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msk > paediatric orthopaedics > Flashcards

paediatric orthopaedics Flashcards

1
Q

what happens to displacement as GMFCS increases

A

displacement levels increase

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2
Q

how big is a problematic curve in scoliosis

A

> 40 degrees before 15yrs

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3
Q

what is spinal fusion

A

Spinal fusion is surgery to permanently connect two or more vertebrae in your spine
-done if curve is greater than 45 degrees
-T2 to pelvis
early adolescence
-to protect respiratory function

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4
Q

what happens during ambulation

A

muscles provide the required force of motion

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5
Q

problems from cerebral palsy

A
  • primary - injury to CNS
  • secondary from growth
  • tertiary - coping responses
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6
Q

aims for cerebral palsy

A
  • pain free hips in joints
  • spine fused or mild scoliosis
  • tone well managed
  • good seating
  • full support measures in place
  • independence maximised
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7
Q

problems with tip toe walking

A
  • CNS
  • PNS
  • muscle
  • idiopathic
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8
Q

what is club foot

A

congenital deformity of foot due to in utero abnormal alignment of joint between talus, calcaneous and navicular

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9
Q

treatment for club foot

A

Ponseti method

-once alignment acheived, child placed in boots attached to a pole to keep boots apart

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10
Q

what can club foot cause

A
  • ankle equinus
  • supination of forefoot
  • varus alignment of forefoot
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11
Q

do growing pains cause limp

A

no

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12
Q

red flags of leg pain

A
  • asymmetry
  • good localisation
  • short history
  • persisting limp
  • not thriving
  • pain worsening
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13
Q

features of anterior knee pain

A
  • adolescent
  • localised patellar tenderness
  • stairs/squats
  • radiographs
  • examine hips
  • treatment is physio
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14
Q

what can large scoliosis do to lungs

A

cause a restrictive lung disease

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15
Q

sign of dislocated hip in babies

A
  • asymmetry
  • loss of knee height
  • crease asymmetry
  • less abduction in flexion
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16
Q

treatment for early DDH

A

pavlik harness

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17
Q

what are the two types of bone formation

A

intramembranous ossification and intracartilage ossification

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18
Q

what happens in intramembranous ossification

A

occurs in mesenchyme that has formed a membranous sheath

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19
Q

what happens in intracartilaginous ossification

A

ossification that occurs in a pre-existing cartilaginous model

  • primary ossification centre
  • secondary ossification centre
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20
Q

when do joints form in feotus?

A

6-8 weeks

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21
Q

how do fibrous joints form

A

interzonal mesenchyme between 2 bones differentiates to fibrous tissue

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22
Q

how do cartilaginous joints form

A

interzonal mesenchyme differentiates into hyaline cartilage or fibrocartilage

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23
Q

how do synovial joints form

A
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24
Q

what are the four types of dysplasias

A
  • chondrodysplasia
  • tumour-like conditions
  • altered bone density
  • storage disorders
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25
Q

what classification is used for growth plate fractures

A

salter-harris fractures

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26
Q

causes of growth plate arrest

A
  • trauma
  • infection
  • tumour
  • irradiation
  • surgery
  • compression
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27
Q

is valgus inwards or outwards

A

inwards

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28
Q

is varus inwards or outwards

A

outwards

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29
Q

what are some disorders of growth

A
  • growth plate injury
  • growth plate over stimulation
  • lack of nutrition
  • vitamin definition
  • skeletal deficiency
  • hormonal
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30
Q

how can we asses growth

A
  • 2nd birthday
  • menelaus
  • moseley charts
  • lower limbs
  • bone age
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31
Q

what are the three zones of the physes

A

hypertrophic
proliferative
resever

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32
Q

how do bones grow

A

from the physes - increase in length

periosteum - increase in width

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33
Q

what is swanson’s classification

A
  • failure of formation
  • failure of separation
  • hypoplasia
  • overgrowth
  • duplication
  • constriction ring syndromes
  • skeletal dysplasia
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34
Q

what are the three stages of limb bud rotation

A

mid-axial
pre-axial
post-axial

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35
Q

when is the cartilaginous stage of vertebral development

A

6th week

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36
Q

when do mesenchymal bones form

A

4-5 weeks - LIMB BUDS

37
Q

what is Perthe’s disease

A

avascular necrosis/compression osteochondritis of hip

38
Q

pathophysiology of Perthe’s disease

A

femoral head transiently loses blood supply resulting in necrosis with subsequent abnormal growth

