paediatric orthopaedic conditions Flashcards
what is congenital talipes equino varus?
-also called clubfoot
-a congenital defect when both of your feet are rotated inwards and downwards
are males or females more likely to experience club foot?
males are more likely
what does the management of club foot involve?
-to obtain a straight, painless, plantigrade and mobile foot
what is the ponseti method?
- a conservative and manipulative method to treat club foot
-involves mobilisation to correct the position and serial casting and tenotomy of the achilles tendon to maintain a corrected position
what is a tenotomy?
a procedure which involves inserting needles into the damaged parts of the tendon
-done to improve movement and correct deformities
what is the role of physio for babies with club foot?
-may have role in correction of deformity during serial casting - may be done by doc, nurse or physio
-restore ROM post casting / surgery
-restore strength post casting and surgery
-gait education
what is developmental dysplasia of the hip (DDH)?
- this is a problem with the way a baby’s hip joint develops - the head of the femur dosent fit into the acetabulum
what are the 3 types of DDH?
classified by the severity of the hip joint instability and dislocation
1. dislocated hip ie the hip joint is out of the acetabulum
2. subluxation - head of femur is partially shifted out of the acetabulum
3. dislocatable- the head of femur moves out/ can dislocate with movement
what are examples of unilateral signs of DDH?
-decreased abduction in the hip
-asymmetrical skin creases
-apparent shortness of 1 leg
-trendelenburg gait
-antalgic gait
what are examples of bilateral symptoms of DDH?
-wide perineum
-wide pelvis
-increased lumbar lordosis
-waddling gait
-trendelenburg
-symmetrical limited abduction
what is the aim of the management of DDH
-aim is to maintain the hip in abduction to encourage the hip capsule to tighten
what’s the difference between the conservative vs surgical management of DDH?
-conservative - manipulation under anaesthetic and can use splints for up to 3-6 months
-if conservative management fails (usually detected at an older age), followed by a period in hip spica
what is the role of physio during the splinting stage of DDH?
- advice to parents on skin care/splint care
-advice to parents on lifting / handling
-promoting normal development
-gait training
what does the role of physio involve post-operatively in DDH?
-ROM
-muscle strengthening
-hydrotherapy
-gait training
what is perthes disease?
- a condition that affects the head of the femur
-the blood supply decreases to the head of femur and leads to osteochrondritis or osteonecrosis of head of femur
what is osteochrondritis?
piece of cartilage, along with a thin layer of the underlying bone, begins to separate from the surrounding bone due to a lack of blood flow
are males or females more likely to experience perthes disease?
-males are more likely than females
what are the stages of perthes?
-condensation
-fragmentation
-reossification
-remodelling
describe condensation as a stage
when the blood supply is smaller or absent - whiter head on xray & hip joint is painful and stiff
describe fragmentation as a stage
-necrotic bone is resorbed and fragmented
-the femoral head becomes derformed ad the acetabulum flattens
describe reossification as a stage
-return of blood supply
-femoral head begins to re-ossify
describe remodelling as a stage
-when the femoral head remodels
what are examples of clinical features of perthes disease?
-pain
-limp
-decreased ROM - abduction and medial rotation
-collapse head of femur
-limb shortening
what can be seen on xray with perthes disease?
X ray
-widening joint space
-short femoral neck
-fragmentation of femoral head
what are examples of conservative treatment for perthes disease?
-observation only
-anti-inflammatory / pain relieving meds
-protected weight bearing
-bed rest
-casting and splinting
what does the surgical management of perthes disease involve?
-femoral and or pelvic osteotomy
-for children aged 8 years of age
what is the role of physiotherapy in perthes disease - during splinting stage and post op?
-detection - PAIN, LIMP AND LIMITATION OF MOVEMENT
-durng splinting stage- advice on skin care/ splint care & promoting normal development and gait training
-post operatively - ROM, strengthening, gait training and hydrotherapy
what are other areas / sites that can be affected by osteochrondritis & what are the diseases called?
-femoral head - perthes
-vertebral bodies - scheuermann’s disease
-naviculr - kohlers disease
-lunate - kienbocks disease
what age range of children can perthes disease?
4-10 years
what is slipped capital femoral epiphysis?
a hip condition that occurs in adolescents where the head of the femur slips off the neck of the femur at the growth plate / known as the epiphysis
- age 11-12-17 - during puberty where growth phase is rapid
-males more likely than female - 5:1 ratio
what are the 2 types of SCFE?
-acute
-chronic
what is acute SCFE?
post trauma eg fall
severe pain and unable to WB
what is chronic SCFE?
gradual onset
presents with
-limp
-loss of abduction and medial rotation
-aching pain
-limb shorter
how is SCFE confirmed?
by x ray
-note externally rotated neck of femur and pushed up
-head of femur remains in acetabulum
what is the go to Rx for SCFE?
-in situ pinning of the epiphysis to stop slipping of the hip
what is the role of physio post op for SCFE?
-ROM exercises
-assisted active exercise - hydrotherapy
-walking aids
-gait education
-NWB initially, progress to PWB
-education
what is idiopathic scoliosis?
a condition where the spine curves laterally with no known cause
-can have infantile (age 3), juvenile (age 4-10) or adolescent (10 years until skeletal maturity)
what are the clinical features of scoliosis?
-spinal curvature
-shoulders not level
-pelvis not level
-waist asymmetrical
-chest asymmetry
how is idiopathic scoliosis managed?
-depends on degrees of curvature
-if less than 40 degrees - conservative which involves observation, physio or bracing - worn for 20+ hrs per day
-surgery if curve more than 40 degrees - using Harrington rods
what are 2 examples of braces for scoliosis?
Milwaukee brace - for thoracic regions
-Boston brace - lower regions of spine
what does the role of physio involve for scoliosis?
-most useful for mild curves
-schroth therapy - stretching, strengthening and breathing in the opposite direction to the curve
-physio can prevent secondary problems eg lack of mobility, reduced spinal strength or resp problems
what is traction apophysitis?
-an overuse injury where repetitive stress or strain causes inflammation of the growth plate where a tendon attaches to bone
-associated with sports
-may be associated with growth spurts in adolescents
where are the common sites of traction apophysitis?
-base of 5th MT
-tibial tuberosity - osgood schlatters (palpable lump @ knee)
-calcaneal epiphysis
describe osgood schlatter disease
-10 5 prevalence reported in adolescents
-presents as knee pain
-pain going down the stairs, long periods of sitting , kneeling or during sports
how is traction apophysitis managed?
-activity modification and education
-ice can help with swelling and pain
-tendon loading programme
-address limitations in flexibility
-strengthening of relevant muscles
-surgery not effective
what are examples of predisposing factors for osgood shlatters?
-quadricep and hamstring tightness
- training intensity - is the training matched to their sport?
-environmental factors
