Paediatric Ortho Flashcards
What are the features of clubfoot?
Cavus.
Adductus.
Varus.
Equinus (foot in a fixed pointy position).
CAVE.
What is the clinical name for clubfoot?
Congenital talipes equinovarus.
What causes clubfoot?
Mainly idiopathic.
Can be associated with myelomeningocoele, diastrophic dwarfism, tibial hemimelia.
What is postural talipes?
Normal malalignment of feet that corrects itself.
How can you distinguish between clubfoot and postural talipes?
Postural talipes - can dorsiflex the foot.
Cannot do this in clubfoot.
How is clubfoot treated?
Ponseti method of serial casting +/- Achilles tenotomy.
What is rocker bottom feet?
AKA congenital vertical talus.
Irreducible dislocation of the talus on the navicular.
What are the clinical features of rocker bottom feet?
Round plantar surface.
Equinus hindfoot.
What are the causes of rocker bottom feet?
Myelmeningocoele.
Arthrogryposis.
Spinal muscular atrophy.
Neurofibromatosis.
Trisomies.
What is the common similarity between clubfoot and rocker bottom feet?
Fixed ankle equinus.
What is neurofibromatosis?
Congenital disorder affecting the extremities, spine (scoliosis - >10%) and skin (neurofibromas).
Autosomal dominant in the NF1 gene on chromosome 17.
What are skeletal dysplasias?
Congenital disorders involving bone and cartilage.
Umbrella term for 436 disorders.
What are the clinical features of skeletal dysplasias?
Shortening of involved bone.
Short stature (usually) <2SD that can be proportionate or disproportionate.
How are skeletal dysplasias classified?
According to the area of bone affected (epiphyseal, metaphyseal, diaphyseal).
According to pathophysiology (storage diseases, fibrous disorders).
What is achondroplasia?
Autosomal dominant mutation in fibroblast growth factor receptor 3 (FGFR3; 80% are spontaneous mutations).
What are the features of achondroplasia?
Normal trunk, short limbs.
Frontal bossing.
Genu varum (prominent forehead).
Normal intelligence.
Motor delay.
What is cerebral palsy?
Non-progressive neuromuscular disorder.
What are the causes of cerebral palsy?
Injury to immature brain (<2 years): prematurity, perinatal (infection, anoxic injuries, meningitis).
What are the features of cerebral palsy?
Upper motor neuron disease causing muscle weakness and spasticity.
Early - abnormal muscle forces leading to dynamic deformity.
Late - contractures, fixed deformity, dislocation.
How can cerebral palsy be classified?
Regional involvement (hemiplegia, diplegia).
Global involvement (quadriplegia, athetoid, dystonic, ataxic).
OR
Pyramidal pathways affected.
Extrapyramidal pathways affected.
OR
Spastic.
Dyskinetic.
Ataxia.
What is the functional classification of cerebral palsy?
Walking.
Non-walking.
What treatments are given to patients with cerebral palsy?
Benzodiazepines - to treat centrally.
Selective dorsal rhizotomy.
Botulinum toxin - paralyse muscles.
What is Duchenne muscular dystrophy?
Inherited disorder causing progressive muscle weakness.
X-linked recessive - seen in boys (1/3 spontaneous mutations) - absence of dystrophin protein causing a replacement of muscle with fibrofatty tissue.
When does Duchenne muscular dystrophy present?
2-5 years.
Walking aids required by age 10.
Wheelchair by age 15.
Usually die in 20s.
What is the treatment of Duchenne muscular dystrophy?
Keep ambulatory for as long as possible.
Decrease contractures.
What are the clinical features of Duchenne muscular dystrophy?
Muscle weakness (proximal>distal).
Clumsy walking.
Positive Gower’s sign (can’t stand up using thigh muscles so walking the body up).
Scoliosis.
How is Duchenne muscular dystrophy diagnosed?
Creatine phosphokinase (CKP).
Muscle biopsy (absence of dystrophin).
What is pes cavus?
High arched foot.
Elevated longitudinal arch and varus hindfoot.
What are the causes of cavus feet?
Idiopathic/familial.
2/3 due to neurological disorders e.g. polio, cerebral palsy, myelomeningocoele, spinal cord injury, Charcot Marie Tooth.
What is a Coleman block test?
Block placed under 4/5th toes.
if deformity of pes cavus reverses then it is flexible (soft tissue management/surgery), if not it is fixed (bony [osteotomies] management/surgery).