39
Q

causes of Perthe’s disease

A
  • positive family history
  • low birth weight
  • second hand smoke
  • asian, Inuit and central european descent
40
Q

symptoms of Perthe’s disease

A
  • pain and limp
  • mostly unilateral
  • if bilateral then underlying skeletal dysplasia or thrombophilia
  • loss of internal rotation followed by loss of abduction
  • later there will be positive trendellenburg fro. gluteal weakness
41
Q

investigations for Perthe’s disease

A

radiographs and MRI’s

42
Q

treatment for Perthe’s disease

A

no specific treatment other than regular x-ray observation and avoidance of physical activity

43
Q

what is developmental dysplasia of hip (DDH)

A

a disorder of abnormal development resulting in dysplasia and possible subluxation or dislocation of hip secondary to capsular laxity and mechanical factors

44
Q

risk factors for DDH

A
  • positive family history
  • breech presentation
  • first born
  • down’s syndrome
  • presence of other congenital disorders
45
Q

symptoms of DDH

A
  • shortening
  • asymmetric groin
  • thigh skin creases
  • clink or clunk on Ortolani or Barlow manoeuvres
  • limping
46
Q

symptoms of DDH

A
  • shortening
  • asymmetric groin
  • thigh skin creases
  • clink or clunk on Ortolani or Barlow manoeuvres
  • limping
47
Q

treatment for DDH

A
  • mild cases = closely observed to ensure hip remains reduced
  • dislocated or persistently unstable = palvik harness
  • persistent dislocation over 18 months or presents late = surgery
48
Q

complications of DDH

A
  • over flexing and abducting hip can cause AVN
  • persistent DDH poorer prognosis as acetabulum very shallow and in more severe cases false acetabulum occurs proximal to original one with shortened lower limb
  • severe arthritis
49
Q

what is slipped upper femoral epiphysis

A

condition which mainly affects overweight pre-pubertal adolescent boys where femoral head epiphysis slips inferiorly in relation to femoral neck

50
Q

what are causes of SUFE

A
  • hypothyroidism
  • renal disease
  • growth plate not strong enough to support weight
  • growth plate may preclude onset and puberty may be delayed
51
Q

symptoms of SUFE

A
  • pain and limp
  • externally rotated foot
  • pain in groin
  • pain in knee
  • loss of internal rotation of hip
52
Q

treatment for SUFE

A

urgent surgery to pin femoral head to prevent further slippage

  • percutaneous pinning of hip
  • +/- pinning of other side
  • +/- open reduction of very severe slip
53
Q

what is transient synovitis of the hip

A

self-limiting inflammation of synovium of joint

54
Q

what commonly causes transient synovitis of hip

A

an upper respiratory tract infection

55
Q

symptoms of transient synovitis of hip

A
  • lump or reluctance to weight bear
  • may have referred pain to knee
  • hip lying flexed
  • range of motion restricted
56
Q

treatment of transient synovitis

A

NSAIDs

-pain usually resolves in a few weeks

57
Q

what is osteogenesis imperfect

A

defect of the maturation and organization of type 1 collagen

58
Q

what are the bones like in osteogenesis imperfecta

A

thin with thin cortices and osetopenic

59
Q

symptoms of osteogenesis imperfecta

A
  • multiple fragility fractures
  • short stature with multiple deformities
  • blue sclerae
  • loss of hearing
60
Q

what is skeletal dysplasias

A

short stature (dwarfism is no longer used) and is due to genetic error (hereditary or sporadic mutation) resulting in abnormal development of bone and connective tissue

