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paediatric orthopaedic conditions Flashcards

1
Q

what is congenital talipes equino varus?

A

-also called clubfoot
-a congenital defect when both of your feet are rotated inwards and downwards

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2
Q

are males or females more likely to experience club foot?

A

males are more likely

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3
Q

what does the management of club foot involve?

A

-to obtain a straight, painless, plantigrade and mobile foot

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4
Q

what is the ponseti method?

A
  • 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
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5
Q

what is a tenotomy?

A

a procedure which involves inserting needles into the damaged parts of the tendon
-done to improve movement and correct deformities

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6
Q

what is the role of physio for babies with club foot?

A

-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

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7
Q

what is developmental dysplasia of the hip (DDH)?

A
  • this is a problem with the way a baby’s hip joint develops - the head of the femur dosent fit into the acetabulum
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8
Q

what are the 3 types of DDH?

A

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

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9
Q

what are examples of unilateral signs of DDH?

A

-decreased abduction in the hip
-asymmetrical skin creases
-apparent shortness of 1 leg
-trendelenburg gait
-antalgic gait

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10
Q

what are examples of bilateral symptoms of DDH?

A

-wide perineum
-wide pelvis
-increased lumbar lordosis
-waddling gait
-trendelenburg
-symmetrical limited abduction

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11
Q

what is the aim of the management of DDH

A

-aim is to maintain the hip in abduction to encourage the hip capsule to tighten

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12
Q

what’s the difference between the conservative vs surgical management of DDH?

A

-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

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13
Q

what is the role of physio during the splinting stage of DDH?

A
  • advice to parents on skin care/splint care
    -advice to parents on lifting / handling
    -promoting normal development
    -gait training
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14
Q

what does the role of physio involve post-operatively in DDH?

A

-ROM
-muscle strengthening
-hydrotherapy
-gait training

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15
Q

what is perthes disease?

A
  • 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
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16
Q

what is osteochrondritis?

A

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

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17
Q

are males or females more likely to experience perthes disease?

A

-males are more likely than females

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18
Q

what are the stages of perthes?

A

-condensation
-fragmentation
-reossification
-remodelling

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19
Q

describe condensation as a stage

A

when the blood supply is smaller or absent - whiter head on xray & hip joint is painful and stiff

20
Q

describe fragmentation as a stage

A

-necrotic bone is resorbed and fragmented
-the femoral head becomes derformed ad the acetabulum flattens

21
Q

describe reossification as a stage

A

-return of blood supply
-femoral head begins to re-ossify

22
Q

describe remodelling as a stage

A

-when the femoral head remodels

23
Q

what are examples of clinical features of perthes disease?

A

-pain
-limp
-decreased ROM - abduction and medial rotation
-collapse head of femur
-limb shortening

24
Q

what can be seen on xray with perthes disease?

A

X ray
-widening joint space
-short femoral neck
-fragmentation of femoral head

25
Q

what are examples of conservative treatment for perthes disease?

A

-observation only
-anti-inflammatory / pain relieving meds
-protected weight bearing
-bed rest
-casting and splinting

26
Q

what does the surgical management of perthes disease involve?

A

-femoral and or pelvic osteotomy
-for children aged 8 years of age

27
Q

what is the role of physiotherapy in perthes disease - during splinting stage and post op?

A

-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

28
Q

what are other areas / sites that can be affected by osteochrondritis & what are the diseases called?

A

-femoral head - perthes
-vertebral bodies - scheuermann’s disease
-naviculr - kohlers disease
-lunate - kienbocks disease

29
Q

what age range of children can perthes disease?

A

4-10 years

30
Q

what is slipped capital femoral epiphysis?

A

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

31
Q

what are the 2 types of SCFE?

A

-acute
-chronic

32
Q

what is acute SCFE?

A

post trauma eg fall
severe pain and unable to WB

33
Q

what is chronic SCFE?

A

gradual onset
presents with
-limp
-loss of abduction and medial rotation
-aching pain
-limb shorter

34
Q

how is SCFE confirmed?

A

by x ray
-note externally rotated neck of femur and pushed up
-head of femur remains in acetabulum

35
Q

what is the go to Rx for SCFE?

A

-in situ pinning of the epiphysis to stop slipping of the hip

36
Q

what is the role of physio post op for SCFE?

A

-ROM exercises
-assisted active exercise - hydrotherapy
-walking aids
-gait education
-NWB initially, progress to PWB
-education

37
Q

what is idiopathic scoliosis?

A

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)

38
Q

what are the clinical features of scoliosis?

A

-spinal curvature
-shoulders not level
-pelvis not level
-waist asymmetrical
-chest asymmetry

39
Q

how is idiopathic scoliosis managed?

A

-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

40
Q

what are 2 examples of braces for scoliosis?

A

Milwaukee brace - for thoracic regions
-Boston brace - lower regions of spine

41
Q

what does the role of physio involve for scoliosis?

A

-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

42
Q

what is traction apophysitis?

A

-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

43
Q

where are the common sites of traction apophysitis?

A

-base of 5th MT
-tibial tuberosity - osgood schlatters (palpable lump @ knee)
-calcaneal epiphysis

44
Q

describe osgood schlatter disease

A

-10 5 prevalence reported in adolescents
-presents as knee pain
-pain going down the stairs, long periods of sitting , kneeling or during sports

45
Q

how is traction apophysitis managed?

A

-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

46
Q

what are examples of predisposing factors for osgood shlatters?

A

-quadricep and hamstring tightness
- training intensity - is the training matched to their sport?
-environmental factors

Advanced MSK - physio (23 decks)

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