paediatric orthopaedic conditions Flashcards
who is patellofemoral dysfunction most commonly seen in?
adolescent girls
athletic (increased activity or recent injury)
how does patellofemoral dysfunction present?
anterior knee pain walking up stairs
anterior knee pain after prolonged periods of sitting
what is osgood schlatters disease?
inflammation of tibial tuberosity - sit of attachment of patellar ligament
who does osgood shclatters disease most commonly present in?
boys aged 10-15
what sign indicates osgood shclatters disease?
pain worse with straight leg raise - contraction of quadriceps
what is osteochrondritis dissecans?
fragment of hyaline cartilage breaks of the surface of the joint
where is osteochondritis dissecans most commonly seen?
knee - medial femoral condyle
what symptoms are seen with osteochondritis dissecans?
poorly localised pain
effusion
occasionally locking
what features of effusion indicates osteochondritis dissecans?
takes hours/days to form
if it does form quickly, will be filled with blood
what imaging is used for osteochondritis dissecans?
MRI (difficult to view on x-ray)
what meniscal abnormality can be seen in children?
lateral meniscus circular rather than c-shaped
causes pain and popping sensation
what is the fancy name for club foot?
talipes equinovarus
what joints are abnormally aligned in club foot?
tallus
calcaneus
navicular
what does club foot cause?
planter flexion of ankle
supination of forefoot
varus alignment of forefoot
what does club foot increase your chances of?
DDH
what technique is used to treat club foot?
Ponseti technique - regimen of serial casts started after birth
what is required for club foot after casting?
achilles tendonotomy
what is required after full correction for club foot?
brace
worn 23 hours a day for 3 months
during sleep until 3-4 years old
what is back pain in children a red flag for?
infection - discitis
tumours - osteoid osteoma
what is scoliosis?
lateral curvature of the spine
what is the most common cause of scoliosis in females?
idiopathic
present as adolescence due to cosmetic appearance
younger children have underlying cause
what are some risks with large curvatures in scoliosis?
restrictive lung defect
risk of spinal cord injury
what is spondylolisthesis?
slippage of one vertebrae over another
what level does spondyloisthesis commonly occur at?
L4/L5 or L5/S1
how does spondyloisthesis present?
in adolescence - increase weight and activity
lower back pain
flat back due to muscle spasm
waddling gait
what is syndactyly?
where does it most commonly occur?
what is polydactyly?
fusion of fingers - most commonly 3rd and 4th
extra finger
what is fibular hemimelia?
how does it present?
partial or complete absence of the fibula
- shortened limb
- bowing of tibia
- ankle deformity
how is fibular hemimelia treated?
if severe, ankle amputation at 10 months to 2 years and use of below knee prosthetic
what does radius deformity cause?
absence of thumb
radius club hand
what most commonly causes obstetric brachial plexus palsy’s?
large babies (macrosomia diabetes) twin deliveries shoulder dystocia
what its he most common obstetric brachial plexus palsy’s?
erb’s palsy
where is the injury in erb’s palsy?
upper nerve roots C5 and C6
what posture is there with erb’s palsy?
waiter tip posture
what muscles are affected with erb’s palsy?
loss of motor innervation of
- deltoid
- supraspinatus
- infraspinatus
- biceps
- brachialis
what is the prognosis with erb’s palsy?
return of bicep function by 6 months good outcomes (90%)
what is klumpe’s palsy?
lower brachial plexus injury - C8 to T1
paralysis of intrinsic hand muscles
fingers flexed
what may cause klumpe’s palsy?
Horner’s syndrome
what is the prognosis for klumpe’s palsy?
bad - less than 50% recover
what is osteogenesis imperfecta?
brittle bone disease
defect in the maturation of type 1 collagen
what is the most common type of osteogenesis imperfecta?
autosomal dominant
what are the symptoms of osteogenesis imperfecta?
multiple fractures in childhood short stature multiple deformities blue sclera loss of hearing
what is seen with osteogenesis imperfecta if autosomal recessive?
very rare
fatal in perinatal period
spinal deformity
what is the outcome of osteogenesis imperfecta?
bones are thin and osteopenic - fractures heal with poor quality callus
most adults have scoliosis
what is achondroplasia?
disproportionately short limbs
prominent forehead
widened nose
what is the genetic mutation in marfans?
autosomal dominant
sporadic mutation of fibrillin gene
what are the symptoms of marfans?
high arched palate scoliosis pectus excaratum spontaneous penumonthorax lens dislocation aortic aneurysm arachnodactyly (long fingers and toes)
what is Ehlers danlos syndrome?
autosomal dominant - abnormal collagen and elastin hyper mobility vascular fragility - bruise easily joint instability scoliosis
what is Down syndrome?
trimosy 21
what orthopaedic symptoms are seen in down syndrome?
short stature
joint laxity
recurrent dislocations - patella
atlanto-axial instability of spine - OA
who do muscular dystrophies affect and why?
boys - x linked recessive conditions
what is Duchenne muscular dystrophy?
defects in dystrophin gene involved in calcium transport
what symptoms are seen with Duchenne muscular dystrophy?
difficulty standing/walking up stairs
Gower’s sign
what is the prognosis for Duchenne muscular dystrophy?
age 10 - no longer walking
age 20 - res and cardiac failure
death in 20s
how is Duchenne muscular dystrophy diagnosed?
raised CK
abnormalities on muscle biopsy
how is becker’s muscular dystrophy different from duchenne’s muscular dystrophy?
milder form
boys able to walk into their teens
survive until 30/40
what is the most common type of cerebral palsy? what are the subtypes?
spastic
hemiplegic - leg and arm on same side
diplegic - both lower limbs
quadraplegic - all 4 limbs
what are the symptoms of spastic CP?
increased tone due to damage to UMN
what is ataxia CP?
reduced co-ordination and balance due to cerebellar damage
what is dyskinetic CP?
damage to basal ganglia and substania nigra
uncontrolled writhing motion
sudden changes in tone
difficulties controlling speech
what causes spina bifida?
2 halves on posterior vertebral arch fail to fuse during first 6 weeks of gestation
what is spina bifida occulta?
mildest form
no associated problems
may have tethering of spinal cord - pes cavus, clawing of toe
birthmark, skin tag, fatty deposit, dimple, tuft of hair
what is spina bifida cystica?
can’t walk
contents of vertebral canal herniate through
what is meningocele spina bifida?
only meninges herniate through
what is myelomeningocle spina bifida?
herniation of meninges with spinal cord/cauda equine
neurological defects - most serious
what is polio?
viral infection of anterior horn cells resulting in lower motor neurone deficit
what can happen due to polio?
variable degree of paralysis affecting muscles of lower limb in 2-3 days
can cause residual paralysis
joint deformities and shortening of limb
