Paediatric orthapaedics - CP, CTEV and Scoliosis Flashcards
What is the definition of complex needs
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
What are the functions that can be affected in complex needs
learning and mental functions
communication
Motor skills
self care
hearing
vision
What is the criteria for a child to have complex exceptional needs
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
What is cerebral palsy
Permanent and non progressive motor disorder due to brain damage before birth or during the first 2 years of life
What are the causes of cerebral palsy
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
What is the most common type of cerebral palsy
spastic - pyramidal system and motor cortex affected which causes stiffness
What is athetoid cerebral palsy
Affecting the extrapyramidal system and basal ganglia - movement disorders and problems with coordination
What is ataxic cerebral palsy
Affects cerebellum and brainstem - balance issues
What is the mixed type of cerebral palsy
Combination of spacticity and athetosis - stiffness and movement disorder
What is monoplegia
one limb involved
What is hemiplegia
One side of the body involved
What is diplegia
Lower limbs involved
What is quadriplegia
Total body involvement
List the gross motor function classification system
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
What are the main symptoms in cerebral palsy
spasticity - increased muscle tone
Lack of voluntary limb control
muscle weakness
Poor coordination
Impaired senses - hearing, vision, taste, smell, touch
What is a dynamic contracture
Limb adopts a posture due to increased tone and hyper-reflexia - the deformity can be overcome
What is a fixed muscle contractures
Persistent spasticity and stiffness of the joint - causes shortened muscle tendons and the deformity cannot be overcome
What is a joint subluxation/dislocation
Severe cases - secondary bony changes and joint arthritis
What is one of the major problems of the hip due to cerebral palsy
Hip dislocation
What increases the risk of displacement of the hip in cerebral palsy
Having a higher level on the gross motor function classification system - GMFCS
What treatment can be done to manage posture in cerebral palsy
Physiotherapy
Seats that correct posture
What is the treatment of spasticity in cerebral palsy
Generalised spasticity - baclofen oral or diazepam - treats muscle spasms
Localised - botulinum toxin - reduces spasms and baclofen intrathecal pump
What is Baclofen
A muscle relaxant drug
What is baclofen intra-thecal pump
The pump delivers baclofen into the cerebrospinal fluid in the spine
What is the surgical interventions to reduce hip dislocation risk in cerebral palsy
Soft tissue release of the hamstrings and adductors
Bony realignment - varus derotation osteotomy
Pelvic osteotomy
What is congenital Talipes equinovarus
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
Who is congenital talipes equinovarus more common in
males
How is congenital talipes equinovarus often diagnosed
Prenatal ultrasound
What is the treatment of congenital talipes equinovarus
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
What is the normal shape of the spine
Cervico-lumbar lordosis
Thoraco-sacral Kyphosis
What is scoliosis
Any deviation in the coronal plane - more than 10 degrees deviation
What is the common cause of a non structural scoliosis
Leg length discrepancy which causes a tilt in the spine
What is the cause of structural scoliosis
Underlying vertebral abnormality - intrinsic spinal problem
What increases the risk of progression of scoliosis
Presentation at an older age - over 12
Increased curvature - greater angle of degree
Premenarchal - in females - if their periods haven’t started
What is idiopathic scoliosis classified by
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
On examination what position can the patient be put in to exaggerate the deformity
Bending forward into flexion - Adams forward flexion test
What investigations are done for scoliosis
Erect whole spine X-ray
MRI - will normally be required
What is the treatment of scoliosis
Bracing - minimises progression of the scoliosis
Surgical treatment - straightening out the spine
What are the complications of surgery to correct scoliosis
Nerve root damage
Cord traction injury
Vascular injury
Degenerative changes later on
