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msk > Paediatric orthapaedics - CP, CTEV and Scoliosis > Flashcards

Paediatric orthapaedics - CP, CTEV and Scoliosis Flashcards

1
Q

What is the definition of complex needs

A

A child with multiple complex disabilities in which they have at least 2 different severe impairments which no professional has a monopoly in the assessment and management

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2
Q

What are the functions that can be affected in complex needs

A

learning and mental functions
communication
Motor skills
self care
hearing
vision

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3
Q

What is the criteria for a child to have complex exceptional needs

A

Under 19 years old

Severe impairment in 4 out of the following with enteral or parenteral feeding :
learning and mental functions
communication
Motor skills
self care
hearing
vision

Severe impairment in 2 categories with ventilation

Impairments which are lasting longer than 6 months

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4
Q

What is cerebral palsy

A

Permanent and non progressive motor disorder due to brain damage before birth or during the first 2 years of life

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5
Q

What are the causes of cerebral palsy

A

neurological damage which occurs before birth or during the first 2 years after birth

Prenatal - placental insufficiency, toxaemia, smoking, alcohol, drugs, infections such as toxoplasmosis

Perinatal - prematurity - most common, anoxic injuries , severe infections , kernicterus - to do with jaundice, haemolytic disease of new born - child developing antibodies to maternal blood

Postnatal - infection and head trauma

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6
Q

What is the most common type of cerebral palsy

A

spastic - pyramidal system and motor cortex affected which causes stiffness

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7
Q

What is athetoid cerebral palsy

A

Affecting the extrapyramidal system and basal ganglia - movement disorders and problems with coordination

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8
Q

What is ataxic cerebral palsy

A

Affects cerebellum and brainstem - balance issues

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9
Q

What is the mixed type of cerebral palsy

A

Combination of spacticity and athetosis - stiffness and movement disorder

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10
Q

What is monoplegia

A

one limb involved

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11
Q

What is hemiplegia

A

One side of the body involved

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12
Q

What is diplegia

A

Lower limbs involved

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13
Q

What is quadriplegia

A

Total body involvement

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14
Q

List the gross motor function classification system

A

level 1 - walks without limitations

level 2 - walks with limitations

level 3 - walks with hand held mobility device

Level 4 - self-mobility with limitations - may use powered mobility

Level 5 - transported in wheelchair

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15
Q

What are the main symptoms in cerebral palsy

A

spasticity - increased muscle tone

Lack of voluntary limb control

muscle weakness

Poor coordination

Impaired senses - hearing, vision, taste, smell, touch

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16
Q

What is a dynamic contracture

A

Limb adopts a posture due to increased tone and hyper-reflexia - the deformity can be overcome

17
Q

What is a fixed muscle contractures

A

Persistent spasticity and stiffness of the joint - causes shortened muscle tendons and the deformity cannot be overcome

18
Q

What is a joint subluxation/dislocation

A

Severe cases - secondary bony changes and joint arthritis

19
Q

What is one of the major problems of the hip due to cerebral palsy

A

Hip dislocation

20
Q

What increases the risk of displacement of the hip in cerebral palsy

A

Having a higher level on the gross motor function classification system - GMFCS

21
Q

What treatment can be done to manage posture in cerebral palsy

A

Physiotherapy

Seats that correct posture

22
Q

What is the treatment of spasticity in cerebral palsy

A

Generalised spasticity - baclofen oral or diazepam - treats muscle spasms

Localised - botulinum toxin - reduces spasms and baclofen intrathecal pump

22
Q

What is Baclofen

A

A muscle relaxant drug

23
Q

What is baclofen intra-thecal pump

A

The pump delivers baclofen into the cerebrospinal fluid in the spine

23
Q

What is the surgical interventions to reduce hip dislocation risk in cerebral palsy

A

Soft tissue release of the hamstrings and adductors

Bony realignment - varus derotation osteotomy
Pelvic osteotomy

23
Q

What is congenital Talipes equinovarus

A

club foot

4 deformities - CAVE

C - Cavus - high arched foot
A - adduction
V - varus - heel is tilted towards the midline
E - equinus - toes are pointing down

23
Q

Who is congenital talipes equinovarus more common in

A

males

24
Q

How is congenital talipes equinovarus often diagnosed

A

Prenatal ultrasound

25
Q

What is the treatment of congenital talipes equinovarus

A

Ponseti techniqueSeries of casts - 5 casts that are applied at intervals
Cavus treated first, then adduction, then varus and then equinus

Percutaneous tenotomy of achilles tendon which allows foot to dorsiflex

26
Q

What is the normal shape of the spine

A

Cervico-lumbar lordosis

Thoraco-sacral Kyphosis

27
Q

What is scoliosis

A

Any deviation in the coronal plane - more than 10 degrees deviation

28
Q

What is the common cause of a non structural scoliosis

A

Leg length discrepancy which causes a tilt in the spine

29
Q

What is the cause of structural scoliosis

A

Underlying vertebral abnormality - intrinsic spinal problem

30
Q

What increases the risk of progression of scoliosis

A

Presentation at an older age - over 12

Increased curvature - greater angle of degree

Premenarchal - in females - if their periods haven’t started

31
Q

What is idiopathic scoliosis classified by

A

Age of presentation:

Infantile - less than 3 years

juvenile 3-10 years

adolescent - over 10 years

Part of spine affected - thoracic, lumbar, thoracolumbar and double

32
Q

On examination what position can the patient be put in to exaggerate the deformity

A

Bending forward into flexion - Adams forward flexion test

33
Q

What investigations are done for scoliosis

A

Erect whole spine X-ray

MRI - will normally be required

34
Q

What is the treatment of scoliosis

A

Bracing - minimises progression of the scoliosis

Surgical treatment - straightening out the spine

35
Q

What are the complications of surgery to correct scoliosis

A

Nerve root damage

Cord traction injury

Vascular injury

Degenerative changes later on

msk (36 decks)

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