Paediatric Ortho Flashcards
What is talipes?
a deformity in whic hthe foot is twisted out of normal position
What is the difference between varus and valgus?
varus is when there is displacement of part of a limb towards the midline whereas valgus is part of a limb away from the midline
What is spina bifida?
an incomplete vertebral arch
What is spina bifida occulta?
if the incompete vertebral arch is covered by skin
What is the difference between meningocoele and meningomyelocele?
meningocoele is a herniation through a bony defect of dura and arachnoid whereas with the meningomyelocele the cord is involved too
What is important about the level of defect of spine in spina bifida?
the higher the defect on the spine, the most severe the complications
What are the prerequisites for normal gait?
stability in stance; sufficient foot clearance (ots of muscles) and joints involved; appropriate swing phase prepositioning of the foot ( put foot on the grounD); adequate step length and energy conservation
What is an antalgic limp?
source of pain is in the limb so walking is done in a way to minimise stance phase and decrese time on painful imb
What is a positive trendelemberg?
hips are not aligned when one foot is off the groun
What does a postive trendenlenberg indicate
adductor insuffiency; defective fulcrum or defective lever
What are causes of tip toe gait?
habitual; structural and neurological
What is habitual tip toe gait?
when someone just gets int othe way of walking like that for no otehr reason
What can cause structural tip toe gait?
a tight achilles
What can cause a neurological tip toe gait?
spasticity; spina bifida; cerebral palsy; muscualr dystrophy
What is spasticity?
veolcity dependent increase in tone- contraction doesnt stop as no central inhibition
What is cerebral palsy?
inclusive term that describes a group of non-progressive disorders in which disease of the brain causes an impairment of motor function
What occurss with the neurological injury?
loss of normal motor development; maintenance of primitive reflexes; loss of selective motor control ; weakness; injury to blaance mechanism and abnormal tone
What are the topographical types of cerebral palsy?
hemiplegia (unilateral); diplegia (bilaterLal: total body involvemtn
How does a brain injury result in bone deformity?
injury leads to increased tone and so abnormal posture which leads to contracture and bone deformity
Why do diplegics with CP walk with in-toeing?
their hips are internally rotated as their hip is still at 40 degres and in order ot walk they ahve to rotate their hip round
What are the risk factors for developmental dysplasi of the hip?
breech position; family history; other MSK anomalies
What is the ortolani manoeuvre?
attempt to reloacte a discolated hip by abductiontry to lift up the femoral head and reloacte it in the acetabulum- positive if a palpable clunk
What is the barlow manoeuvre?
when you attempt to sublux or dislocate an unstable hip by adduction
What is the imaging of choice for DDH?
ultrasound
What is the treatment for early diagnosed DDH?
a Pavlik harness
What is perthes disease?
idiopathic avascular necrosis which causes osteochondritis
Who gets perthes disease?
M:F 4:1; ages 4-8
What is SUFE?
slipped upper femoral epiphysis- displacement of the growth plate with the epiphysis always slipping down and back
What is seen on x-ray with SUFE
a line drawn along the superior edge of the femoral neck does not intersect the femoral head- which it should
Who gets SUFE?
10-16years; M:F 2:1; much more common in the obese
What is the treatment of SUFE?
stabilisisation acorss the physis
How does SUFE presnet?
an adolescent with limping and pain in the groin; ant. thigh or knee
What is the most common cause of hip pain in children?
transient synovitis of the hip
What must always be ruled out in a child with hip pain?
septic arthritis
