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2MBChB Musculoskeletal > Paediatric Ortho > Flashcards

Paediatric Ortho Flashcards

1
Q

What are the features of clubfoot?

A

Cavus.

Adductus.

Varus.

Equinus (foot in a fixed pointy position).

CAVE.

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2
Q

What is the clinical name for clubfoot?

A

Congenital talipes equinovarus.

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3
Q

What causes clubfoot?

A

Mainly idiopathic.

Can be associated with myelomeningocoele, diastrophic dwarfism, tibial hemimelia.

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4
Q

What is postural talipes?

A

Normal malalignment of feet that corrects itself.

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5
Q

How can you distinguish between clubfoot and postural talipes?

A

Postural talipes - can dorsiflex the foot.

Cannot do this in clubfoot.

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6
Q

How is clubfoot treated?

A

Ponseti method of serial casting +/- Achilles tenotomy.

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7
Q

What is rocker bottom feet?

A

AKA congenital vertical talus.

Irreducible dislocation of the talus on the navicular.

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8
Q

What are the clinical features of rocker bottom feet?

A

Round plantar surface.

Equinus hindfoot.

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9
Q

What are the causes of rocker bottom feet?

A

Myelmeningocoele.

Arthrogryposis.

Spinal muscular atrophy.

Neurofibromatosis.

Trisomies.

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10
Q

What is the common similarity between clubfoot and rocker bottom feet?

A

Fixed ankle equinus.

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11
Q

What is neurofibromatosis?

A

Congenital disorder affecting the extremities, spine (scoliosis - >10%) and skin (neurofibromas).

Autosomal dominant in the NF1 gene on chromosome 17.

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12
Q

What are skeletal dysplasias?

A

Congenital disorders involving bone and cartilage.

Umbrella term for 436 disorders.

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13
Q

What are the clinical features of skeletal dysplasias?

A

Shortening of involved bone.

Short stature (usually) <2SD that can be proportionate or disproportionate.

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14
Q

How are skeletal dysplasias classified?

A

According to the area of bone affected (epiphyseal, metaphyseal, diaphyseal).

According to pathophysiology (storage diseases, fibrous disorders).

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15
Q

What is achondroplasia?

A

Autosomal dominant mutation in fibroblast growth factor receptor 3 (FGFR3; 80% are spontaneous mutations).

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16
Q

What are the features of achondroplasia?

A

Normal trunk, short limbs.

Frontal bossing.

Genu varum (prominent forehead).

Normal intelligence.

Motor delay.

17
Q

What is cerebral palsy?

A

Non-progressive neuromuscular disorder.

18
Q

What are the causes of cerebral palsy?

A

Injury to immature brain (<2 years): prematurity, perinatal (infection, anoxic injuries, meningitis).

19
Q

What are the features of cerebral palsy?

A

Upper motor neuron disease causing muscle weakness and spasticity.

Early - abnormal muscle forces leading to dynamic deformity.

Late - contractures, fixed deformity, dislocation.

20
Q

How can cerebral palsy be classified?

A

Regional involvement (hemiplegia, diplegia).

Global involvement (quadriplegia, athetoid, dystonic, ataxic).

OR

Pyramidal pathways affected.

Extrapyramidal pathways affected.

OR

Spastic.

Dyskinetic.

Ataxia.

21
Q

What is the functional classification of cerebral palsy?

A

Walking.

Non-walking.

22
Q

What treatments are given to patients with cerebral palsy?

A

Benzodiazepines - to treat centrally.

Selective dorsal rhizotomy.

Botulinum toxin - paralyse muscles.

23
Q

What is Duchenne muscular dystrophy?

A

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.

24
Q

When does Duchenne muscular dystrophy present?

A

2-5 years.

Walking aids required by age 10.

Wheelchair by age 15.

Usually die in 20s.

25
Q

What is the treatment of Duchenne muscular dystrophy?

A

Keep ambulatory for as long as possible.

Decrease contractures.

26
Q

What are the clinical features of Duchenne muscular dystrophy?

A

Muscle weakness (proximal>distal).

Clumsy walking.

Positive Gower’s sign (can’t stand up using thigh muscles so walking the body up).

Scoliosis.

27
Q

How is Duchenne muscular dystrophy diagnosed?

A

Creatine phosphokinase (CKP).

Muscle biopsy (absence of dystrophin).

28
Q

What is pes cavus?

A

High arched foot.

Elevated longitudinal arch and varus hindfoot.

29
Q

What are the causes of cavus feet?

A

Idiopathic/familial.

2/3 due to neurological disorders e.g. polio, cerebral palsy, myelomeningocoele, spinal cord injury, Charcot Marie Tooth.

30
Q

What is a Coleman block test?

A

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).

2MBChB Musculoskeletal (17 decks)

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