61
Q

what is the commonest type of skeletal dysplasia

A

achondroplasia

62
Q

what is marfan’s syndrome

A

Marfan’s syndrome is an autosomal dominant or sporadic mutation of the fibrillin gene resulting in tall stature with disproportionately long limbs and ligamentous laxity

63
Q

symptoms of Marfan’s

A

-high arched palate
-scoliosis
-flattening of the chest
-eye problems
-aortic aneurysm
-cardiac valve incompetence
-

64
Q

what is Ehlers-Danlos syndrome

A

abnormal elastin and collagen formation

65
Q

msk features of down syndrome

A
  • short stature
  • joint laxity
  • possible recurrent dislocation
  • atalnto-axial instability in the c-spine my occur
66
Q

what is Duchenne muscular dystrophy

A

A defect in the dystrophin gene involved in calcium transport results in muscle weakness which may only be noticed when the boy starts to walk with difficulty standing

67
Q

presentation of duchenne muscular dystrophy

A

can’t walk by age of 10 then usually death by age of 20 because of cardiac and resp problems

68
Q

causes of cerebral palsy

A
  • genetics
  • brain malformation
  • intrauterine infection
  • prematurity
  • intra-cranial haemorrhage
  • hypoxia during birth
  • meningitis
69
Q

what is the commonest expression of cerebral palsy

A

spastic cp

70
Q

how does spastic CP happen

A

injury to the motor cortex, upper motor neurons or corticospinal tract

71
Q

msk problems with CP

A
  • joint contractures
  • scoliosis
  • hip dislocation
72
Q

non-surgical treatment for CP

A
  • physio
  • splintage
  • baclofen
  • botox
73
Q

surgical treatment for CP

A
  • hip excision or replacement
  • surgical release of joint contractures
  • correction of severe scoliosis
  • joint fusions
  • tendon transfers
74
Q

what is spinal bifida

A

Spina bifida is a congenital disorder where the two halves of the posterior vertebral arch fail to fuse, probably in the first six weeks of gestation.

75
Q

orthopaedic management for spinal bifida

A
  • scoliosis correction
  • reduction and containment procedures for the hip
  • contracture released
  • correction of foot deformities
76
Q

examples of limb malformations

A
  • extra bones
  • absent bones
  • short bones
  • fusions of bone and/or skin and soft tissue
77
Q

what is syndactyly

A

the commonest congenital malformation of the limbs where two digits are fused due to failure of separation of the skin/soft tissues or phalanges of adjacent digits either partially or along the entire length of the digits

78
Q

what is polydactyly

A

where an extra digit is formed

79
Q

what is fibular hemimelia

A

partial or complete absence of the lateral foot rays leading to a shortened limb, bowing of the tibia and ankle deformity

80
Q

what is Erb’s palsy

A

injury to the upper nerve roots resulting in loss of motor innervation of the deltoid, supraspinatus, biceps and brachilais muscles

81
Q

what causes genu varum

A

a growth disorder of the medial proximal tibial physis known as Blount’s disease resulting in marked and persisting (beyond 4‐5 years) varus deformity

82
Q

causes of genu valgum

A
  • rickets
  • tumours
  • trauma
  • neurofibromatosis
83
Q

what is developmental dysplasia of the hip (DDH)?

A

dislocation or subluxation of the femoral head during the perinatal period which affects the subsequent development of the hip joint.

84
Q

risk factors for DDH

A
  • family history
  • breech presentation
  • first born babies
  • down’s syndrome
85
Q

signs of DDH

A
  • shortening
  • asymmetric groin/thigh skin creases
  • click or clunk on the Ortolani or Barlow manoeuvres
86
Q

who gets slipped upper femoral epiphysis

A

overweight pre-pubertal adolescent boys

87
Q

what happens in SUFE

A

the growth plate is not strong enough to support body weight and the femoral epiphysis slips due to the strain

88
Q

treatment of SUFE

A

-urgent surgery to pin the femoral head to prevent further slippage

msk (45 decks)

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