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Musculoskeletal > Paediatric Orthopaedics > Flashcards

Paediatric Orthopaedics Flashcards

1
Q

Define the epiphysis of bone

A

End of long bone initially growing separately from the shaft

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2
Q

Define the physis of bone

A

The growth plate

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3
Q

Define the metaphysis of bone

A

Narrow portion between epiphysis and diaphysis that contains the physis

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4
Q

Define the diaphysis of bone

A

The shaft or central part of long bone

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5
Q

Longitudinal bone growth occurs at the ___1___ which is a cartilage structure between the _____2____ and ____2____ Growth stops at ___3____ when _____4___

A

1) physis
2) epiphysis and metaphysis
3) 18-21
4) epiphysis and metaphysis fuse

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6
Q

Some physes contribute more to growth than others, name some important ones

A

Knee contribute a lot

Wrist and shoulder contribute most in the arm

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7
Q

All babies have ___1____ knees (normal up to about 2/3) when they walk this will gradually change to __2____ knees as they begin to walk. If a child has a ____3____ deformity after age 7 they should be investigated

A

1) varus (knees point outwards)
2) valgus (knees point slightly inwards, everyone is slightly vales)
3) varus

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8
Q

When is varus deformity more likely to be severe?

A

Unilateral, severe, child has short stature or painful

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9
Q

Explain what intoeing is?

A

When walking and standing the child’s feet point towards the midline. Often exaggerated when running and children are thought to be clumsy and wear through shoes quickly.

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10
Q

What movement is increased in femoral ante version?

A

Internal hip rotation (this is why the kids often sit in W position)

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11
Q

As part of the normal anatomy the femoral neck is slightly ____1____ Excessive ante version can give the appearance of ____2_______ These kids have increased ____3______ and sit in ___4____ This is usually of no consequence but can predispose to ________5_______

A

1) anteverted
2) intoeing and knock knees
3) internal hip rotation
4) W position
5) patellofemoral problems

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12
Q

Are flat feet usually pathological?

A

No

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13
Q

True or false. At birth all feet are flat?

A

true

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14
Q

What do you need to determine with flat feet? How do you do this?

A

Need to determine if they are mobile or fixed. Mobile flat feet are those where the flattened medial arch forms with dorsiflexion of the great toe (Jacks test)

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15
Q

What may flexible flat feet be due to?

A

Ligamentous laxity, familial or idiopathic

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16
Q

What are rigid flat feet usually caused by?

A

Tarsal coalition. The bones of the hind foot have abnormal bony or cartilaginous connection. This may need surgery.

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17
Q

Describe curly toe deformities?

A

Minor overlapping of the toes and curling is common with 5th toe most frequently affected. Most correct themselves but occasionally surgery is required.

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18
Q

What is osteogenesis imperfecta?

A

AKA brittle bone disease
Defect in type 1 collagen meaning bones are fragile and get lots of fractures. Can be mistaken for abuse.
Most cases are autosomal dominant

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19
Q

What is skeletal dysplasia?

A

Medical term for short stature due to genetic error resulting in abnormal development of bone and connective tissue

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20
Q

Describe the most common type of skeletal dysplasia?

A

Most common is achondroplasia which results in disproportionately short limbs with a prominent forehead and a widened nose. Joints are lax and mental development is normal.

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21
Q

What score is used for hypermobility?

A

Beightons

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22
Q

Describe marfans?

A

Autosomal dominant or sporadic mutation in fibrillar gene results in tall stature with disproportionately long limbs and ligamentous laxity. Associated features= high arched palate, scoliosis, flattening of chest, eye issues, aortic aneurysm and cardiac valve abnormalities.

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23
Q

What is ehlers danlos syndrome?

A

Genetic condition with abnormal elastin and collagen. Joint hypermobility, vascular fragility, easy bruising, joint instability and scoliosis.

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24
Q

MSK manifestations of Down Syndrome? (Trisomy 21)

A

Short stature, joint laxity with recurrent infection

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25
Q

Describe Duchenne Muscular Dystrophy?

A

Defect in the gene for Ca transport results in muscle weakness which may only be noticed when the boy starts to walk with difficult, standing and going upstairs.
Gowers sign, has to use hands to walk up own body to stand
Dies in early 20s but important to diagnose for genetic counselling for future children

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26
Q

What is developmental dysplasia of the hip?

A

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

27
Q

DDH is more common in the _____ hip but can be bilateral

A

left

it is thought in normal womb position there is more pressure on the left hip

28
Q

Name five risk factors for DDH?

A

Positive family history, breech position, first born babies, Down’s syndrome and the presence of other congenital disorders.

29
Q

Name some signs of DDH on the 6-8 week baby check?

A

Shortening, asymmetric groin/ thigh skin creases and a positive Ortolani or Barlow

30
Q

Describe the Ortolani test?

A

Able to reduce a dislocated hip. As the hip is abducted there is a clunk as it is pushed back into the socket. When adducted the hip dislocates again.

31
Q

Describe the Barlow test?

A

Able to dislocate a reduced hip. The hip is adducted and backward pressure is applied. In a positive test the hip sublimates and glides off. If dislocating there is a sudden loss of resistance.

32
Q

What should you do if positive Ortolani or Barlow test?

A

Requires further evaluation with Us where should see a dislocated hip, an unstable hip or a shallow acetabulum.

33
Q

If DDH is not picked up at 6-8 week baby check when will it be picked up?

A

When baby starts to walk

34
Q

Signs of DDH in a walking child?

A

If unilateral: Tredelnberg fait. If bilateral: harder to notice but may waddle.

35
Q

What is key to success of treatment of DDH?

A

Early diagnosis

36
Q

Treatment of DDH if caught early?

