q

why are serial x rays important in a tibial fracture

A

ensure there is no angulation drifting in AP/lat

84
Q

when would you offer casting for a tibial fracture in children

A

undisplaced spiral fracture, usually in toddlers

stable fractures that have little to no angulation or are manipulated

85
Q

how would you stabilise an unstable/open tibial fracture in children

A

flexible IM nail or in closed prox tibial physis an adult one
plates and screws
external fixator

MB2 Rheumatology and Orthopaedics (22 decks)

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