Paediatric Orthopaedics Flashcards
What is ‘flat foot’?
When the arch of the foot doesn’t fully develop, and this may appear as weak ankles which turn inwards
What is the treatment for ‘flat foot’?
Orthotics to aid the arch with stretching or surgery
What are the potential causes of flat feet?
Muscle imbalances or issues with the tarsal bones
What may persistent toe walking in older children indicate?
Cerebral palsy, DMD or nervous system disorders
How may toe walking be corrected?
A cast for the foot and ankle or stretching of the calf muscles
What is club foot?
Where the foot looks like a foot; also known as talipes equinovarus which means there is a fixed varus and equinus deformity and calf underdevelopment
What is the epidemiology of club foot?
1 in 1,000 children have it and it’s more common in boys
What are the risk factors for developing club foot?
Breech presentation, connective tissue disorders, too little amniotic fluid, Edwards Syndrom
How is club foot treated?
Ponseti method - manipulative technique to correct the foot using braces and stretching
What is the Ponseti method?
Method of manipulative treatment for club foot
What is Edward’s syndrome?
Trisomy 18
What is hip dysplasia?
When the hip joint is mal-aligned
How common is congenital hip dysplasia?
1.5 in 1,000 children
What are the risk factors for congenital hip dysplasia
Breech delivery and family history of club foot or scoliosis, and is commoner in females
How may congenital hip dysplasia present in infants?
Tends to be double creases when the leg is turned outwards, with asymmetric gluteal folds (double crease on affected side)
Why is the use of x-ray limited in the diagnosis of congenital hip dysplasia in infants?
As the femoral head doesn’t ossify until 4-6 months and therefore won’t be visible on x-ray
How may an ultrasound be used to diagnose congenital hip dysplasia?
The femoral head will move back on the gluteal muscles, causing the fibres to look more vertical
How is ‘Barlows test’ used to diagnose congenital hip dysplasia?
Knees are brought together and pushed on slightly whilst the infant is lying down. If the hip can be dislocated like this, this is a positive test
How is ‘Ortolani test’ used to diagnose congenital hip dysplasia?
This usually follows on from Barlows test, and involves abducting the hip to see whether the hip will pop back in, to confirm the diagnosis
How is ‘Galeazzi test’ used to diagnose congenital hip dysplasia?
Flex the hip and knee and see if there is a leg length discrepancy in the height of the knee, affected side will be shorter
How is congenital hip dysplasia treated?
Under 6 months = Pavlik harness to keep the femoral head in the true acetabulum
Over 6 months or doesn’t work = closed reduction with hip spikes or open reduction
Often resolves spontaneously though, however.
What is Perthes’ disease?
Self-limiting avascular necrosis of the femoral head often due to loss of the acetabular branch of the obturator artery which supplies the femoral head
Is Perthes’ disease usually unilateral or bilateral?
Unilateral
What are the four stages of Perthes’ disease?
Necrosis, fragmentation, reossification and remodelling
Describe the necrosis stage of Perthes’ disease
A portion of the femoral head dies and the shape of the femoral head changes, causing pain, stiffness and inflammation and this takes up to one year
Describe the fragmentation stage of Perthes’ disease
The dead cells from the necrosis of the femoral head are then absorbed and replaced by new bone, and as the new bone forms it produces varying femoral head shapes, this takes 1-3 years to take place
Describe the reossification stage of Perthes’ disease
The femoral head continues to growth with new bone cells, taking 1-3 years
Describe the remodelling stage of Perthes’ disease
New bone cells are gradually replaced by normal bone cells and remodelling continues, and this can take 1-3 years or more
What is slipped upper femoral epiphysis (SUFE)?
Where the epiphysis (growth plate) of the femur stays in place, but the femoral neck and shaft displace
Which side is more likely to be affected by SUFE?
Left hip
What are risk factors for SUFE?
Obesity, hypothyroidism, deficiency or increased androgen production and trauma
How may SUFE appear on x-ray
Hip joint may appear as ice-cream falling off it’s cone
How may Klein’s line be useful in diagnosing SUFE on x-ray?
This is a line drawn along the superior border of the femoral neck, and should cross at least a portion of the femoral head, if the femoral head drops below this line, this is indicative of SUFE
How may SUFE be treated?
Rest, analgesia, surgery (to close growth plate with screws or bone removal)
What is Blount’s disease?
where there is a growth problem of the distal tibia (in the medial compartment) which causes tibia varus)
What is thought to be the cause of Blount’s disease?
Effect of weight (obesity) on the growth plate
What is Osgood Schlatters disease?
Quadriceps insert onto the tibial tuberosity, which causes the tuberosity to be pulled due to exercise. This causes the bone to grow anteriorly at the insertion point.
What type of condition are Severs’ and Schlatters disease?
Osteochondroses
What may cause Osgood Schlatters disease?
Repeated traction from patellar ligament on tibial tuberosity (due to heavy exercise) or avulsion fractures to part of the tibial tuberosity