A

Mild cases with slightly shallow acetabulum and mildly dislocatable but reducible hip can be closely observed. Persistent dislocated or unstable hips are reduced and held with a Pavlik harness which keeps hips flexed and and abducted thus maintaining reduction.

37
Q

What does Pavlik harness do?

A

Keeps hips flexed and abducted maintaining reduction

38
Q

Treatment of DDH if caught late?

A

For children with persistent dislocation over 18 months old reduction is more likely to be required by surgery and the acetabulum is very likely to be shallow by this stage. Typically the child will ned an open reduction to clear soft tissues and may also need an osteomy to shorten and rotate the femur and/ or pelvic osteomy to deepen and reorientate the acetabulum. This has a much poorer prognosis.

39
Q

What is transient synovitis?

A

Self limiting inflammation of the synovial of the joint commonly the hip. Commonly occurs after URTI although sometimes no cause is found

40
Q

What is the most commonest cause of hip pain in childhood?

A

Transient Synovitis

41
Q

Treatment of transient synovitis?

A

EXCLUDE SEPTIC ARTHRITIS, PERTHES DISEASE AND JUVENILE IDIOPATHIC ARTHRITIS OR RHEUMATOID.

Should resolve in a few weeks with rest and NSAIDs. If not resolving must look for other cause of the pain.

42
Q

Presentation of transient synovitis?

A

Limp or reluctance to weight bear on the affected side. Range of motion may be restricted (less pain and less restriction than septic arthritis) May have low grade fever but will not be systemically unwell.

43
Q

What is Perthes Disease?

A

Idiopathic osteochondritis of the femoral head (avascular necrosis of articular surface). The femoral head transiently looses its blood supply resulting in necrosis and subsequent abnormal growth

44
Q

Who commonly gets Perthes Disease?

A

Usually occurs between ages 4-9. More common in very active boys of short stature.

45
Q

Presentation of Perthes Disease?

A

Children present with pain and a limp. Most cases are unilateral. Loss of internal rotation is usually first clinical sign followed by loss of abduction and later on positive Tredelenburg test from gluteal weakness.

46
Q

What is usually the first clinical sign of Perthes Disease?

A

Loss of internal rotation

47
Q

Treatment of Perthes Disease?

A

No specific treatment- X-ray and avoidance of physical activity.

48
Q

What is SUFE?

A

The femoral head epiphysis (but above the growth plate that grows) slips inferiorly in relation to the femoral neck. This is due to growth plate not being strong enough to support body weight so epiphysis slips due to strain.

49
Q

Who does SUFE usually affect?

A

Mainly affects overweight pre-pubertal adolescent boys whereas girls are less commonly affected. Renal disease or hypothyroidism may predispose to SUFE.

50
Q

What is the predominant clinical sign of SUFE? What are X-ray changes?

A

Loss of internal rotation of the hip

X-ray changes may be subtle and a lateral view myst be obtained to detect mild slips.

51
Q

Presentation of SUFE?

A

Cases can be acute, chronic or acute on chronic in history. Patients may have pain and a limp. Pain may be felt in groin but pain may also be felt purely in the KNEE. Must examine the hip if sore knee.

52
Q

Treatment of SUFE?

A

Urgent surgery to pin femoral head to prevent further slip. Greater degree of slip the worse the prognosis and some cases may require hip replacement in adolescence or early adulthood. Prognosis for mild slips is usually favourable. Severe acute slips could manipulate back on but risks avascular necrosis. Chronic severe slips may require osteotomy.

53
Q

Describe anterior knee pain in paediatrics?

A

(MUST CHECK HIPS)
Anterior knee pain is common in adolescence especially in girls, the aetiology is unclear. Most cases are self limiting and the main treatment is physiotherapy to rebalance muscles.

54
Q

Describe growing pain?

A

Common. More in females than males. In adolescents. Bilateral. Growing pains DO NOT cause limp and pain should not be localised or severe, more of a generalised ache.

55
Q

What is cerebral palsy?

A

A NM disorder with onset before 2-3 yrs of age due to insult to the immature brain, before, during or after birth. Lots of causes. Expression of disease and severity vary depending on region of the brain affected.

56
Q

Why do children with cerebral palsy get problems with their hip?

A

Majority develop spasticity in which their muscles tighten involuntarily causing stiffness. Spasticity in the muscles around the hip places abnormal forces on the hip joint eventually causing the hip to dislocate from the socket. Once the child reaches 18 the hip will remain stable.

57
Q

Describe spinal problems with cerebral palsy?

A

Progressive scoliosis and spinal fusion. Untreated scoliosis if severe can cause major problems as can affect organ function.

58
Q

What is talipes equinovarus?

A

Clubfeet- structural deformity of feet (soles point in)

59
Q

Who tends to get talipes equinovarus/ club feet?

A

Boys are affected more than girls. May be a genetic link. May be part of another condition.

60
Q

Treatment of talipes equinovarus/ club feet?

A

Early treatment with splintage- ponsetti method then boots with bar. Late or resistant cases need surgery.

61
Q

Cause of brachial plexus palsy?

A

Usually injury during vaginal delivery

62
Q

Who commonly gets brachial plexus palsy?

A

Common in large babies, twin deliveries and shoulder dystocia (difficult delivery of shoulder)

63
Q

Describe three types of brachial plexus palsy?

A

Erbs- C5 and 6 nerve roots- loss of motor innervation of deltoid, supraspinatous, infrapinatous, biceps and brachial. Results in IR of humerus
Klumpkes Palsy- C8 and T1-paralysis of intrinsic muscles of hand- does worse than Erb’s palsy
Total palsy- affects all of upper limb, not good

Musculoskeletal (18 decks)

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